“I think if you look at the role of physicians historically, it is not too surprising why we are in the situation we are in today. Back in the 1920s and 1930s, the system was very simple. There were patients who needed care and there were doctors—providers—who could provide that care. There was a very close partnership in decision making between the patient and the doctor on what to do—medication, therapy, surgery—and the cost of the are needed. The doctor was well aware of the inconvenience or cost of the procedure or medication, and together they made the decision. Then medicine began to get a more complicated. We need specialized facilities to be able to provide care. Hospitals became more sophisticated. So now patients were not only treated at home or in hospitals. But at a specialized facilities like nursing homes or even disease-specific facilities such as TB sanitarians. So now the system had three parts, the patients, the providers, and the facilities. That worked very well, and it was still a direct patient-to-provider relationship. . . . The next things that happened was the development of the third party payer system. Healthcare was getting more expensive and a safety net was needed. . . . The process became quite complicated and doctors were willing to give up some of that decision making, either because of their lack of knowledge in management or because of the lack of leadership skills in the overall healthcare system, and that leadership need was provided by insurance companies, government, third party payers and hospitals. . . . Now there are five players in the healthcare system of today: patients, providers, facilities, insurance companies, and payers (employers and the government0. Who has taken over the decision-making power? Instead of the patient and the doctors making decisions, the power has shifted to the hospitals, insurance companies, and the payers.” [Daniel S. Durrie, MD, Ophthalmologist, President, Durrie Vision Center]
The case is being made for the physician leader to be at the table—a case being made as well by the Compliant Rainbow leader. With this knowledge of present-day complexities in health care, it takes courage to move forward. A full heart is required given full knowledge of the challenges that are likely to be faced. In many ways, the Tangy Orange leader stands with the Compliant Rainbow leader as the most courageous of the various types we have identified. Both leaders tend to feel uncomfortable with conflict, yet they move forward with the thoughtful engagement of change.
The challenge for a Purposeful Tangy Orange leader is being asked to keep the end point always in sight. This concern about lost end points is often voiced by Influential Azure Blue leaders. There is the excitement of planned and managed change—but for what purpose? This excitement is manifest in the statement offered by one of McKenna and Pugno’s (2006, p. 90) leaders. Dr. Geerlofs offers the following observation and recommendation:
“I know many physician executives who manage but do not lead They’re prevalent in health plans, integrated delivery networks, and large medical clinics. They’re fulfilling their day-to-day roles, but not making innovative transformative change happen. In fact, executive roles can actually incline people to be more conservative, so the most creative ideas often come from others who are working outside the context of large organizations, . . . We need to help physicians and others catch a glimpse of what a transformed healthcare system can be, what it can mean to patients and the professionals who work within it. We need leaders with passion.” [J. Peter Geerlofs, MD Family Physician Chief Medical Officer, A!lscripts Healthcare Solutions, Inc.]
While the challenge offered by Dr. Geerlofs is compelling and very timely given the contemporary crises in many health care systems, one might ask Dr. Geerlofs to identify the desired outcomes to achieved in bringing about “innovative transformative change.” He suggests that physicians need to catch a glimpse of what the outcomes of this change can be—but doesn’t indicate what he thinks this outcome will be. Like many other Tangy Orange leaders (and similar leaders in other systems) emphasis is placed on the process of change rather than the outcomes of this change. Education and Training is needed—but to what ends? New technologies are to be engaged—but what will they improve?
