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Centering on...Building Common Ground

Today, every person and institution involved in health care, from professionals and hospitals to practices, insurers, schools, and suppliers, are engaged in a great undertaking of reinvention. Many of these entities, perhaps even most, are carrying out this strategic repositioning from the solid position of where they and their interests have been located over the past five decades as the modern American health care system emerged. While their self-interested orientation is understandable, and even normal, it is not the orientation which will produce the changes necessary to maximize the quality of healthcare services while achieving sustainable increases in access, including accessible costs. The islands of self-interest and parochial perspectives that divide healthcare into hundreds of ill-fitting parts, leaving consumers and providers in a sea of confusion, need to change at the most fundamental level. Whether measured in dollars or avoidable deaths, so many of the unnecessary costs peculiar to our system of healthcare occur at the borderlines between in-patient and out-patient, specialist and generalist, nurse and physician, acute care and chronic care, and prevention and treatment.

Finding common ground and uniting to approach it together will take leadership. It is a task that can be carried out at every level of policy and operation within health care, from professional team work in a hospital to the alignment of public and private finance. Obviously, as the number of participants and the variety of perspectives grow, the complexity of the leadership task increases, as does the time it takes to move forward. While the investment by leadership will vary with the scale and scope of the undertaking, there are four basic challenges in the process.

First, it is essential to fully understand the desired outcomes of the new collaborative effort. While this sounds obvious, it never fails to amaze me how many leaders do not fully think through their proposed strategies in terms of desired outcomes or the contingencies around them. Too often, strategies are pursued because they are the solutions de jour rather than thoughtful responses to the demands of the changing environment.

The second challenge involves an exploration of your fears and interests around the change. Many valuable collaborative efforts require that each participant push him or herself to a level of discomfort in order to create something new, so being aware of the emotional dimensions that you bring to the undertaking will be a necessary part of any significant change.

The third challenge is to fully understand the interests of the other collaborators. We often fail to find common ground with others because we assume that we know their interests. But it takes effort to understand the perspectives of others. The best way to gain understanding is to systematically ask questions of the others about their interests and anxieties. Another critical dimension of this process is engaging your potential partners, so that they can see how their interests and yours come together. This process creates a public space for on-going learning. Initially, this involves the respective parties learning about each other, but later they develop a shared learning from their common ground perspective.

Finally, it is important that parties be able to craft a statement of their common or shared direction. This might be a common vision or mission statement or simply a shared statement about the undertaking. The discipline of reducing a common understanding and expectations to words is an essential step in the process of reaching common ground.

In a rapidly changing world, leaders will need to wield a skill set that helps them work to develop common ground across professions, settings, and expectations. Given the variety of perspectives, the intensity of the challenge, and the nature of the stakes at hand, leading the process of generating common ground may be the essential skill of the successful health care leader.

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