Early in my career, I was enamored of stories of healthcare innovation.
I would devour medical journals, newspapers, and industry magazines and get inspired.
I was young (and naive) and believed everything I read.
Then at some point, my academic, government, and corporate careers took me to many hospitals and systems and innovative companies to see these “innovations” up close.
In one such visit to a midwest health system, I was struck by the difference between what I read and I was seeing on the ground in practice.
The renowned “open access” scheduling system to ensure primary care patients had access to same-day appointments had made its way into the pages of the Wall Street Journal.
The system was alive and well in one clinic of a 40+ clinic system—but had not scaled to other clinics.
And there were no plans to do so.
The team-rounding that was touted as the future of inpatient care was restricted to one part of one floor of one hospital in a 4-hospital institution.
And there were no plans to scale the model to other parts of the hospital, much less the system.
Years later, in a visit to another famous health system that touted a deep focus on social determinants of health, I was alarmed to learn of the infinitesimally small number of hungry patients who were actually fed by the system’s food program despite national acclaim.
My initial reaction was to judge the systems—for proclaiming great results—but failing to take the next step to scale what work across the system.
With years of hindsight, I now see in that health system what I see everywhere: an epidemic of inauthenticity and superficial execution.
Pilots that fail to scale and disappear into oblivion.
Persistent window-dressing of broken care process.
Single-market results that are scaled to represent company-wide performance that aren’t close to being replicable.
Regression to the mean being sold as evidence of impact.
You could (and should) call it what it is: a hustle, of sorts.
In a field ostensibly dominated by scientific discovery and rigor, many results fail to meet the basic standards of a sixth-grade science teacher’s lecture on the scientific method.
And, yet, round and round we go with story-telling of scaling innovations and wondrous industry change that never seems to materialize.
And while I first observed this phenomenon in health systems and, later startups, no sector of health care is immune. Managed care (my own industry), pharmaceuticals and biotech—are all guilty of overstating impact and potential and profoundly under-delivering. So too are the armies of investors, startups, and consultants promising change—but delivering little.
Healthcare seems only to get worse, while we are being told that it is getting better.
We have normalized inauthenticity.
When I share my outrage with close colleagues—they say some version of “lighten up, man!”
It’s salesmanship, they say. It’s just how it works.
People are selling their ideas. Building their brands. Nothing wrong with it. You do it too.
And, they’re right about that last point. Every so often, I feel myself selling that we are making more impact than I have—and I hate myself for it.
When we proclaim the success of solutions that aren’t really successful or haven’t or can’t scale—we create the false sense of security that “someone’s got it under control.”
That company X has got it solved. When they don’t really.
We send them business when we shouldn’t.
In other words, when we create a false reality that declares progress—the effort and will of those who might get to work on solving that problem is deflected and lost and more resources go to groups that don’t effectively serve patients.
There are far too many people who take at face value the company declarations of miraculous results—who learn far too late about the epidemic of normalized inauthenticity.
And, yet, there’s an even more significant issue with the industry’s fakery.
Which is—the bone-deep cynicism that it breeds.
Where we were once an industry that boasted high degree of trust with the public between management and the frontlines—cynicism and burnout are now the dominant feeling of far too many people in and around healthcare.
A sort of fatigue that was borne of the normalized double-speak and dissonance of life inside of most healthcare organizations.
“We care about value-based care and right care, right place, right time” — “Now please know we’ve invested in many new MRI machines and let’s get those machines humming.”
“We believe in innovating healthcare!” — “Unfortunately, we have to cut non-revenue generating programs.”
“We are nothing if not passionate about our mission to serve the poor.” — “We aggressively go after patients who aren’t paying their bills.”
You get the idea. And it’s no wonder that a lot of good, honest people are saying, “Get me out.”
All of that said, I have gone through my Kubler-Ross Stages and have begun to accept that my innocence is lost.
I have resolved that there will always be a difference between what healthcare organizations say and what they do.
But I also know that truly great healthcare organizations will be deeply and endlessly restless to close the gap.
Absent that restlessness, health care organizations are left to further devolve into what many already believe they have—self-satisfaction and abject mediocrity.
What is your role in making it better? What is my role in making it better?
I believe it starts with speaking up at every turn. With challenging the fakery.
With rallying around the lonely critics of the fakery—making them less lonely—and driving absolutely clarity on the reality, naming clearly the problems that must be solved.
Ending the whitewashing and begin, once and for all, to denormalize the double-speak.
To assess claims critically and demand more integrity.
To refuse to be gaslighted into accepting things are better than they are.
To end our collective denial.
If we don’t, we will be the people who will suffer the most—when we need the saccharine-sweet care and services ourselves.
And realize what many before us already have.
That there’s unfortunately nothing real there.