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Sunday, May 19, 2013

Silent Culture Change 

Cultures can be said to change in one of two ways – noisily or silently. 

The sexual revolution and other culture changes that occurred during the 1960’s were of the noisy variety. 

The one currently going on in the health care delivery system is silent. 

I happen to be on the mailing list of Doug Hawthorne, CEO of Texas Health Resources; a large hospital system headquartered in Arlington, Texas.  I recently received a letter from him announcing the appointment of one Dr. Daniel Varga as Chief Clinical Officer.  That appointment was stated to be in accordance with the strategy of “transforming Texas Health from a hospital-centric organization to a patient-centered, fully integrated health system.” 

In my day, a hospital administrator engaging in that kind of talk would have been fired.  The ideas of the “self-governing medical staff” and the independence of the medical profession that it implied were sacred.  Any suggestion that it be compromised would have been perilous in the extreme.   

Now, without any public discussion of the change that is under way, the institutionalization of the medical profession can be openly, if obliquely, discussed, using terms like Accountable Care Organizations and fully integrated health systems. 

Perhaps it is easier to abandon a strongly held belief if nobody mentions it.

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