Falling through the cracks

I’m only about half-way through The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by T. R. Reid, so not ready to review the book yet, other than to say that it’s been an eye-opening read.

But as I made my way through Reid’s accounts of health care systems around the world, it got me thinking about how often the biggest problems leaders face are those that fall between the cracks…and healthcare is just such an issue.

Here’s what I mean: Beyond simply the institutions in play (insurers, providers, patients, governments) there’s the cultural dimension of how a given society thinks about medicine and health. For example, in most other countries, medical school is free (or practically so) and medical malpractice is virtually unheard of, but doctors make significantly less than they do in the States.

If we decided that moving closer to this model would be beneficial, how would we do it? It would require changes not only to our university system but to how and why folks become doctors in the first place…and what would we do with those folks who are currently doctors? Could we cut their salaries by 66% even if we made their loans and malpractice insurance go away?

But enough rhetorical questions. My point here isn’t to get into a debate about how we can solve health care, but rather to examine the challenge of health care for what we can learn about leadership. And I think this idea of falling between the cracks is important in that respect.

In almost every job I’ve had, the organization had difficulty addressing problems that fell between the cracks, whether because they spanned multiple functional areas, no one owned both the pain of the problem and benefits of the solution, the connections between the various pains and the overall solution were invisible, and so on.

The leaders I admired, the ones who were successful at leading change in the organization, were precisely the ones who were able to effectively address the between-the-crack problems. They saw beyond the immediately apparent details to reach the essential facts of the matter, and doing so allowed them to find solutions (or at least options) that others couldn’t.

Then there were the leaders that were less-than-admirable: they failed to rise above the obvious details to find root causes and were unable to move past the noise and chatter to hit upon meaningful options and effective solutions. The end result of their efforts was merely to deepen the churn the whole organization was struggling with.

So as someone who’s actively transforming towards leadership, I find myself wondering how you go about developing this ability. Can you even develop it? Or is it something fundamental to who a person is that just needs to be developed and nurtured?

Would love to hear folks’ thoughts and experiences (positive and negative) with leadership between the cracks…


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