Breakthrough Newsletter Volume 2 Issue 5

 



 
Breakthrough Newsletter

  Volume II, Issue  5                                                                           May 2010

PITAGORSKY
CONSULTING
 
In This Issue
Healthy Conflict
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Healthy Conflict
By George Pitagorsky

doctors

 
The recent Health Care Bill process has been an interesting case study for exploring conflict, change and systems management.
 
Here we have systemic problems in a highly complex system. Complex systems are ones in which it is hard if not impossible to predict the outcome of a particular event. There is a ripple effect, for example reducing fees paid to doctors changes their economic status. Their loans and malpractice insurance bills remain high. Being squeezed, some may acquiesce, some happily embracing it while others opt out or work against the new payment system. It is hard to predict what will happen in each instances but it is certain that there will be some effect.
 
 
Looking at the whole picture?
Any significant issue is multifaceted.  Facets in health care are payments and costs of services, scope of coverage, decision-making authority, price controls, ethics, compassion, justice, politics, philosophy of government and economic theory. Each is extremely complex in its own way. Combine them in an issue that impacts people's health, wealth and welfare and you have a very interesting problem.
 
The health care system has evolved over hundreds of years. In Europe and elsewhere there is socialized medicine, with universal coverage. I am told that doctors and insurance companies and perhaps pharmaceutical companies in socialized systems tend to make less money than U.S. doctors and health insurance companies.
 
Socialized health care is more than adequate, and where it has emerged it is not perceived, even by the conservatives, as something that is going to undermine the culture and bring on a Communist takeover.
 
In the U.S. the system of private health services supplemented by government, religious and philanthropic resources, provides wonderful medicine. Though, there is no universal coverage. The government provides a net but at a very low level of income and many fall through the net. The middle class is squeezed and may be driven down to the poverty level under extreme circumstances. Preventative care is less emphasized than a curative approach that spends billions on research and reaps huge profits. Medical professionals are often squeezed between desires for high incomes, low insurance payments, and high insurance costs.
 
Managed Evolution
To change an evolved, embedded system is a daunting undertaking. Revolution, worsening dysfunction and free market driven or managed evolution are the choices. Personally, I vote for managed evolution: having a vision, a strategy for achieving it, short term planning to make steps towards achieving the vision, evaluating results along the way, questioning the vision, and changing course as the situation requires. Managed evolution recognizes that there is uncertainty in complex systems and that dynamic change management is required.
 
Managed Conflict
Managed evolution engenders conflict. People have differences of opinions about goals, values and means. If the differences are about goals and values, it is much more difficult to resolve the conflict, particularly if the goals are mutually exclusive. So first we try to come to an understanding of a mutual goal based on mutually held values so we can share a vision of the future and agree to work towards it.
 
Conflicts in projects, organizations and personal relationships tend to be easier to resolve than those, like health care, in the public arena. Projects and organizations are about achieving stated objectives. While this may not happen all the time, once a project begins all conflicts can be evaluated objectively in light of the degree to which proposed resolutions best achieve project goals and objectives. In personal relationships individuals can work together to achieve a vision of how they would like to see their relationship evolve.
 
Of course emotions arise. But they are managed so that they do not disrupt the conflict resolution and the achievement of common goals.
 
Conflicts in the public arena often arise from conflicting goals and resistance to step out of the conflict to see if there is a common vision that would satisfy all sides. Effective conflict management requires that there be some picture of how the "system" is intended to look, feel and cost in three years; five years; fifty years.  Not a static picture like a snap shot but a movie of the dynamic evolution of the system in an intentional change program. It also requires that there be agreed upon values. These set the base for priories and priorities are means to make trade-offs and find effective.
 
We sense the context of the conflict; the system or project or organization or family that the conflict is within. We seek to understand our own position and the positions of others objectively. We come to terms regarding common goals and vision and then we work together to make sure that individual needs are met, to the degree possible, and the vision is achieved.  

© 2010 Pitagorsky Consulting