President's Page December 2005   Only together can we raise all boats— 2005 was a busy but productive year

by Leslie H. Secrest, MD 2005 DCMS President

As my presidential year concludes, I continue to ponder the dynamics and the interdependency associated with the delivery of health care, and the need for healthcare institutions to recognize their interdependency. It is amazing that patients receive excellent health care in such complex dynamics, whether the care is in the office, the clinic, the emergency room, the operating room, the ward, or the intensive care unit. A dot in the center of a blank sheet of paper with arrows extending outward to connect to each person involved with a single episode of care rapidly will fill a blank page. We haven’t even included all the other arrows that could illustrate the people involved in support of those providing direct patient care. If the episode is long enough and we are sampling the care provided in a hospital, all the people involved will be replaced by other people as each shift changes. The complexity quickly is increased if the care includes multiple physicians, facilities, and institutions that must communicate with the patient and with each other. We need only to add such elements as finances and competition for excellence and reputation to realize that it is amazing that our healthcare delivery system functions on any given day.

It sounds naive to suggest that the goal and expectation of everyone just pictured is to raise the level of all boats involved in the delivery of health care. Raising the level of everyone is necessary to provide excellent, efficient, up-to-date care to our communities. The patient-physician relationship is the core of health care, but it has evolved into a complex interdependent team of individuals and institutions to provide care to each individual patient. With increased frequency, our health care is no longer community; it has become regionally based. Institutions must work together as teams, much like physicians who have evolved from functioning autonomously to being interdependent and requiring a team of individuals to deliver an episode of patient care. Like the physician, institutions cannot expect to be all things to all people. Like the physician, attitudes must evolve to develop interdependent institutional relationships to provide care as a unit. One of the most important ingredients to accomplish such shifts is trust.

Trust can be difficult to describe succinctly. When present, it usually is recognizable. Our healthcare institutions are realizing that to work as teams, they must establish principles which, if followed, will produce trust. The expectation is that honesty is present and that individual vulnerabilities are respected. Teams quickly understand the strengths and vulnerabilities of each member and agree not to disadvantage one another. To have teams of institutions, organizations, or facilities requires leadership that will operate in an environment that nurtures respect, restraint, self-disclosure, and honesty with goals to improve our communities and region while benefiting everyone.

One factor in life is alive and well in these situations … there are no guarantees. There are no assurances of a return on invested resources, money, and reputation. Such situations require a leap of faith, dependency on each other, and trust in our organizations that most would interpret as illogical. With a “can-do” attitude, those who take the challenge often are greatly rewarded.

A number of community initiatives, such as the Medicaid delivery system and the Regional Health Information Organization, require healthcare institutions to team up to accomplish goals that will raise the level of all boats. These initiatives require constant nurturing, trust and servant leadership.

As with teams, leadership is dynamic and exerts itself through service. Individuals who provide needed functions on a team become the servants who provide the leadership needed by the team. An individual who provides service that is weighted intentionally or unintentionally to his own advantage will nurture distrust and disruption within the team. Many of the current community initiatives will require each institution to commit and invest millions of dollars to return tens of millions of dollars into our communities. There are no guarantees that each institution will get a proportionate share of the new dollars, but it is clear that our region will benefit as a whole and the level of all institutions will be raised. My hope is that our healthcare institutions in North Texas will find the courage to develop the teams that can nurture trust, honesty, and servant leadership that few other regions have been able to create and maintain. By working together we can raise the level of all boats and improve the health of our citizens and our patients.

Being your president this year has been a wonderful experience. I thank the membership and the staff of the Dallas County Medical Society for their teamwork, and for providing a forum where trust and servant leadership is nurtured and valued.
Thanks for allowing me to be your president.

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