Forest Fires and Garden Hoses

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Forest fires are once again raging in California, burning in unpredictable patterns and leaving catastrophic destruction in their wake. In October, the Tubbs fire decimated Santa Rosa, destroying neighborhoods, jumping Highway 101, and forcing the evacuation of a hospital.

According to The Mercury News, “a team of Kaiser Permanente nurses and doctors, faces covered by respirators, gently raced critical patients in hospital beds down the street, with bright orange flames in the background. About 130 patients were safely evacuated in three hours, including women in labor and a “very sick” child. Some hospital employees drove patients in their own cars. When the evacuation started at 3 a.m., the patients “were stunned. They didn’t have time to process a thing,” said Judi Goodin, the hospital’s safety operations. The fire came perilously close to Kaiser Santa Rosa medical center and its huge liquid oxygen and diesel tanks. Firefighters weren’t sure they could stave off the blaze that was engulfing the adjacent mobile home park called “Journey’s End,” she said…As residents returned Monday afternoon for a glimpse of what was left, the scenes around the city were apocalyptic: old people on canes and walkers shuffling along sidewalks through the orange glow; families dragging luggage and wearing blue surgical masks through the thick smoke.”[1]

Physicians, nurses and other care providers are trained to respond to emergencies, whether wildfires or “Code Blue” alerts. For some healthcare professionals, like emergency medical technicians, crisis management is their only job.

The same is not true for health system executives. In most C-suites, people are fond of saying that “culture eats strategy for breakfast”, and the word “change” is usually modified by adjectives such as “incremental” or “deliberate” or “thoughtful”. Decisions are often made by committees, and the very task of forming committees takes months. The only way to find time for an urgent meeting is to be lucky enough to be in a month where a day of the week will occur for the fifth time that month.

In the past four days, CVS and Aetna have announced their merger plan, and United/Optum has announced the plan to acquire DaVita. CVS will have the ability to leverage its retail expertise against the Aetna membership, and Aetna will instantly have the ability to encourage or entice or force consumers to use MinuteClinic.

United, which already employs more physicians than anyone, will add to that number through DaVita’s Health Care Partners division, particularly in attractive markets like Southern California. In addition, United will increase its ownership of leading brands in ambulatory services, which will now include MedExpress (200+ urgent care clinics), Surgical Care Affiliates (200+ surgery centers), and DaVita (200+ dialysis centers).

Hospitals are the Poland of the healthcare industry. United/Optum and CVS/Aetna are planning a blitzkrieg in every market they operate, which in United’s case includes every US state.

If Paul Revere were alive today, he would be riding cross-country.

Health system leaders that continue to focus on deliberate, consensus-driven incremental change are in for a big surprise. And yet, in a world full of enemies, the most dangerous threat to a health system is a fear of disrupting the status quo. For many health systems, the words of Pogo ring true: “We have met the enemy, and he is us”.
If your leadership team has been spending more time thinking about Epic’s roadmap than how United and Aetna are about to separate your system from “your” patients who are “their” members, New Year’s may be a good time to make a new resolution: commit to change now, and dramatically. For the foreseeable future, health systems will be fighting unprecedented fires on multiple fronts, and using a garden hose as a defense is doomed to fail. As General Eric Shinseki said, “if you don’t like change, you are going to like irrelevance even less.”
[1] http://www.mercurynews.com/2017/10/09/santa-rosa-fire-how-a-sudden-firestorm-obliterated-a-city/