HJNO May/Jun 2022

CHANGING THE WORLD 18 MAY / JUN 2022 I  HEALTHCARE JOURNAL OF NEW ORLEANS   sible. With very few exceptions, providers go into healthcare because of their genuine desire to help care for those in need. When we suc- ceed in helping people become healthier, it brings us joy. It gives us meaning, a sense of be- longing to a cause greater than ourselves, and it renews our sense of purpose as to why we en- tered the profession in the first place. And when we successfully improve the health of those we serve, it reduces healthcare costs, both finan- cial and emotional. One of the great myths in healthcare is that excessive healthcare spend- ing is driven by inexorable forces, and that only by rationing beneficial care will we be able to reduce the total cost of care. The simple fact is that improving health reduces health expen- ditures. These two variables go hand in hand. ACKNOWLEDGING THE MISTAKES OF THE PAST One of the major hallmarks that differentiated the people working on NASA’s “moon shot,” was striving for a cause greater than them- selves. Less than a decade following President Kennedy’s famous declaration, we heard anoth- er world-changing quote from Neil Armstrong, “That’s one small step for a man, one giant leap for mankind.” Like any big, bold mission, mistakes along the way are the norm, and in improving the health of humanity, we certainly have committed our fair share. One of our big- gest mistakes thus far has been a failure to un- derstand the true drivers of health outcomes. Traditional clinical care only accounts for about 20% of outcomes. Our physical environment, like the air we breathe, accounts for another 10%. But socioeconomic factors and unhealthy behaviors (40% and 30% respectively) account for the majority. We will not solve the challenge of affordable care for all or deliver the world’s best outcomes until we address and incorporate these factors into our approach to clinical care. There are at least four other major mistakes that have impeded our progress toward im- proving health. The first of these is the failure to adequately define health. And the second is failure to explicitly measure and hold ourselves accountable for health outcomes. How can we adequately manage what we don’t mea- sure? The third is that somewhere along the way, we divorced mental health from physical health. Instead of understanding that health is more than just the absence of infirmity or disease, we must acknowledge that health is a complete state of mental, emotional, so- cial, and physical well-being. And the fourth is to ascribe moral judgments around an indi- vidual’s unhealthy behaviors, without attempt- ing to understand the “why” behind them. Health behaviors certainly include voluntary choices. But we also know that the prevalence of uncontrolled chronic conditions is causally linked to a history of adverse childhood trau- matic experiences. Likewise, mental health im- pairments can be both genetically acquired as well as influenced by impaired coping mecha- nisms in response to stressors during child- hood and adolescence, through no fault of an afflicted individual. And socioeconomic factors that are beyond an individual’s control are not simply the result of life choices. Indeed, there is an aura of judgmentalism that still abounds in healthcare, where we sometimes lack em- pathy and demand patient compliance. Some caregivers still view their role as one of “telling” patients what to do and educating them on the perils of doing otherwise. But behavior change is hard and requires more than expectation of compliance. Studies consistently show that commanding compliance does not work well — not in education, not in management, and not in healthcare. The better approach is coaching with compassion. Compassion is the action arm of empathy, where our job is to understand the reason behind behaviors, how they evolved, and then working together to overcome the challenges that stand in the way of changing them. Tightly integrated behavioral health, care coordination, nutritional support coun- seling, and health coaching become essential to facilitate progress toward a shared goal. CHARTING THE COURSE If we emerged from history’s deadliest pan- demic — the 1918 influenza — to lead the way with discoveries that led to antibiotics and immunizations, thus saving lives of countless children and young adults, then we can also emerge from this one by better managing the true drivers of today’s health outcomes. If we can lead the world in automobile manufac- turing to create the largest expansion of the middle class in the history of our country, then we can figure out how to make healthcare af- fordable for all. And if we can put a man on the moon less than 70 years after learning to fly, then we can figure out how to deliver the best health outcomes in the world. It will take heal- ers and leaders who are bold enough to dream the impossible and then focus all the energies and efforts of their organization on transform- ing that dream into reality. We will make plenty of mistakes along the way, but we will learn from them, constantly refining and improving our efforts until we get to a place where we measure our success based on how well we de- liver the health outcomes that matter most. n Kenny J. Cole, MD, MHCDS, began his role as system vice president over clinical improvement for Ochsner Health in New Orleans in September 2019. He is a practicing primary care internist with advanced degrees from LSU Health Sciences Center and Dartmouth, as well as executive training from Harvard Business School. Prior to joining Ochsner Health, Cole was the chief clinical transformation officer for Baton Rouge General Medical Center, where he designed, developed, and implemented a completely reimagined multidisciplinary team-based model of primary care that focused on aligning clinical with financial outcomes. His current work at Ochsner Health builds on that prior foundation where he is now scaling new care models across the state that specialize in improving health outcomes for older adults. Kenny J. Cole, MD, MHCDS System VP, Clinical Improvement, Ochsner Health