REMEMBERING TO REMEMBER: HOW TRANSPARENCY IS THE HEART OF LEARNING HEALTHCARE SYSTEMS

I’m bad at remembering my jacket in the overhead. Three wounded soldiers in three years. I travel a lot and have a lot on my mind, but that’s no excuse. I was distracted on a call with our Marketing Lead and had to race to my folks’ home for Thanksgiving, but that’s no excuse.

In the margin these are all important things. But how do I not leave another jacket on a plane?

My job is to understand how hospital leaders manage toward better patient care. While they might call it different things, the common goal most have is becoming a Learning Healthcare System. Aligning science, informatics, incentives, and culture toward self-improvement and innovation—particularly when collected through the instincts of patients and providers. Sounds like the kind of place I'd want my parents to find care when they need it most.

Unfortunately, becoming a Learning Healthcare System is operationally challenging. Leaders wake up with the highest aspirations, only to find themselves hours later straining to put out fires. Just showing up feels like a challenge. Sometimes in body, more often in soul. The idea of a Learning Healthcare System is there. The motivation and desire are there. Mountains of research exist (and arguably too many consultants). What health systems lack are the tools to build transparency and alignment around the best opportunities for betterment.

Forgotten jackets and unnecessary catheter days are orders of magnitude different importance. Yet I relate: how do I become a better (less forgetful?) me when I want to, but don’t know where to start… until it is too late, if I ever find out?

Right now is fleeting. The only thing scarier than what I don’t know right now is who I am and how I act generally. By the time one remembers to remember their jacket, the jacket has often already been forgotten, and something more important, unknown, has been missed.

Where should I focus my attention tomorrow? Me, specifically?

When I founded Agathos in 2015, I was enraptured by the concept of transparency. Because transparency into something would only be valuable when that something could be one thing or another. True or false. This or that. Close or far. Good or bad. A lot or a little. In other words, transparency is only valuable where there is the potential for variation. And there is a lot of clinical variation in healthcare. Combing health data on a daily basis... some of it is warranted, some of it illusory, and some of it real and relevant.

Some physicians discharge patients earlier. Others later. Some ace process adherence. Others are exceptional negotiators. Some were trained to do X. Others were trained to do Y. Some work harder. Others work smarter. Some have a knack for heroics. Others [almost] never have “never” events. Some are just better. Others are in challenging seasons—work and life.

Some CEOs leave jackets on planes. They may talk too much, too loud, or struggle to show up on time, overutilize frameworks, underutilize mentors, over-coach, under-delegate. They also might be excellent strategists, advocates for their team, wells of energy where everybody needs it most.

All are very curious what they should focus on tomorrow to fuel their mission. Typically, this only makes sense in context of what we do well, poorly, or differently—relative to peers. But I could be doing dozens of things differently that I have no idea about yet. Little, high impact things that, if I knew them today, I would change tomorrow. They would be written by now, if I knew them.

Transparency facilitates new habits and collaboration, while cultivating a culture of learning, respectful debate, healthy competition, peer support, honest education, and objectivity. Like a shot, transparency can sting at first. But, for Learning Healthcare Systems (and people, of course), transparency becomes a trusted alley. Transparency is not the feedback we would give ourselves today. It is the surprising behavior change that happens tomorrow.

And probably more important than suit jackets.

P.S., if any other road warriors out there found a lonely charcoal J.Crew, Theory, or Boss (all 41L) suit jacket without pant bottoms, stuffed in the overhead bin above your carry-on, please drop me a line. Much appreciated!