No one can deny that healthcare is at a crossroads. Current thought leaders like Atul Gawande and Richard Baron have proposed that history will label our current time period as the “healthcare revolution”. The introduction and adoption of electronic medical records will have an impact no less powerful than the cotton gin had during the industrial revolution.
If you are working in the medical field, you have felt the tension between the “change-makers” and the “change-resistors”. Depending upon which camp you are in, you either love or hate what’s happening in the field of medicine. If you talk to anyone in healthcare these days about EMR, mobile health, payment reform or ICD-10, you’re bound to get a passionate response – sometimes positive, sometimes negative. Much like our political system, the two camps sometimes face a gridlock.
To help me understand the conflict going on in healthcare right now, I’ve looked to Dr. Helen Fisher’s Personality Type Study which describes four broad basic personality types. She uses her data to help people find love on her internet dating site Chemistry.com. I propose that this same framework can help those working in healthcare to find common ground as well. After all, like marriage, we’re all in this field for better or for worse, so we might as well figure out how to live together so that we can navigate these choppy waters and not overturn the ship!
Per Dr. Fisher, the two most basic personality types are “Explorers” and “Builders”. Explorers are driven by the neurotransmitter dopamine which fills these individuals with enthusiasm, heightened energy, curiosity, creativity, spontaneity, optimism and the propensity to seek novelty and take risks. Builders, on the other hand, are calm, social, cautious, persistent, loyal, fond of rules and facts and orderly. These individuals are driven by the serotonin system. Given these biologic facts, it’s obvious that Explorers are more likely to be “change-makers” and Builders are more likely to be “change-resistors”. Asking an Explorer to be more like a Builder or vice-versa is like asking a zebra to change its stripes to spots – it’s not going to happen.
Dr. Fisher’s study shows that in the romantic world, Explorers are attracted to other Explorers and Builders are attracted to other Builders. We see this in the world of healthcare too. Explorers are the ones driving the healthcare revolution, and the Builders, given their much more calm and cautious nature, are putting on the breaks. Evolution has shown us that both character sets are important. Without the Explorer’s impulsivity, tendency to value rewards more than fear consequences and propensity to try new things, we would not continue to evolve. Although it is true that Explorers often win big, they are also much more likely to suffer disastrous consequences. Explorers are the group most likely to come up with revolutionary ideas that lead to big changes or big business rewards, but a much higher percentage of Explorers than Builders may lose big too. We need the Builder’s caution to balance the Explorer’s impetuousness, but at the same time, we can’t let the Builder’s sometimes excessive caution and fear of change allow us to stagnate.
I’ll reveal that I’m an Explorer that lives and works in a Builder’s world. This unique, but sometimes lonely position, has given me the ability to truly understand what motivates both camps. A “radical academic” by nature, I came to the suburbs at the beginning of my child bearing years thinking I wanted to focus on motherhood and just be a “regular doctor”. This suited me well when high levels of estrogen, prolactin and oxytocin induced by my four pregnancies suppressed my drive to explore new territory. But when my hormonal-induced fog began to clear, the “change-maker” area of my brain reactivated, and healthcare IT became my new drug and obsession.
What I’ve learned during my time in the suburbs is that most private practice physicians, especially primary care doctors, are Builders, which makes perfect sense. Builders tend to be affable, tactful, careful, orderly, precise, detail-oriented, persistent, patient, conscientious and have exceptional managerial skills. This absolutely sounds like the skillset I’d like my doctor to have! But this same group of people, while amazing providers can be a nightmare to those trying to encourage healthcare reform or the broad-scale adoption of HIT because they like routine, predictability, tend to be frugal and are wary of fast changes. Builders are more likely to hold tightly to the “right” way of doing things and can be closed-minded and stubborn. The Builder’s realism and caution can also sometimes morph into deep pessimism or fatalism, which leads them to strongly believe that nothing will ever change for the better.
As I began to see the revolutionary changes EMR would bring to healthcare, I initially suffered from many delusions. I believed that with the right product and optimized workflow scenarios, any physician office could successfully implement the new technology. I mistakenly thought that the ability to do away with paper, collect structured data and ultimately reduce costs while improving outcomes would automatically appeal to everyone! As I reflect on my actions during that time period, I can only laugh at my naiveté. I was completely oblivious to the fact that many of my fellow physicians were NOT exhilarated by this opportunity for change, and actually dreaded it. But like a bull in a china shop, I was going to prove how wonderful it was. Needless to say, my first big exercise in change management could have gone better.
An entire industry of “implementation specialists” has evolved to help manage the pain that comes from transitioning from a paper-based to an electronic healthcare system. What many of these experts forget though is that effective change only happens when the system is ready to embrace it. Large corporate organizations have recognized this and actually employ many people in full time “organizational readiness” positions. But with healthcare being so strapped for financial resources, this critical piece of the journey is not often put in place even when monumental changes are anticipated.
The stages of change are often described as pre-contemplative, contemplative, preparation, action and maintenance. I think many working in healthcare these days are frustrated because attention is not being given to the necessary elements for successfully navigating each stage. So much has been written about change management, but I’ve gained my deepest knowledge of the process from the Harvard MBA professor Dr. John Kotter who wrote Leading Change. It’s a great place to start for those trying to steer healthcare innovation.
The inspiration for this posting came from watching my 12-year-old daughter experience the turmoil of a middle school girl. Adolescents are so awkward because they are changing so rapidly. We’re seeing the same in healthcare. Some days are exhilarating, and some days everyone wants to regress and throw tantrums. As a mother and a healthcare “change maker”, my hope is to continue to study, learn and help others develop the skillsets to navigate this choppy time.
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About Kara Nance, MD, FACP:
Kara currently works in private practice in Rolling Meadows, IL. Dr. Nance approaches the care of her patients with a very holistic attitude that targets the many factors that contribute to overall wellbeing. In addition to her clinical practice, Dr. Nance is passionate about electronic medical records and the establishment of electronic health exchanges. She consults with local physicians, hospitals, and medical groups about transitioning over to electronic medical records. Kara also participates in advocacy activities relating to primary care. As a Fellow in the American College of Physicians and a member of the ACP’s Northern Illinois Council, Dr. Nance frequently travels to Washington to lobby for important issues in health care reform.