Skating to Where the Puck May Be and the Hole in the Ice Likely Is: Reflections on the Work of the Blue Ridge Academic Health Group
For almost twenty years now, the Blue Ridge Academic Health Group (http://whsc.emory.edu/blueridge/index.html) has published annual or biannual reports on aspects of the academic health enterprise. Some are very much “inside baseball” and therefore speak to an audience very familiar with the field. Others, while calling on a reader with interest in and a basic understanding of patient care and physician education and training, are nevertheless important documents since they reflect the thinking and no doubt the concerns of people on the frontlines of health care and medical education.
As a search firm involved in academic medicine through searches for deans of medicine, pharmacy, nursing, and dentistry and chairs of various medical school departments and specialties, we await each report’s release with keen interest. The dog-eared pages of both digital print versions attest to our sense of the relevance of the reports’ findings.
Of particular note for us is one of the Group’s most recent reports, SYNCHRONIZING THE ACADEMIC HEALTH CENTER CLINICAL ENTERPRISE AND EDUCATION MISSION IN CHANGING ENVIRONMENTS. As the title indicates, the Group was concerned for seeing to it that the adaptations underway in the clinical setting – essential as those are – nevertheless incorporate fully the educational mission of academic health centers in two essential ways.
First, time and space accommodations must be sufficient to enable students to observe and practice. Again, this is not new, but the economic drivers of treatment are much more intense now, so time in and space committed to heuristics are even more valuable than previously was the case. The Group is clear, however, that time and space cannot be compromised except to the detriment of preparing the next generation of physicians.
Second, the best hospitals and other treatment settings (e.g., nursing homes) are changing protocols to anticipate the conditions of health care that are emerging in the changed landscape. Students will need to understand not only how the change is taking place but why as they may well find themselves working in settings that are themselves at various but different stages of adaptation. And it is quite likely that the clinical settings vary, as the Group points out, because the missions of the institutions are distinctive.
This is all by way of observing that the Group is concerned in this particular report for seeing to it that the adaptations made in clinical environments be undertaken with due consideration for their effects on the education and training of physicians.
This report is also important for what it says about the key attributes of those charged with leading academic health centers (AHCs). In times of discontinuous change when the present is not incrementally but qualitatively different from the past, experience – while still very important – requires imagination and discernment if a leader is to navigate unchartered waters. Imagination is needed In order to hazard a judgment that conditions really are different this time and will not regress toward what they were. Call it intuition, but whatever its name, the ability to sense that the circumstances of today will no longer prevail tomorrow is essential for anyone leading an organization in the midst of urgent and radical change.
Discernment is another important attribute of leaders of AHCs. Even or perhaps especially when working in discontinuous change, very few leaders are apt to discard what they have learned from their experience, nor should they. But drawing on personal experience and the history of both the practice of medicine and the preparation of physicians requires discernment. As Stanford’s Jack Rakove recently noted:
Historians are very nervous about the idea of learning lessons from the past. That sounds somewhat counter-intuitive because common sense wisdom is that we study the past to learn lessons that we can somehow apply to the present. Many, perhaps most, historians would say something rather different—that the reason we study history is partly to understand the origins of the present. You cannot be an informed person in any full sense of the term if you don’t know how the past led to the present, or how the present evolved out of the past.
But when it comes to the question of lessons, many historians think that the real value of learning history is not to synthesize too easily or too casually or too deliberately. It’s really to try to appreciate differences (“Expert Says Partisanship Makes the Presidency #1,” reproduced in FUTURITY (http://www.futurity.org/presidency-democracy-1240362-2/?utm_source=Futurity+Today&utm_campaign=3bc181bc13-September_5_20169_6_2016&utm_medium=email&utm_term=0_e34e8ee443-3bc181bc13-206324717).
Even as the perceptive AHC leader concludes that “this time things really are different,” and the changing landscape of medicine requires adaptation, s/he will need to discern what has to change and what remains the same.
This has some interesting implications for the search for new AHC leaders. Experience is not hard to gauge: a person’s resumé or CV memorializes the way stations of a person’s professional life. Imagination and discernment are less readily apparent.
As a guide for determining exactly who possesses how much imagination or discernment, we find it useful to ask of prospective candidates for AHC leadership roles not only what change they effected when the opportunity presented itself in the past, but also what left the same and why. A rule of thumb is that what someone leaves as is often affords insight into what the person prizes.
These attributes take on special importance in environments the Group characterizes as “change unmanaged to the point of turmoil.” Imagination and discernment coupled with experience and perhaps a dose of humility can go a long way in mitigating the sense that some in medicine feel that change is perpetual and unguided. Providing a coherent narrative of how and why health care reached its current state of affairs entails both experience and discernment. Suggesting where health care needs to go and how to get there requires imagination and, again, discernment. Acknowledging that you as leader may be wrong reveals both humility and, most likely, experience.
In one of the Group’s reports the Wayne Gretzky aphorism is invoked about “skating to where the puck will be” as guidance for AHCs. For nearly a score of years, the Blue Ridge Group has sought to forecast exactly where the puck will be and, in the process, we suspect, moved the puck itself by dint of their reports. In addition, the Group may well have also afforded some AHC leaders a sense of where the holes in the ice are.