We live in a transformational time. The speed of change fueled by aging demographics, increased multi-generational complexity, a global economy, the digital revolution and consumerism with counter-balancing rights and responsibilities (to be determined), have over-taken nearly ever sector in our society. Education, energy, environment, labor, housing, transportation – all shaken to the core because they have been unable to evolve rapidly enough to adjust to the changing needs of a modern world.
Resistance to change in each case has come from within from those in power who stood to benefit from the status quo. Moving forward has been further complicated by the enormity of proceeding in the absence of a proven preferable future visions and collaborative leaders with the strength and skill to manage the complex dance. But if you look at just two sectors – Education and Health – there is movement, and it’s coming from within.
Faced with deeply entrenched and powerful insiders, reformers are building out new approaches in parallel. The charter school movement is a case in point. It began in 1992 in opposition to the existing educational bureaucracy and teachers unions. Faced with questionable performance, a lack of accountability and high variability from one community to another, charters were an inside experiment. What would happen if the power center shifted away from tenure, school boards, and top heavy multi-layered leadership, and instead laser focused on the students and their educational health?
Eighteen years later, we’re beginning to see signs of real change. But change has not come easy. There are now over 5,000 charter schools in 39 states. Based on performance, these schools must be re-chartered every few years by local authorities – given permission if you will to “break the rules”. Over the years 740, roughly 15% of those granted charters have been shut down for poor performance while 85% have succeeded. 1.5 million school children nationwide now attend these schools, only 3% of the population. But numbers are growing at an 11% clip and 365,000 kids are on the waiting list nationwide.
Are some of these lessons learned in the education sector transferable to Health Reform? I think so. First, meaningful change must come from within and be built out “in parallel”. Second, change will not come easily and will require determination, local leadership, careful monitoring of measures of effectivness. Third successful change requires recentering our focus on patient, home and care team rather than on hospital. Fourth success must be measurable and rewarded. Fifth, our federal goverment will need to play an important enabling roll by aligning financial incentives and directing investment funds toward those states, regions, and institutions who demonstrate the courage and readiness to bring the health sector into alignment with our current health needs and requirements.
For Health Commentary, I’m Mike Magee