Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD

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Take Two: EP438: Is It Mission and/or Margin? With John Lee, MD

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I am so focused right now on the intersection (or lack thereof) of mission and margin, so I’m taking a second listen to this episode right now with John Lee, MD, because it is so ridiculously relevant given that I am, as stated, on a bit of a tear. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. This mission/margin bender kicked off actually, if I had to diagnose the root cause, it’s because of all of the conversations that happen after what I’m calling the trust through line episode (EP477). Because if you think about it—and I have—if we are talking about trust, what does that even mean? Like, trust to what end? And when you start distilling it down, you wind up with trust that someone is gonna do right by patients and purchasers and the actual clinicians providing the care that even if there’s a stack of Benjamins to be had by doing the wrong thing, we can trust that mission will be put over margin—or at least balanced with it in some kind of palatable way. Right? That’s a big piece of what it means to be trustworthy in healthcare. “You are what you won’t do for money.” That was a headline to a Ryan Holiday article I read recently and wrote down, because … right? Now, it’s one thing for each of us listening here to contemplate mission and margin, and that matters. But it’s quite another thing for this contemplation to happen at scale, at status quo consolidated health systems, carriers; many status quo, not transparent brokerages, PBMs (pharmacy benefit managers), TPAs (third-party administrators); status quo stakeholders across the board. But because of this, actions being taken at the organizational level may not mirror the mission/margin ratio that you or I might aspire to. So, why this episode with Dr. John Lee, you may be wondering? How did this conversation get teed up for a Take Two in the midst of this mission/margin tear that I apparently am on right now? Dr. John Lee talks about and gives some advice for individuals in a status quo, not transparent organization how to find a mission to feel good about. I would also highly recommend listening to the show with Larry Bauer, MSW, MEd. It’s a Summer Short, and it’s called “Knights, Knaves, and Pawns.” So, here’s my conversation with Dr. John Lee, and next week come back because I’m gonna continue the mission margin conversation with Ben Schwartz, MD, MBA—and it’s a really good one. So, come back next Thursday, too. Let’s say a person believes they want to do well by patients but their performance review depends on, as just one example, making care less affordable for patients. But somehow, this individual is able to conclude that what they’re doing is a net neutral or a net positive despite (in this hypothetical, let’s just say) obvious indications that it is not. In this hypothetical, there are, say, clear facts that show that what this person is up to is indisputably a problem for patients. But yet at every opportunity, this person talks about their commitment to patients, this rationalization or earmuffs don’t look, don’t see is cognitive dissonance. Cognitive dissonance is when what someone winds up doing, their actions, are in conflict with what they believe in. Now, it’s harder to engage in cognitive dissonance the closer you are to patients because you see the impact up close. Unless these at-the-bedside clinicians enjoy a robust lack of self-awareness, those who are seeing patients don’t, a lot of times, have the luxury of pretending that what is going on is good for patients when they can see with their own two eyes that it is not good for patients. The further from the exam room or the community, however, the easier it is to not acknowledge the downstream impact, if you can even figure out what that downstream impact is. Sometimes it’s legitimately difficult to connect the dots all the way down the line to the customers, members, or patients. Today I am talking with Dr. John Lee about what to do in the face of all this when working in the, as I call it, the belly of the beast—working for a large healthcare organization such as a hospital. Because hospitals sometimes (and we certainly do not want to put all hospitals in the same category—they are a wildly diverse bunch), but sometimes some people at some hospitals do some things which are not things I think they should be doing anyway. They’re fairly egregious breaches of trust, actually. But yet within that same organization, you have doctors and other clinicians or others who are working really hard to serve patients as best they can. This is the real world that we’re talking about, and the question of the day is … so, now what? When you are a person not suffering from cognitive dissonance, at least to the level of those around you, what do you do to not get, I don’t know, demoralized? And ...