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Finding the pony in healthcare

Posted Jun 27 2013 9:53am

by Kenneth H. Cohn

I confess to having an out-of-body experience last week.

As I listened to two orthopedic surgeons state why they could not trust hospital administrators to keep their word, I imagined Ronald Reagan telling a favorite story about twin boys whose parents brought them to a psychiatrist because they seemed to develop extreme personalities.

First, the psychiatrist approached the overly pessimistic boy with a bunch of new toys. The boy cried. "If I played with them, I'm afraid that I'd break them," he explained.

The psychiatrist next approached the optimistic twin, taking him to a room full of horse manure. The boy climbed to the top of the pile and began scooping with his bare hands. "With all this manure, there must be a pony in here somewhere!"

According to Ed Meese, who served as President Reagan's attorney general from 1985 to 1988, whenever something would go wrong, somebody on the staff often said, "There must be a pony in here somewhere."

As I wrote in "Collaborative Change," a surgeon with whom I worked commented, "Only a baby desires change." And Paul Batalden, professor of Pediatrics at Dartmouth and an IHI Senior Fellow, once counseled, "Change feels like failure when we are in the middle of it."

The choice is ours as to whether we embrace the present opportunity to transform healthcare or have change forced upon us by people who do not share our beliefs in the sacredness of our individual relationships with patients and their families.

We need to cultivate a spirit of inquiry rather than advocacy, depersonalize our differences and dig to find the pony amidst the manure.

Ken is a practicing general surgeon/MBA and CEO of , who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance.

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