Vectors of Change

Northwestern Health Sciences University held an interesting presentation and discussion on May 12, 2015 titled ‘A Different Path: Career Options and Your Northwestern Degree.’ Various speakers gave short presentations about how they are working with other providers, data, and various industry stakeholders to broaden the presence, effectiveness and value of doctors of chiropractic in the health care system.

Every speaker had ‘cracked the code’ of some aspect of deeper participation than customary solo chiropractic, massage and acupuncture/TCM practices. Their accomplishments are worth noting and they are to be commended for their achievements. Their examples  stand as proof that it is possible to take clinical and transferable skills and move to a different position within health care, often with a dramatically larger sphere of potential influence. Can other doctors of chiropractic follow in their footsteps? Or are they unique leaders who are difficult to follow?

The fact that they stand out both as pioneers and, in many cases, as either unique examples or representatives of a very small group of people who’ve achieved this says at least two things. For one, it’s proof that it’s possible, and some of these individuals have put in decades of work establishing and ‘proving’ themselves. For another, it’s a sign that unless something fundamental changes in how not just chiropractic clinical services are viewed by the system but how doctors of chiropractic are viewed as trained professionals that these achievements may not move the needle much for the profession as a whole.

It was encouraging evidence that many good people are working within the system to try and change it. Because they’re change agents, it also is interesting to consider others. Many of these ‘vectors of change’ exist, and all will influence health care evolution and reform. I think there are three basic groups of vectors for change, representing different stakeholders.  Each is undergoing very, very profound–even harsh–change and disruption. Some are mobilizing around the disruption and pressures, and some seem to still be using magical thinking, hoping things blow over–or that they end up very differently than may be feared. What also might be seen as sobering is that aside from what we may want to believe about the untapped contribution chiropractic might make to population health, there is tremendous uncertainty about how many DCs may even be needed by the system. Further, there are very real questions whether working within the system is a viable change strategy when the system is under such profound disruption and uncertainty.

The System: Supply Chain Transformation
The system that ‘hosts’ all that’s going on in health care is being pushed in all directions to adjust to current and future reforms. The impact of spiraling health care costs, employers shrinking from dominant roles in choosing health benefits and shifting greater responsibilities to consumers, the influence and requirements of the Affordable Care Act (PPACA, aka “Obamacare”), changing provider roles and consumer sensibilities (see below) are among the forces quickly reshaping the health care ‘supply side’ to be more and more like a retail supply chain. What the system is good at is managing financial transactions, and that ‘core competency’ is probably going to emerge more and more distinctly as its core business as well. What the system is bad at is innovation, and there’s so much small-scale innovation taking place that few if any health plans will be able to stay or become nimble enough to keep up or compete.

Providers: Fuzzy Roles, Uncertain Futures
When consumer/patients can walk into providers’ offices with printouts from condition-specific information that are often more up-to-date than providers’ knowledge, health care workers are suddenly in a very different role–less the oracle and more the consultant. Increasingly less needed (in many cases of ‘elective’ health care service needs) for diagnostic acumen and more for clinical wisdom–how their knowledges can be applied–providers who are compensated for the types and volume of services they accomplish are suddenly less secure, vulnerable in the new way of doing things. The uncertainty of changing roles and identities is only magnified by the fact that the costs of provider education are so greatly out of alignment with what the marketplace pays people once they’re in practice. This adds financial insecurity on top of other sources of potential anxiety.  And to pile on, the explosive growth forecasted for the role of technology means that providers will move away from a role of gathering clinical information and more to a role of data management and interpretation viagra en costa rica.

Consumers: From Patients to Customers to Partners
No stakeholder’s identity is undergoing greater transformation than that of what up to recently have just been called ‘patients.’ Burdened in just a few short years with dramatically more ‘skin in the game’ from having to be responsible for more personal financial and clinical management, independent decision making and purchasing autonomy, people have realized quickly that things have changed–and few are happy about it so far. The former, paternalistic posture the system and providers adopted that sought to have everyone involved feel like they were being cared for and protected has changed very quickly to one that has instituted accountability in ways that few dreamed were even possible just a short time ago. Consumers are actually in charge now; it’s just that few of them or other stakeholders understand it yet. When they do, the system’s pivot to the new way of doing things will be complete.

Many people are working from within the system and from within the ranks of providers to explore these changes and opportunities. Their efforts, like those represented on the panel at Northwestern’s event will be important sources of assessment, engineering, growth and development. It’s probably important for the growth and maturation of the profession that others are encouraged to follow suit. One of the more important questions that needs to be asked, however, is whether or not the rush of innovation and its disruptive influence is going to force a pace and direction of change on the host system and providers that they simply can’t keep up with.

This is not to say the efforts of those committed to working from the inside out are going to be unneeded or wasted, or to say that working outside the system is a way to be more effective in general. Rather, it is to question whether or not it’s possible to change a system that isn’t just becoming a moving target, but becoming one that is picking up a great deal of speed. Any institution will work hard to control its own changes. It may be impossible, at this point, for health care to achieve this on its own behalf. For DCs and other providers, understanding that it’s not a question of whether the system will be reinvented but when and how, it’s time to come to terms with the fact that anyone who isn’t a change agent is going to be buffeted by some very strong tides and forces. Knowing that, each of us have the opportunity to decide where we want to stand and use the leverage we have to influence the types of positive change we believe we need to see.

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