I was recently introduced to a book by futurist Rebecca Ryan,  “Regeneration: A Manifesto for America’s Next Leaders”.  A key premise of  the book is the our country moves through seasons (Spring, Summer, Fall and Winter) of change about every 20 years.  Right now we are in Winter; why does that not surprise me?  She says that although we didn’t realize it at the time, we entered Winter on 9/11.  It would be hard to argue with that date as a turning point in this country.  Winter is about contracting, a period of dormancy or hibernation as we store up energy for the upcoming spring.  And, as anyone who lives north knows, winter is dark and cold and can be scary.  All of these are apt descriptions for this country post 9/11.  But the good news is that after Winter there is Spring, and we emerge restored and re-energized and ready for growth.  That is true for our society just like our environment; and, it made me wonder if the metaphor could be applied to health care.

I suppose you could make the metaphor work.  Lots of people say these are dark days for health care.  They are certainly scary times.   A 2015 Commonwealth Fund and Kaiser Family Foundation (http://www.commoneatlhfund.org/publications/issue-briefs/2015/aug/primary-care-providers) survey of primary care providers found that although there were lots of positive findings, and although the large majority of respondents were satisfied with their practice overall, nearly half of the physicians and a quarter of NP and PA respondents said that recent trends in health care was causing them to consider early retirement.  But it is hard for me to see contraction or dormancy, but perhaps that is because health  care hasn’t been allowed to, or can’t afford to  hibernate.  But let’s, for the sake of argument, assume that we are in a health care Winter as is our country and look at the questions and opportunities Ryan suggests we consider to assure that we are stronger and better as we emerge into Spring.  Clearly these questions apply to health care and push us to look at health care in new and novel ways.

1. How will we balance the needs of our children with those of our elders? That is certainly relevant to health care and addresses not only disproportionate spending at the end of life, but also the issue of spending on illness care (more elderly) vs. prevention (more children).
2. Are we a top down or bottom up system? Are we open or closed system?  Transparently and patient-centered care trends indicate we  are working toward a more open and bottom-up system, but I would question just how transparent and patient-centered we REALLY are.
3. Does the middle class matter?  Perhaps that can be re-phrased as “do young and mid-life adults matter?”  What are we doing to meet the needs of anyone who isn’t ill?  And how are we reaching out to the people who don’t come to our practices? How do we reach people where they work and play?
4. Jobs- what is it going to take?  Are any of you NOT aware that health care jobs are different today than they were decades ago and that they will continue to change?  How are we re-thinking how we work?  It seems like it would be hard to export health care, but tell that to radiologists in India.  It seems like it would be hard to computerize health care, but  tell that to IBM Watson or the new diagnostic tests lab tests that tell us more that you could even discover in a health history.  But health care will always need to be relational; so we need to be clear about when we really need “high touch” and when are we better served by “high tech”?
5. What is the point of America? One could ask that of the US health care system since we clearly don’t do as well as other developed countries on most quality metrics, BUT where does the innovation in health care come from..America! I don’t know the numbers but I would predict that a substantial majority of health care innovation in the world comes from the US.  So how do we keep that entrepreneurial, innovative spirit working to improve quality, satisfaction, and costs?
6. What commitment are we willing to make to our planet?  Wow! that is a huge!.  With all the challenges we have in health  care today, we really haven’t put the time and thought into our impact on the environment we need to.  So this needs to go somewhere near the top of our “to do” list.

Ryan has great thoughts about what to do to bring Spring to America, and I suggest your read the book. But suffice it to say it is all about valuing diversity and balance, thinking beyond “me”, and taking a systems perspective.