High Stakes

Recognizing the ‘Unprotected’ in Healthcare’s Midst

Who are your unprotected people?

In a meditation on our current volatile political climate, columnist and storied Reagan speechwriter Peggy Noonan considered the perspective of the voters empowering party-crashers Donald Trump and Bernie Sanders:

There’s the protected and the unprotected. The protected make public policy. The unprotected live in it…The protected are the accomplished, the secure, the successful — those who have power or access to it. They are protected from much of the roughness of the world. More to the point, they are protected from the world they have created.

And, one other point:

Because they are protected [these leaders] they feel they can do pretty much anything, impose any reality. They’re insulated from many of the effects of their own decisions…The unprotected are starting to push back, powerfully.

There’s something important here for us.

Every significant organization with thousands of staff serving tens of thousands of customers has centers of concentrated power and many people – far from that center – who are likely to feel unprotected from the use and potential abuse of that power.

If you lead a hospital or health system, pay attention.

If the national political polls are reflected by the people walking the halls of your hospitals and clinics, better than 40% of your staff, physicians and patients are supporting Trump or Sanders, these so-called “voices for the unprotected.”

It would be short-sighted – or wishful thinking – to believe your health system or your leadership is immune from the angst roiling America’s electorate.  It does not evaporate when your staff don their badges and scrubs.

Your unprotected people are the women and men who work for you who are (or who feel) unprotected from the consequences of your decisions. Your line nurses, perhaps? Your dietitians? Security? Maybe the people working in your recently-acquired hospital 100 miles from the mothership?

At least 65% of U.S. employees are “disengaged” in their work, according to Gallup’s daily rolling average for employee engagement. You’ll find the unprotected here.

Bad service is planted in this ground. So is high staff churn. So are labor unions and votes of no confidence.

Your unprotected can be your customers, too. Think of patients or independent physicians who have few if any options for services but yours, and feel subject to your whims and helpless in the face of your perceived indifference.

How much longer will emboldened patients accept dysfunctional caregiving that can appear prioritized for the convenience, the territorialism and for the financial return of the caregivers? Hint: Not long. How welcoming will they be to disruptive competition? Very.

To be sure, it is unclear that the voter’s mood toward presidential politics reflects their mood – or willingness to act – as employees or customers. Presidential politics can seem distant and abstract and safe to disturb. Your job, however, is how you feed your family. Your health is your life. You don’t mess with these things lightly.

But there are lessons developing for us here.

In the presidential primaries, voters from both sides of the aisle are supporting leaders who threaten to shatter a ruling establishment they find nothing short of disloyal, disrespectful and dismissive. As Noonan writes: They are starting to push back, powerfully.

What is a health leader to do?

  • Assess your staff and customers candidly from their perspective and identify those groups who would consider themselves “unprotected.”

You and your leadership team may have worked hard to shield them as much as possible from the great turbulence in our industry. But what you’ve done and how they feel may be two different things entirely. Despite your efforts, what if any groups would consider themselves a victim of your system and lay the responsibility with you?

  • Appreciate their perspective. Not agree with their perspective, necessarily. Appreciate. You cannot help if you cannot grasp their perspective. Your willingness to listen and consider their perspective from a neutral position may be the toughest task of all.
  • Engage with these groups. And show your work. We know well health systems whose leaders are making mission-critical, difficult and dramatic changes to their organization but have struggled with bringing their staff and patients along for the ride.

Engagement tactics will be unique to the organization, your style of leadership and to the group that needs to benefit from them. But it should be considered as much a part of your work as your clinical, financial and operational priorities.

Heed the missteps of the leadership from both political parties. They never saw (or, worse yet, ignored) the very people they were supposed to represent and protect. The price for their failure is high and some may not recover.

One last thought: The changes in healthcare are big, fast and permanent.

You cannot protect your staff or patients from the systemic changes occurring in the delivery of care any more than they can be protected from the change of seasons. In our experience, most staff know change is coming and know it is a tide to ride, not resist.

Acknowledgement and engagement – attention – can win supporters, persuade fence-sitters and neutralize opponents. Consider carefully the perspective and needs of those farthest from your system’s center of power. Protect yourself and your system by protecting your unprotected.


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