By Carl A. Hammerschlag, M.D.

Welcome to the new business world of fast companies, nanotechnology, zero time and E-commerce. This is the information revolution where all new information becomes old with the click of the keyboard. Success in today’s marketplace has nothing to do with having access to information or being able to transmit it rapidly, it’s about creating environments that generate new ideas and that value relationships. To generate new ideas means that you have to accelerate the unlearning of old ones.

What this means for the Association industry is that those who create environments that welcome new ideas and who value relationships will thrive. I spoke to several friends in the business about what will define successful associations in the future. Susan Sarfati, CEO of G.W.S.A.E., said “we need to create ’safe harbors,’ places that encourage courageous, open, and honest exchanges where people can take risks and even talk about fears and failures.” Russ Abolt, CEO of International Sleep Products Association, said, “successful associations are those who continue to build community. We are a global phenomenon, so the need has become even greater to make tangible what it means to be family.” Ed Griffin, CEO of Meeting Professionals International, said “we have to master the technology, otherwise we will only depend on virtual relationships. More than ever we have to remember to maintain personal relationships with our memberships.”

I share their opinions. If you care about what you do and you like the people you’re doing it with, in an environment that encourages new ideas, you’ll be the fast company. ASAE reported that associations provide 90% of all post-graduate education. Associations can do what politicians and diplomats have been unable to do through their meetings, break down the boundaries that separate people and nations.

Seeing things from a new perspective, however, is not so easy. We tend to see what we already know. As a species we seem to look for ways to maintain the status quo. We get settled into old habits.
Neurophysiologists and learning theorists have long taught that the brain does not change after you are six years old. The theory was that the longer the learning, the harder it is to give up. It’s as if the young brain is a fast-hardening Jell-O into which a fruit cocktail of facts and behaviors is poured. Once the Jell-O solidifies, it’s hard to get the fruit out.

Current findings tell us that there are dramatic anatomical changes in the brain throughout adolescence and that cellular changes continue throughout one’s life. The brain is continually changing itself through a phenomenon called “pruning.” The body trims cells that aren’t being used, so it’s continually evolving. It’s still incredibly difficult, though, to loosen patterns of behaviors and thoughts that have been reinforced by years of repetition. The things we learned as children are teachings that can build character but they can also be the source of later pain and dysfunction. For example, be nice, honor your parents, share what you have, be strong, don’t cry, make us proud of you, be perfect, don’t speak up.

The greatest block to creativity is old judgementalism. We stifle our ideas because we judge them as unlikely to be attainable. To be creative means accelerating the process of unlearning or in today’s language, “reprogram your software.” The crux of creativity is seeing things from a new perspective.

Here are some ways to accelerate the unlearning of old judgments and limitations:

1. Learn to play again. Kids are the most creative creatures because they let their imaginations run wild. Kids don’t put down their ideas; instead, they jump in with wild enthusiasm, excited by their originality. Let go.

2. Take more risks. Seek out new experiences (sky dive, scuba, climb a mountain, write a poem, try improv comedy). Do something that gets you outside your comfort zone. These experiences invite the brain to consider things it might not otherwise encounter.

3. Seek out the awesome. Find something or some place that leaves you with your mouth wide open in awe-watching the birth of a newborn, standing at the edge of the Grand Canyon. Seek out experiences that help you not take yourself so seriously. Awe is the best way to keep your ego in check. Taming the ego allows you to make mistakes, even fail, and still feel okay about yourself.

4. Trust your unconscious. Our most important self is that part over which we have no conscious control, like breathing, responding instinctively to threats or falling in love. Our unconscious mind, or intuitive self, has a lot to teach us. Anyway you can see beyond your ordinary consciousness opens you up to new ways of seeing. Some people get in touch with their unconscious minds through long distance running, practicing yoga, listening to music, looking at a fire all night long while listening to drumbeats, or other ceremonies.

All of these ways open the unconscious mind to allow fresh ideas to bubble up. Accelerate your unlearning in an environment that values openness. Perhaps Marcel Proust said it best, “the real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”

Excerpted from a presentation to the VHA/SW Annual Trustees Conference

I believe we have reached the point in health-care delivery when the trajectory of culture, economics and technology are colliding to compromise the care of patients. You are all familiar with struggles: constantly changing legislation and regulations which make it hard to stay in compliance; new technology is changing the way we do business; the impact of managed care; and decreasing reimbursements all challenge our survival. You are non-profit community hospitals whose mission and charter is to address the needs of your communities. How are you going to deal with these issues? How will you absorb the costs of the uninsured, which accounts for 25% of the population in some states? In the old days, paying patients would cover those who couldn’t pay, but this is no longer the case.

Community hospitals, and especially teaching hospitals, are laying-off workers, rationing care to the uninsured, even selling control to “for-profit” companies. Competition for scarcer resources does not breed good neighborliness; as physicians, administrators, and trustees we are increasingly struggling among ourselves. Doctors are feeling that their clinical judgments are being subordinated to fiscal considerations. In order to do right to by their patients, doctors feel it necessary to play games with insurance companies. Forty percent of 720 doctors interviewed in an article in the April 12, 2000 issue of the JAMA said that they exaggerated illness, changed diagnoses, or otherwise “gamed the system” in order to do what was best for their patients. Lots of doctors are leaving practice and many say that they would have chosen a different profession if given the chance to start over.

Administrators are saying the same things; fiscal restraints are forcing compromises. They cannot buy every orthopedic appliance known to man or every new machine. With everyone struggling to preserve income and territory, we are no longer sure we have each other’s best interests at heart. It’s creating an environment that is dividing us and threatens the foundation of our profession. We cannot allow this atmosphere of dissention to divide our communities and our values. We must remind ourselves what we stand for, and that’s a sacred obligation to heal the sick.

The first thing we need to do is stop blaming everybody else for our predicament. Pointing the finger of blame is a narcissistic response that creates fear and division. We need to find ways to come together openly and honestly if we are to sustain a healing community. We can’t all have it our way, so we need to set some limits that we can all live with.

Unless we maintain our faith and trust in each other, we will never be able to address the new pressures that the technologic age and genomic revolution hold in store for us. This is how the future looks: surgeons will be able to operate remotely; altered chromosomes will eliminate some diseases and create new ones; transplanted organs will be cloned, and as a species we will be growing older. How will you sustain community hospitals when patients will be able to get Internet advice and treatment from experts geographically far removed? I believe it is by inspiring their faith and trust in you. Opinions will always differ; surgeons in Boston recommend a different type of back surgery than do those in Seattle for the exact same pathology. Patients can get as much information as they can handle; the task in today’s environment is not getting more information, but getting help processing that information. Community hospitals and physicians will always be relied on because our patients still trust us. Health outcome studies show that improvement in a patient’s health is most directly correlated to the patient’s trust in their hospital, their physician, and their physician’s knowledge of their home life. We must sustain that trust, which is our cause and calling. Our patients will stay with us if they have faith in us and know that if what they need exceeds our capacity we will refer them elsewhere.

These are my recommendations for how to ensure our success.

1. Lighten up. Find more ways to love what you do. Get connected to things that bring you joy everyday.

2. Be open. That means going away on retreat somewhere and sharing your strengths and weaknesses, successes and failures. No finger pointing. The more we come together, the more ideas and solutions will come about naturally. Focus on problem solving and you will create unity.

3. Take risks. Even if the venture doesn’t work out, successful innovation is built on trial and error. The way it was is not the way it is.

4. Use technology. Get an Internet presence, share information but not at the expense of sacrificing personal relationships. We must stay connected to each other and to our patients. High touch is as important as high tech. The huge rise in the cash business of Complementary and Alternative Medicine (CAM) is a statement that people want more hands-on, personal attention

5. Think generationally. We are now thinking quarterly in the language of balance sheets. When the bottom line compromises care we will become just another industry. Healthcare is a ministry and we must look ahead to twenty years from now, and know that we have retained our fundamental values. Remember your mission and advertise it

6. Establish coalitions. Make relationships with others who can complement your services. Nobody makes it alone. Build a community of support, away and at home. Remember the lives that place themselves in your hands and believe in you, and go with joy on our shared healing journey.

Excerpted from a presentation to the VHA/SW Annual Trustees Conference