Originally published: . Volume 7, No. 5. Source pages: 2.
Thinking outside of the box is sometimes not enough to create system-wide change. In 1981, Barry Marshall and Robin Warren, working in a hospital in Perth, Australia discovered that ulcers were caused by the bacteria, H. pylori. This idea had the potential of improving the lives of hundreds of millions of people worldwide, because 10 percent of us are going to suffer with ulcers sooner or later.
The news of a cure was not well received––no medical journal would publish their work. Totally frustrated, Marshall decided to do something unusual. Instead of his breakfast one morning, he chugged down a full glass of H. pyloria. Two days later he was sick as a dog, vomiting, nauseous, and with all the symptoms of gastritis, common precursor to ulcers. The endoscopic exam confirmed it––his stomach lining was inflamed and ripe for problems. A dose of antibiotic and bismuth cured him. Marshall and Robin eventually won the Nobel Prize for the discovery.
But it took well over a decade for the innovation to be fully accepted.
It also took physicians 25 years to stop x-raying pregnant women, even though the evidence was available that the procedure damage the babies.
It has taken decades for us to figure out if sunshine and D3 are essential. I first read the idea and proof in the 80s. Vitamin D3 is accepted finally, and in March an article in J. of Internal Medicine, in a study of 30,000 Swedish women, found avoiding the sun was as dangerous as smoking for life expectancy.
Pregnant women are today regularly warned to take adequate folic acid, something I knew 37 years ago because I was pregnant with our first child and knew how to use the library. Luckily I had a home-birth doctor who was a curmudgeon, and when I asked him about it, he said he had no idea, but I should “Do what you want to do, you’re going to anyway.” My mom and sister freaked however, since folic acid sounds like something that could eat through metal, rather than a B vitamin.
The chaos and change in health is calling for out of the box thinking and good problem-solving, at the individual, group and multi-group levels. But, health care seems to me especially prone to poor problem-solving. Last week the CMS announces its new bonus plans, presumably to shape behaviors of providers. They are starting with “eligible professions” –– physicians, physician assistants, and nurses. And, they have 900+ pages of rules.
This is not a formula for innovative problem-solving. Restricting who can create new approaches and then pouring hundreds of pages of regulations on things, including the possibility of being targeted by the enforcement arm of government when you try something novel, is sure to douse any spark of genius that slips through.
But we have to try and good people, some insightful Senators and a hopeful governor right now in our state, who want to make things better. But, I wonder about if these “task teams” and other efforts, and wish they might be designed for the quality outcomes our state really needs. So, I decided to give some tips:
1) Don’t create task teams of 10, or 15, and especially not 17 people. The task teams created by recent bills include lots of “stakeholders” and just the number and the hidden agendas would give them very little chance of being truly effective.
2) Make sure members know their problem-solving styles and check to see if your team is top-heavy (this is likely) in one style or the other, which means your solutions and even your problem- finding efforts will be skewed.
3) Train your team members in group and interpersonal skills. Make sure to help those who dominate the process or those who flee at the first sign of conflict, and especially those with hidden agendas.
4) Make sure your meeting schedule supports good thinking. Or does it cause mental and emotional fatigue, so that people give up, give in, or give thanks for the sugar the secretaries have brought in to poison everyone.
5) Consider a competent facilitator who can help deal with challenges, and who does not have an agenda. For complex groups this might be the only way.
If this sounds complicated, that’s because it is. We’ve got to find the right problems to solve, that includes innovation but doesn’t stop there. As W. Edwards Deming said, “It is not enough to do your best; you must know what to do, and then do your best.”
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.