The Water Is Wide.

IN THIS COLUMN...

Before you build your bridge to the future, stop and take time to lay a goad foundation. Discover your own core beliefs and, perhaps more importantly, discover those of your employees.

The leap of a bridge dazzles.

It's as if steel could fly, as if stone or concrete could backstroke on the wind, as if the law of gravity itself were being suspended.

Yet the engineer who designed the bridge can always tell you exactly where the weight goes and how the bridge accepts each physical law as if it were its own. The engineer can tell you about footings, stress loads, redundancy, and force moments.

In 21st century health care, we are all building bridges to the future--from where we are to where we hope to be, from what is to what's possible. That future may seem magical when we picture it, a dazzling leap into the unknown that's defiant of the way things really are.

Yet the path to that future is real. It's about footings, redundancy, and stress loads.

When efforts at change go sour--when the "bridges to the future" fail--it is often due to poor foundations.

Any engineer can tell you: Don't just leap off into the unknown. Pay attention to your footings first. Discover whether they are sound. Strengthen them where necessary to accommodate the added weight and dynamic tension of the bridge you intend to build.

What is the footing?

The real foundation is almost always in the hearts and minds of people.

As author Antoine de St. Exupery put it, "What is essential is invisible to the eye." No matter how impressive your buildings, your helicopter fleet, your robotic surgeons or fusion-technology scanners, these things are ephemeral and easily replaced compared to the dreams stories, and visions in the hearts of your staff and your customers.

And your staff can walk out the door--or they can recruit like-minded colleagues.

Your customers can go elsewhere--or they can tell their neighbors about you.

The footing on the far side of the bridge is the clarity of your vision, the future that you hope to create, the possibilities that you can see.

What is the footing on this side?

Ask yourself this: For you, in your own life, in your own decision to be a physician and to engage in the management of health care, what is it that does not go away ever? What is it that will not budge? What is the core?

At the same time, what is your day-to-day experience? What, in that daily experience, gets you out of bed in the morning? What puts meaning into your day? What, in that daily experience, makes you want to walk out the door?

Is there a tension between that core, the thing that will not budge, and your day-to-day experience? Is your daily experience in conflict with your deep purposes?

When that conflict gets large enough, that's when people get the urge to leave, to find something easier, higher paying, more satisfying, less of a hassle.

Your staff--from clinicians to parking lot attendants--are asking themselves the same questions. They had an original, core purpose. What, beyond the paycheck, brings them to work every day now?

Does their day-to-day experience support that core purpose? Or erode it? How would you know? What if you got deeply curious about the question: Who would you ask? Pick someone, get up out of your chair, and go ask.

We'll wait.

The knee of listening

So, who did you ask? What did they say? What did you learn? What would you learn if you asked a lot of people in your organization?

Don't ask with the ear of problem-solving.

Sit at the knee of listening.

Ask with an ear for challenge and struggle, for dissatisfaction, for conflict, for what is missing, what is not being said. Listen for the individual's story, then let that story stand for a part of the range of human experience.

Ultimately, it is not about solving the problems of each person. It is about accommodating the range.

There are people in your organization who know chapter and verse on this one--but you are not them. You don't know other people's experience until you ask, and until you listen.

Did you find a gap between perception and reality, between what you hoped for and what people actually tell you? How sound is your foundation? What about the other bridge supports?

How deeply and realistically do you know the attitudes of your physicians and the perceptions of your customers? What is in the minds of doctors and nurses who leave their professions?

The deep gap

All over health care we encounter the echoing chasm between the noble sentiments of mission statements and visioning exercises, and the way people treat each other in the workplace.

* In Michigan, we hear a CEO glibly refer to task number one when a therapy fails--divert the blame to someone else. He calls it "the ABCs of health care--Assess, Blame, and Criticize."

* In Florida, Illinois, and California, we hear executives complain of nurses who care little for nursing and only want special treatment, special hours and more pay.

* Everywhere we hear nurses complain of having little time for real nursing, increasing bureaucratic demands and not enough tools and support to do the job.

* Everywhere we hear doctors talk of the pressures of time, the lack of support, the time spent arguing with insurers.

And a letter appears in Judith Martin's "Miss Manners" column from "a group of professional hospital nurses" complaining of "the regular insults we face:"

"We are often yelled at, objects are thrown at or around us, and charts are slammed in front of us.

"On the phone, we are frequently hung up on. We are insulted personally and professionally with regard to our abilities. This is done in a loud, screaming fashion, sometimes in public, while shaking a finger in our faces. Even more insulting is to not be acknowledged at all or even addressed by our names...."

This is not a universal scenario, but versions of it are far too common.

All over health care, we dangle a carrot of "meaning" in front of employees and potential employees: This is a caring field, a healing experience.

Yet, the reality is too often quite different. The gap between that noble image and the daily experience of work is huge and growing. If we want to prepare for the future, we have to reverse that trend. We have to reshape the daily experience of work to match the core drivers of the people who do the work.

As Tim Gallwey put it in a recent interview we conducted for the Health Forum Journal:

"The strength of the [health care] industry is that it addresses the noblest part of the human being. Yet the environment of a health care organization can also evoke the worst in human beings, with even greater rivalries, between individuals, within and between departments, professions, and sub-groups, than in other places.

"When people feel that what is really going on is at great variance with what is supposed to be going on, it can be extremely disruptive. What would it be like if the health care industry were to represent not only physical health, but also corporate health, the sincerity, the humility, and the integrity of values?

"If the industry made an internal commitment to corporate health that paralleled their commitment to the health of the patients, it could transform the way people work together, as well as the health care that people receive."

Joe Flower is an internationally recognized health care futurist. Patrice Guillaume is a personal and executive coach. Their company, What If..., is dedicated to bridging the gap between what is and what's possible. What If ..., offers a technology of inquiry that helps people and organizations imagine and build toward their own best future.