July 29, 2015

Change Brings Anxiety. But It Doesn’t Have To

A shift in viewpoint eases the journey to acceptance


By Toby Cosgrove, MD
President and CEO, Cleveland Clinic


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Change is happening fast and furious in healthcare, touching all aspects of the industry — how we identify and treat disease, who provides treatment, where we offer healthcare services, how patients interact with their caregivers and how we are paid.

All of these changes — while necessary — have created some anxiety for many in the profession. To put it in terms of Kubler-Ross’s five stages of grief, we’ve passed denial, anger, and bargaining and have reached Stage Four, which is depression. Soon, though, we’ll all reach the final stage: acceptance.

Reasons for anxiety

Looking at the myriad changes, though, it’s easy to see why caregivers may be feeling anxious:

  • Identifying and treating disease: Increasingly, treatment decisions will be directed by big data, checklists and algorithms. Super-computers like Watson will soon become essential tools of patient care, crunching patient data to cross-check every conceivable option. Checklists and algorithms will direct doctors and patients toward evidence-based care paths to reduce variation and improve quality. And genomics will guide personalized healthcare decisions based on a patient’s unique genetic profile.
  • Patient interaction: Patients’ voices have never been stronger, thanks to online physician reviews and surveys that are tied directly to reimbursements. Patients also have better access to and greater control of their health information, through the growth of electronic medical records that include everything from appointment reminders to test results to medication renewals to doctors’ notes.
  • Who provides care and where it’s provided: Some basic services are moving out of doctors’ offices and into drug stores and grocery stores, while physician assistants and nurse practitioners are taking on a larger portion of care.
  • Payment: Medicare reimbursement is being cut by $415 billion over the next decade. What’s left will be doled out based on specific quality metrics. (A decade ago, the Centers for Medicare & Medicaid Services compiled 10 quality measures; this year, it was 115.)

These and other changes are happening alongside rapid technological advances, the uncertain effects of legislation, and the tectonic shift from volume-based reimbursement to a value-based system.

Acceptance and adaptability

We need what the philosopher Friedrich Nietzsche called “courage in the face of reality.” These fearsome changes are actually an opportunity for us to reinvent healthcare. At Cleveland Clinic, we’re stripping away the superficialities and trying to answer the most basic question in medicine: What is best for the patient? We’re focusing on quality, access and affordability.

To accept change, you need what Microsoft CEO Satya Nadell calls “a culture that is fundamentally not opposed to new concepts and new capabilities.” For some large medical centers, this will be hard. But we have no choice. Charles Darwin put it best: “It’s not the strongest of the species that survives but the most adaptable.”


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