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The Complexity of 21st Century Health Care

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COVID is rapidly changes, seems to operate in cycles, creates chaos (in terms of both prediction and control). Perhaps of greatest importance is the highly stable (and often stagnant) health care system in which it is now swirling about. COVID knows that we can’t keep up and that the structures we have built to protect us from chaos are now actually contributing to our ineffectiveness in addressing the COVID challenge—thus creating even more chaos.

With regard to Contradiction, we can identify the frequent presence of contradictory constructions and interpretations of reality and the differing meaning assigning to the reality that is being constructed in American health care. As we will not repeatedly in this essay, there are alternative perspectives on the treatment of COVID that are both contradictory and valid.

What do we do? It seems that we are living and leading in a world of contradiction. We must make health-care related decisions that are contingent and subject to frequent review and modification. Obviously, Turbulence and Contradiction are strongly influenced by and tightly interweave with all four of the VUCA challenges. We will use the term VUCA-Plus with this expansion on the description of a VUCA environment. Taken together with COVID, these six conditions of VUCA-Plus have created a whitewater world that we cannot readily navigate.

The Evolution of Healthcare and The Leadership Journey in a World of VUCA-Plus

Healthcare’s origin story emerges from the faith-based institutions in Western Culture—the term professional stems from Catholicism and many early physicians grew out from the clergy and in less densely populated areas of the US were the same person. The primary relationship of the physician has been the doctor/patient relationship—a very private, confessional level relationship steeped in mystery and overloaded with expectations for healings and cures. For much of American life finding the right doctor was essential and master-apprentice was the primary means of training and developing new doctors.

From Cottage Industry to Big Business

As a cottage industry, physicians owned their practices and the patients who visited them there were considered their patients. With the emergence and necessity of hospitals growing in the 20th Century and the rise of health insurance in America, we saw a rise in Hospital Administrators, whose primary role was to attract enough local physicians to select their hospital. Catering to physicians came in the form of free food, Doctor’s lounges, and growing technological capabilities to entice physicians to utilize their hospitals. Health plans established themselves as a means for a broader array of people to access the growing alliance of physicians and hospitals to provide comprehensive care for nearly any ailment. Powerful medicines like antibiotics and insulin further launched physicians into powerful trust and support of the public as the stewards of healthcare.

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