Batalden updates Machiavelli

There is nothing more difficult to
take in hand, more perilous to conduct, or more uncertain in its
success, than to take the lead in the introduction of a new order of
things. For the reformer has enemies in all those who profit by the old
order, and only lukewarm defenders in all those who would profit by the
new order, this lukewarmness arising partly from fear of their
adversaries … and partly from the incredulity of mankind, who do not
truly believe in anything new until they have had actual experience of

This famous quote by Machiavelli is both a hearty
warning and a healthy piece of advice to those who seek to change a
political or social system. If those in today’s health care system were
looking for the equivalent piece of warning and advice, they might just
have obtained it from Paul Batalden,
Professor and Director of the Center for Leadership and Improvement at
the Dartmouth Institute for Health Policy and Clinical Practice. He
presented it to a small group of us today, in a talk entitled "The
challenge of leading the leading of the improvement of health care". I
present it with his permission. I think he has nailed the issue and
admire his ability to do it so succinctly.

The key slide had the following heading:

“Anchors” of a synergistic culture holding the present in place…

And the following four major observations about why change is so hard to achieve:

agreement about what the common and individual work is (at the
behavioral level) that will be necessary to create anything different
than the present reality;
We seek and find reinforcement for our self-interests, beliefs in the current payment methods and systems of health care;Desire
to focus on “islands of excellence” (and we love to give “Island
Tours”) rather than create and maintain uniformly safe, high quality,
good value, reliable and accessible operations; and
well-developed capacity to rationalize away the newsworthiness of
potentially disconfirming data (financial, quality, safety) and
external assessments by patients, payers, etc.

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4 replies »

  1. Any one can have some bad luck and be stricken with a serious injury, that is what happened to me, just bad luck. The result is that now I have been blacklisted from getting any kind of health insurance. It is a helpless feeling, that most people will never have to experience. I am a non-smoker and drinker, and in good shape except for my neck and back. Insurance in current high risk pools are too expensive, for most people, especially if they’re laid, up like me.
    Many people, mostly Republican’s scream, about their rates going up. I should remind people like that that others pay more so that they can live in remote, fire prone areas, and in other types of insurance that is spread out too.
    I believe that the for-profit healthcare should me abolished. when did it become more important to produce higher and higher stock market results, over the needs and care of our people. I think that these people, who many say are church and temple going people, have lost sight of God’s intent. That is to tend for the sick and injured in our society, not use them to make huge profits over.
    We need to get rid of the private insurers! or limit their monopoly. More choice should be available for people who have had a serious previous injury and surgery, but are still healthy. I only wish that these people against reform could experience what I have had to endure, the repeated denial of applications, the anger, and frustration, the helpless feeling. It makes you wonder how this could happen in this Country. All you get is un-caring, people in this industry.
    I want the non-reformers to look inside themselves and think about what a human life means, it is not a Widget to make a profit over. I want them to think about, what if someone in their family came down with a serious or chronic condition, and were denied care, or told everything is “experimental” that’s code for, their not paying for it. The pain and anguish you will feel for a loved one, because, it’s too expensive and the hospital, insurance company, and Wall Street need to make a huge profit. Many of these people say ” it’s just business”. When the day comes that you are judged before God, tell him, my actions were “JUST business” I hope you like it hot, and I’m not talking about Texas in the summer! Think about it!

  2. Health Insurance Blog read this.
    “It’s the Prices Stupid”
    The biggest obstacles to change are the people who are profiting from the staus quo and who block change by bribing the political system.”For the reformer has enemies in all those who profit by the old order” It’s been said here many times but Machiavelli is more eloquent.

  3. Many people think that we have a terrible healthcare system. I do not agree with that. I feel that we have created a great system where people can get the world’s best treatment. The problems are in the financial end of the healthcare system. I am not a fan of government controls but we need some way to increase regulations in healthcare. Hospitals need to be audited so we can understand why the cost of healthcare is rising at such a dramatic rate.

  4. Paul,
    The problem with changing American health care is not nearly so lofty as this. I’ve written about it ad nausem – see Reform’s Tougher Problem (https://thehealthcareblog.com/the_health_care_blog/2007/08/the-tougher-pro.html). It fundamentally stems from the fact that Congress is bought off by the health care industry, and that the groups representing the other six-sevenths of the economy are generally unwilling to band together to focus specifically on this problem. In other words, we cannot fix health care until we fix America.
    Great quote from Machiavelli, though.