Essays January 2011

Book Review: Lessons Learned In Changing Healthcare And How We Learn Them

Chris C Carruthers

In this book, 14 American physicians from a range of disciplines, all of whom are health care leaders and change agents, reflect on what, and how, they have learned through their experiences. This is therefore a personal account of moving forward in health care and bringing about positive change. 

Each physician’s story, circumstances, challenges and learnings are unique, and are told by them with considerable detail. Despite the uniqueness of the 14 accounts, some similarities emerge. Perhaps not surprisingly, many of the themes and lessons the physicians identify resonate with those identified in other business books or writings.


Let’s begin at the beginning, where in the first chapter plastic surgeon Dr. Caroline Kerrigan set the tone by succinctly listing seven lessons she has learned:


1. Work smarter, not harder.

2. Change is awkward

3. Measure

4. Innovate to customize

5. Walk the talk

6. Be tenacious

7. Engage the players


The other physicians took up these themes, albeit in different ways, and raised others. Some key ones are: A compelling vision is driven by aspiration, not fear. Change is truly propelled by a burning platform. To bring about change, leaders must lead through  influence rather by control.


Those lessons apply to more than just health care settings. But what lessons apply only to health care? Here are some:


First, doing what is right for the patient is always the number one goal of any change process.


Second, pay attention to culture. In health care, culture is dominant. It plays a powerful role in dictating the adoption of change, and all leaders must understand their organization’s culture.


Third, the quality improvement process is a major aspect of health care change. Dr.  Linda Headrick noted that the champions of quality improvement process must also demonstrate its use within their own offices or areas of responsibility. Leaders must lead by example.


Four, prepare yourself to expect flak. If you are not taking flak, then you are probably not hitting the target.


Five, the translation of research to the bedside is difficult and can take 10 to 15 years. Patience is thus required. Dr. Thomas Lee noted no magic breakthrough to bring about change is anticipated. Instead, we should expect door-to-door fighting for the rest of our careers. Perseverance, and working alongside a team of change champions, bolsters chances of success.


Six, be transparent and honest. The latter may be difficult during the change process but is necessary.


Seven, pursue innovation. Some may well fail, but without innovation, significant change is impossible.


Eight, recognize that politics does matter.


Finally, as a leader, this is your turn to effect change. You are not here forever, so use your time wisely.


This book contains valuable information and lessons for anyone trying to lead change in health care. My only regret is that I feel the conclusion could have better summarized the key points from the 14 contributors. That said, I highly recommend this book.



Anton Hart wrote:

Posted 2011/01/25 at 10:45 AM EST

Dr. Carruthers is the editor of an excellent collection of Lessons Learned featuring Canadian physician leaders. Its a book that motivated Jeff Lozon to write: ". . . I discovered a set of reflections, prescriptions for success, and powerful and meaningful questions about physician leadership. To me, they demonstrated new insights and marked progress in thinking about the important and ever-evolving questions concerning physicians’ roles as leaders in health care—not just medicine." It can be found here.


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