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Wednesday
Aug012012

The 90/30 Conundrum: How To Change Medicine (If It's Even Possible)

nonclinical physician changeGuest post by Aaron Schenone

Is it possible to change the healthcare industry?

I recently read an article entitled “Rebels at Work: Motivated to Make a Difference” a conversation with Lois Kelly. In her research she refers to the 90/30 conundrum where 90% of respondents agreed activating creative thinking can improve culture and drive innovation, yet only a third of those respondents were satisfied with innovative individuals’, the so called rebels, ability to provide that outcome.

Her research goes further defining these innovative individuals as creative, curious risk takers that aren’t driven by monetary gain, but by the ability to make a difference. They aren’t afraid to call out problems or be the first to do things differently. She also found people are uncomfortable with these individuals who challenge the status quo, circumvent the rules, question organizational leaders, and initiate projects without permission. Too often leaders react by throwing these habitual truants into the trapped box with the label “Rebel” on it.

It’s no surprise that innovative individuals gravitate to the world of entrepreneurship, starting their own organizations where they can create a culture that not only understands their purpose, but more importantly can provide an outlet for their ideas to make a difference in the world. We intuitively know some of these types of individuals such as Steve Jobs, and Richard Branson, but these individuals are in every industry and industry leaders are starting to recognize their value. People like Carmen Medina, former CIA Deputy Director of Intelligence, who supported the creation of a novel and dynamic approach to searchable actionable intelligence through a program affectionately called Intellipedia.

In medicine many of our innovative medical students and residents have had similar frustrations often being misunderstood and thrown into the trapped box with the label “Cowboy” on it. We feel misunderstood, locked out and all too often make an early exit from the very organizations and patients who need our ideas the most. I believe the 90/30 conundrum is a reflection on the challenges innovative people and organizational leaders have had in attempting to build trusting, productive relationships. It’s something that as innovative minded medical students and residents many of us have been battling since we sat in our first years of didactic lectures. We continue to ask whether actionable change is possible in such a large numbers driven industry.

Today, I believe it is possible to make actionable change in the healthcare industry. But to get there we must first gain the trust of our leaders. We must prove we’re not just cowboys without a cause; we’re passionate activists ready to drink H. Pylori to prove there’s a better way.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology

Reader Comments (2)

There are many advantages to look at medicine as a breakdown of individual issues to change. We live in a world that has brought billions to the medical industry. Most of our medication and treatments are held up in legislation and approval. There needs to be a faster way to gather this type of data to approve the medications and treatments more efficiently. I understand that research can take years to complete, but no one has thought up a way to change the way we are introduced to the research. There needs to be a clinical research data management system where the public can observe the progress of the possible changes in medicine. There have been some great developments that have shown promise of change like EHRs. EHRs are a great evolution in the medical field because they are allowing patients and medical professional to maintain accuracy and efficiency. Thank you for covering this topic. I feel that everyone should strive for change and progress.

There is a big disconnect between being innovative and knowing how to validate, promote and promulgate that innovation. In my career, I was always an outlier, the one who spent "too long" with patients yet had lower prescribing, lower referrals, lower expenditures per patient, and better (I think) outcomes. Despite being in a university practice at one point, I had no idea and no training in how to study and measure what I was doing, especially since I was questioning the effectiveness of the very men who ran the department. Finding ways to easily access and follow evidence based recommendations and guidelines would go a long ways to reforming our medical practice and making it far more cost effective. It would make sense to encorporate evidence based information into EMRs or other systems for easier provider accessibility, but I have no clue how one would go about implementing that, or even how to reach regular docs out there in their offices to educate them about the existence and importance of evidence based medicine. Doctors always seem too busy, consumed by the minutiae of seeing patients and getting all the work done, to ever question the way they practice not to mention overhaul it.

Sep 26 | Unregistered CommenterMyrtle

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