HJNO Sep/Oct 2022

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2022 19 reimbursement for primary care services. How- ever, by changing the fundamental economic model and reengineering how time, talent, teamwork, and technology are optimally uti- lized, it becomes possible to reallocate time spent with patients based on factors such as age and/or complexity. These new business models allow us to develop specialized clinics for older adults with much longer visits, more time spent with patients, and more time devot- ed to coaching them and leading care teams. However, we can also use these same vari- ables of talent, technology, and teamwork to save time and deliver care more efficiently and effectively. Indeed, one of the next frontiers of healthcare will become the exploitation of ex- plicit knowledge. Hypertension management is an early but classic example. Knowledge of the management of hypertension is so complete that it is has essentially become explicit and can therefore easily be converted into stan- dardized care processes and algorithms. Once knowledge for a given condition becomes ex- plicit, the reliability of the outcome no longer depends on the individual locus of knowledge and processes of a given clinician, but rather on the execution of a protocolized algorithm. Explicit knowledge can then be codified and turned into a digital solution, hence why our system’s digital hypertension programs achieve greater than 90% rates of blood pressure control even among socioeconomically disadvantaged populations. An additional benefit is that busy primary care physicians now have more time to devote to solving more complex, unstructured problems that require the application of tacit knowledge rather than explicit knowledge. Therein lies the real promise of technology in healthcare, to give clinicians more time to devote to other aspects of care as it relates to patients, like relationship-building and com- plex clinical problem solving. And eventually, technology will be used to speed up evidence- driven clinical decision-making, along with processes and workflows that correlate more with improving health outcomes than simply to support the coding and documentation functionality necessary for transactional billing. The fifth and final “T” is the most important in my opinion: trust . Trust is both the output of getting the right configurations of talent, team- work, technology, and time in place, as well as the input that enables the physician-led team to generate the best health outcomes pos- sible. And it is essential to both understanding and influencing patients to change unhealthy behaviors. Based on the exhaustive research of Frances Frei, Harvard Business School profes- sor and author of the book, Unleashed: The Unapologetic Leader’s Guide to Empowering Everyone Around You , Frei asserts that lead- ership is about empowering others, and that its focus shifts from elevating oneself to pro- tecting, developing, and enabling the people around you. This shift becomes a pivot in how a physician views their leadership role and forces them to see the full humanity of the people and patients they seek to lead, including a patient’s ability to evolve. Frei asserts that only when you can imagine a better version of someone can you play a role in helping to unleash them. This type of leadership is predicated on the idea that human beings can adapt and that we can play an important role in each other’s adaptation. This progression requires a leader’s willingness to both believe in someone else’s unrealized potential and to find ways to com- municate that conviction. And trust is the foun- dation of that leadership framework. If lead- ership is about influencing and empowering others, then trust is the emotional framework that allows the service to be freely exchanged. “I’m willing to be led by you because I trust you,” were words written by Frei, but that could have just as easily come out of the mouth of a patient. It is not the patient’s job to comply with what we tell them do. It is our job to earn their trust and go on a journey with them where we co-create a shared action plan of how to get there. The patient is our customer, and I use the word customer with the utmost reverence and respect. They come to us with a need or a prob- lem to be solved, requesting — and directly or indirectly paying — for a service that they desire. Trust is the primary currency with which to exert our influence. Instead, the traditional “Under reinvented business models, teams of caregivers — typically coached and led by physicians — will work together to help patients attain their health goals and optimal state of health, where the patient themself becomes the most important member of the team.”