The Ill Effects of Shutting off Constructive Healthcare Reform Debate: First, Do No Harm

Congress: First Do No Harm

The Democrats in Congress are discussing whether to apply reconciliation procedures to passing health care redesign legislation (I would call this redesign rather than reform, since the latter term implies improvement, which is not established at this time).

Reconciliation procedures were originally created to prevent the government from shutting down over budget disagreement. They allow passage of legislation with a simple majority and prevent filibustering, which requires 60 votes to close.

Our experience as healthcare management consultants validates that the principles underlying reconciliation procedures are dangerous for organizations.

Research on conflict management shows that conflict can be beneficial for decision-making if used correctly. Conflict arises from differences in points of view. By discussing these differences in perspective, organizations can uncover hidden assumptions about a wide variety of issues, which are important considerations.

Research shows that failing to consider these types of differences results in poorer decision quality. Cutting off discussion prematurely has the same adverse effects as groupthink.

Managers can fall into the same trap as Congress by rushing an opportunity to make change.

Leaders know how hard it is to mobilize people for change. Consequently, there is a desire to seize the moment. Wise leaders use the moment to create momentum, but understand that poor preparation for change can have unanticipated and undesirable effects.

There is no substitute for planning that integrates task conflict (good conflict), and when necessary, undertakes small tests of change before widespread implementation. We have a highly visible example right before our eyes with the Massachusetts Healthcare Reform experiment. While still to early to fully assess, already we are seeing unexpected consequences that should not be ignored as we move forward with national reform.

Our political leaders are failing all of us by rushing to a pre-conceived solution and then using the reconciliation procedure to eliminate constructive conflict to arrive at a more well thought-out solution. Two tactics are being used to interfere with constructive conflict.

First, Declare an Emergency to Stop Cognitive Discussions

The first technique that people follow when they want their own way is to declare that the situation is “an emergency.” They announce that the emergency requires immediate action.

Keep in mind that an emergency is not the same thing as a need to change or reform a broken system.

Example: A person with significant coronary artery disease may need angioplasty or cardiac surgery, but the condition is not an emergency unless that person has elevated enzymes or arrhythmias. So we do more discovery and testing to arrive at the best treatment. If we do have a real cardiac emergency, medical practioners have well-tested methods for addressing the emergency.

The exact opposite is true with large-scale healthcare reform. If we concede that we are really in an emergency situation, we don’t have a well-studied roadmap for resolution.

The principle of “First, do no harm” is about not rushing into action before an action plan is well-designed. And a well-designed plan is not rushed to implementation until sufficient discussion, information-gathering, and exploration has been conducted – with people who have a range of ideas that can lead to a better, more effective implementation.

Second, Drive a Stake Deep into the Ground and Refuse to Discuss Options

The second technique to stop constructive conflict is that both sides are unwilling to see the other party’s view. Republicans refuse to agree to the legislation proposed by the Democrats.

This is a perfect example of poor conflict management.

In a successful organization, the goal of conflict management is not to force the opposition to accept the majority perspective but to encourage the opposition to explain the reasons why opposition exists.

After the reasons are identified, the organization’s leadership tries to resolve the differences of opinion (it always comes down to opinions) by discussion, seeking more data, or conducting experiments that help resolve differences of opinions.

Exploration of the conflict usually results in a better solution.

As advocates of Better American Hospitals, we want to encourage Washington to develop legislation that provides hospital managers with the ability to care for patients. We do not want to see any process put in place that will result in incomplete planning and testing before implementation.

Congress needs to act like responsible managers and ensure (not just hope) that legislative changes enhance the health care system’s ability to provide care. Do Americans deserve less than the best plan? Like good organizational leaders, in an effort to “first, do no harm”, Congress ought to ensure that a full debate on any proposed legislation occurs before any redesign legislation is passed.

In response to this type of oppositional thinking, I hope they don’t repeal “First, do no harm”.

Filed Under: Featured Articles • Hospital Leadership

Tags: Featured Articles, Federal Policy, Obama Healthcare Reform, Obama Healthcare Reform Legislation