Welcome to Center for Advancing Health

Change is messy and inevitably disruptive to those who rely on the status quo. That probably explains why it so often comes from outsiders whose expertise isn’t acknowledged by those within the system.

That’s what happened when Ted Turner challenged journalistic norms by inventing the Cable News Network. Decades earlier, Abraham Flexner, who was not schooled in medicine, created new norms for American medical education that survive today.

America’s hospitality industry annually benefits from a full calendar of conferences sponsored by some experts and attended by many others on how to reform the nation’s healthcare system. Involved are a tag team of the usual suspects, all of whom are quite smart. Irrespective of who pays them and picks up their expenses, participants see themselves as part of the solution.

Whether these experts are ready to consider -- let alone embrace -- changes that challenge a system that has served them so well personally is an open question. Like the rest of us, they don’t find it easy to distinguish doing well from doing good.

Those who study change say that insiders create a steady stream of incremental improvements, but big ones generally come from outsiders. So the journalistic insiders at the networks expanded the nightly news, originally 15 minutes, to a half hour and bravely experimented with using two anchors instead of one.
Ted Turner, sports entrepreneur, invented cable news.

Academics and foundations came up with the idea of a National News Council, a bureaucratic institution designed to respond to journalistic complaints and impose professional standards. At roughly the same time this effort to raise standards faltered, Fox News began its aggressive campaign to relax them.

This selective slice of history may be a lesson -- and perhaps a warning -- for those who think about improving the nation’s health delivery system.

If a few tweaks at the margins will aggregate into an adequate response to public dissatisfaction, then those who attend the conferences are the right team to get the job done.
But if something bigger and more basic is required, the task may exceed their grasp. They’re too invested in the current culture. What’s required is a powerful institution with clout -- a Microsoft or Wal-Mart -- with the resources to successfully challenge them.

Of course, big new ideas aren’t necessarily good ones. Visualizing a better system won’t create one. Any new, improved system will probably involve reorganizing many of the existing moving parts.
The challenge lies in enlisting the inside experts in fitting together existing moving parts in the new structure invented by others. Turner didn’t establish CNN alone. He hired journalists and the medical schools Flexner designed were staffed by doctors. The outsiders outline the Big Picture while the inside experts paint the details within new lines.

That’s basically how Medicare and Medicaid were created.

The process starts with agreement on a specific and achievable goal. In the l960s, it was insuring the poor and elderly. Unfortunately, there’s no such target now.

The ultimate goal is providing quality and affordable care for all Americans, but that’s too big to achieve in a single bite. There are a number of subsidiary goals ranging from convincing people to lead healthier lives to making hospitals safer to expanding evidence-based medicine.

The coming political campaign won’t yield progress unless we agree that such a goal is worth a concerted effort, thereby initiating the grittier debate about how to best achieve it.

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