Change Redux
Almost six years ago in my first blog I talked about change. I said then, “As I think about the opening days working for AUPHA as your new President and CEO, I’m sometimes overwhelmed by the magnitude of the change that I face.” While I had years of experience in the workplace, “[n]ew functions (writing blogs), new responsibilities, new expectations, new technologies (Google Hangouts), new bosses (Board and diverse constituents), new colleagues/staff, and a new city” presented monumental change. I concluded, however, that compared with the changes that Obama/Sebelius, and many others, were facing at the time with healthcare reform, changes faced each year by the students that enrolled in our many programs, and disruption occurring on many college campuses, my changes were relatively minor. What is more, the consequences for me were less severe. I was nearer the end of my career than the beginning thus career mistakes would not have the same impact as our students face. I also would not be making decisions that determine if millions of people in the US would get access to health insurance and healthcare services.
The point that I tried to make in the blog was actually more global than just a discussion of change, however. What I was really discussing was the “change” from the private perspective of an individual program (UAB for me) to the public or industry perspective of AUPHA. I needed to learn to focus on the provision of public goods. In my prior work, I struggled, mostly independently, with the many challenges we faced when delivering healthcare management education. Decisions involved what is best for my programs and faculty. At AUPHA, I needed to enhance the value from learning and sharing with colleagues. Many of your programs join AUPHA to enable you to engage with your AUPHA colleagues to improve education quality and effectiveness. We are all in this together and we will fail if the field does not provide uniformly high quality education to our students. All of our graduates must demonstrate to employers that they have the necessary competencies for success. Always, and especially during times of uncertainty, we all need assurances that we are doing the right things in the right way. Interaction with colleagues provides these assurances.
Our ability to learn, share, and support one another constitutes a core value proposition for AUPHA. No one of us and especially not the small AUPHA staff have all of the answers thus we rely on the “wisdom of the crowd” as described by the 2004 book by James Surowiecki.
AUPHA facilitates the crowd and thus we enable each member to find a place to contribute to this common pool of knowledge. The beneficial functions of AUPHA participation then come from the hundreds of volunteers that serve on our board, lead and staff the many formal committees, post and comment on our Network and Faculty Forums, present and/or attend our meetings. Interestingly, many question crowd wisdom and for good reason. It turns out that if members of the crowd let themselves be influenced by others in the crowd, group consensus improves with less divergent views but that consensus can stray from the best or true value. To help make the crowd decision better, the literature suggests that the members of the group should be independent so as not to be influenced by the opinions of others but more importantly, the group (and perspectives) must be diverse. Diversity in fact trumps independence. (See a concise review by Philip Ball in BBC Future [http://www.bbc.com/future/story/20140708-when-crowd-wisdom-goes-wrong]). At least in recent times, AUPHA has expanded its efforts to develop greater diversity in its membership, leadership, and professional speaker input. We make every effort to enable all to have a voice in all that we do.
Consequently, the direct collective benefit from the crowd facilitation that AUPHA supports improves the outcomes for all of those seeking to improve the quality of healthcare management education. No individual program or small group of programs can effectively harness the wisdom of the crowd thus AUPHA provides a true public good to members. The indirect benefit may be even greater, however. Participation in AUPHA networks and other activities enables all members to demonstrate our commitment to this collective benefit and to the importance of the provision of pubic goods. Our students are instructed in the provision of a public good and also witness us participating in that activity, e.g. walking the talk. Students observe our faculty and programs giving back to the field for collective benefit often by sacrificing time and energy on private pursuits.
This modeling is vital as many of our graduates will oversee organizations that strive to provide quality healthcare, at a reasonable cost to all, irrespective of ability to pay. The complex organizations that they manage have obligations to survive and prosper but not at the expense of those paying the bills. Our teaching recognizes that our graduates must navigate the slippery slope of economic profits for their organization while adhering to social norms regarding enabling individuals to obtain needed healthcare services. Most agree that the ethical customs should be a part of an organization’s pricing decisions and to the provision of services to select markets, even if they lose money. Those ethical customs must be taught and modeled within our educational processes.
The failure of this aspect of healthcare management education has been evidenced a great deal of late. We have seen and continue to see horrid examples of exceptions to this obligation. For example, the late Uwe Reinhardt described the EpiPen pricing actions as “savage” but consistent with tenants of free market capitalism. The pricing is consistent with maximizing the value from sales if the market permits it. It effectively ignores the impact of this pricing on access to needed emergency care. Further, Gary Filerman issued a challenge to us in this regard in the Pattullo Lecture in Philadelphia. He cautioned that the challenges future graduates will face greatly exceed those faced today and we have an obligation to assure that our students are prepared.
As I closed in 2013, “we are all in this together!” AUPHA continues to assist “all you all” to succeed in preparing your students to succeed in their careers in healthcare management and to assist you while facing monumental changes within your educational institutions. The most recently ended Annual Meeting with record attendance demonstrated the value of this networking. I hope that everyone learned something, shared insight and had some fun. The Annual Meeting and most everything that AUPHA does with your dues is directed to facilitating the collective good obtained from having our graduates deliver exceptional, ethical healthcare leadership.
Jerry