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Healthcare in America: All safety nets and no trapeze

“Some men look at things the way they are and ask why? I dream of things that are not and ask why not?”

— Robert Kennedy

I remember watching a live trapeze act at the Ringling Brother’s circus as a child. I loved the spectacle, the grace, and the magnificence of the men and women who “fly through the air with the greatest of ease.” I spent the next year of my childhood organizing my sisters and other neighborhood children into a daring playground act called “The Flying Flamingos.” I began to see everything around me as something I could climb, swing, or balance on. We would wear bright clothes and hoot with delight as we pushed ourselves to do daring things. I am sure that we must have got an occasional bruise, or scraped knee, but in exchange for a little risk (we never did anything truly dangerous…we were all pretty responsible kids), we had an amazing time. To this day, I can still balance a standing child in my hands, toss her into the air, and catch her with one foot. It’s hard to explain in a blog, but my daughter begs me to do it all the time.

Like most people, I became a “provider” because I love working with people, and helping them get well. I am a licensed psychologist, and it is my privilege to watch people transform their misery into something spectacular. I encourage people to take small, reasonable risks so that they can have a life worth living. I am blogging for Occupy Healthcare today for the same reason. Like so many people, I am tired of focusing on the misery of a broken healthcare system. If we want to have healthcare that is truly amazing, I believe we must be willing to take risks and try new things. Unfortunately, my experience is that people who have innovative and exciting ideas are often met with irrational hum-buggery: anxiety about innovation that masquerades as “risk management.”

At some point in the culture of healthcare, risk management became a central activity, a goal unto itself. It went from a supportive, protective administrative practice to a frenzied beast that took on a life of its own. As a provider, I have spent countless hours learning to manage minute and unlikely risks through Herculean efforts in documentation and policy iterations. I work in an agency that values risk management so much that it has become a salaried administrative position. Like pretty much everyone who works in healthcare, I have moved from regularly asking myself, “What would be the optimal outcome/experience for my patient, and how can I make that happen?” to “How do I cover my ass?”

There is never a day at work when I am not in the business of building a safety net. And I know this is true for my colleagues. We spend far more time talking about the “safest” way to just write about the care we deliver, than we do about delivering outstanding care. When it comes to innovation, we have replaced caution and consultation with anxiety and avoidance. We have moved from risk management to risk aversion, effectively strangling the vibrancy of our healthcare system.

At heart, I am an innovator. I believe I can do more, and better, and I am naturally motivated to try. I want what is best for my patients, and myself, and at the same time I tend to be responsible and appropriately cautious. Intuitively, I have always understood that there should be a purpose to your caution, a payoff for assuming and managing the risks of healthcare practice. I believe in our healthcare culture we need to ask ourselves the following question:

Are we doing ANYTHING in healthcare that is worthy of the safety nets that we are building?

Or, has healthcare become a circus without a center ring act?

I did not fully understand how deeply anxiety about the risks of innovation ran, until this past year. This year I attempted several projects that involved the responsible use social media and mobile technology to grow as a professional and to improve rural mental healthcare. I was baffled by the constant anxiety and alarm that administrators from different agencies and various colleagues had to what I was doing. You can read a description of one of these projects here.

Even in the social media-verse I would get tweeted warnings about risks of innovation that sounded a lot like this. For me, what was especially troubling was that I was just dreaming, simply imagining things that would help me and my patients have a better healthcare experience. Just expressing ideas seemed to trigger strong, but vague warnings of danger. This woke me up.

When did it become dangerous to even dream of innovative healthcare? When did risk management turn in a culture of thought policing? I realized that something had gone horribly wrong. We can innovate and manage risk at the same time. That is the proper balance of things. Unfortunately, the current bureaucratic climate would lead us to believe that innovation can only be had at the expense of reasonable safety. I see it differently.

There is NO POINT to building a safety net of risk management if we do not attempt magnificent, spectacular healthcare. In healthcare lately we have regularly dismissed innovations as “too risky.” Often, we have done a poor job of factoring in the costs of lost opportunities and benefits. W. Edwards Deming said, “No one has to change. Survival is optional.” Failure to change and innovate in healthcare has never been more expensive and risky than it is now.

We (both providers and patients) DESERVE healthcare innovation that inspires and A-spires.

John W. Holt, Jr., described how to fly on the trapeze, “Throw your heart over the bar”, he said, “Your body will follow.”

In healthcare we should dream up a big center ring act. And, after we have thoughtfully built our safety nets, we deserve the delight of climbing the ladder, taking hold of the trapeze bar, and leaping into the air…

And, for the naysayers, I share one final thought. When it comes to innovation, “The bigger the humbug, the better people will like it.” Thanks for that, P.T. Barnum.