The Well-Being Journal

The Central Tendon


By: John Anderson, MD, FACS, Senior Vice President, Navvis Healthways

As a young surgeon some years ago, I had wonderful teachers and mentors who imparted to me a number of fundamental principles of practicing medicine. Though initially intended to be applied in clinical settings, a number of these principles I learned early on have sensible application to the complex domain of healthcare more broadly defined than traditional medicine and surgery. I’ve discovered this as I’ve increasingly devoted my career in recent years to the administrative side of medicine and healthcare.

For example, one mentor used to say that every patient – and more specifically, every surgical patient and every operation – had a “central tendon” which, when identified and “clipped,” made everything else seem minor and secondary. I quickly learned that this principle was significantly true in a clinical setting and have since realized it has much broader relevance.

As the Patient Protection and Affordable Care Act, aka ObamaCare, has swung into full gear with the opening of the exchanges and the expansion of Medicaid in 2014, virtually everyone believes that the healthcare industry has crossed into a very different place. This new reality has already begun to challenge our market’s brightest and most innovative minds to generate solutions that will position the American healthcare system as one to be emulated, rather than one that lags behind in virtually every imaginable dashboard metric. We as a country can do better…much better.

That said, here are a few observations regarding the current situation that I believe to be essential, beginning with my own view of what the “central tendon” might actually be. This short list is by no means intended to be comprehensive, rather just one person’s view of a few things that should be top of mind when thinking about how we fundamentally change and innovate our way out of the current reality with all of its issues.

Issue 1 – Physician Engagement

Others might have a different view, but I believe that “physician alignment” or perhaps preferably, “physician engagement” is just that central tendon issue, from which most all else in healthcare flows. Still the most respected and admired profession in the world, doctors always have and always will have a distinctive and irreplaceable role in the so-called conscience of the healthcare debate. (That in no way is meant to disrespect or undervalue the role of so many other healthcare professionals, especially that of nurses who will forever be the most intimate of partners with physicians at the sharp end of care. Enough said on that lest I be misunderstood.)

While not everyone will agree with me, I for one believe that our historically bifurcated payment schemes have ­– more than anything else over the last 75 years – driven doctors and hospitals further apart. Doctors ran the doctor business, and hospital administrators did likewise for facilities. Meanwhile, patients always thought of their care as “integrated,” and likely didn’t fully understand the distinction between professional and technical services. Nevertheless, we collectively have messaged within the industry something like this: “You take care of your business and I will take care of mine.”

The economic reality of where we are today, with our total healthcare spend being in excess of $2 trillion, cannot – and should not support – that kind of inefficiency and misalignment. We need the collective insight that both, really all, parties bring to the table. It is my belief that those hospitals and healthcare systems that “crack the code” when it comes to solving the physician relationship and engagement issue will be advantaged in the marketplace, regardless of local market forces and dynamics. The models for such alignment are numerous and certainly not confined to full employment and all should be fully explored.

Issue 2 – Healthcare Leadership

Second, and very much tied to the issue above, is the whole topic around leadership in healthcare. No, we don’t just need to train up an army of physicians with graduate business degrees to take over and fix what needs to be fixed. Rather, we need to thoughtfully and respectfully look at how leadership in healthcare has evolved and how narrowly focused we’ve been – something I think has happened from natural progress and isn’t anyone’s fault.

Regardless, our thinking about what healthcare is, where does it start and stop, who are the crucial stakeholders, where are the boundaries, and not least the question of role clarity are critical. We need to be intentional about leadership re-design, and we need to be bold. We need to build upon the strengths of the current leadership model, but not be constrained by it.

Much is said in today’s environment about taking risk, and most of the time we are talking about financial risk associated with the healthcare premium dollar. But we also need to think about bold risk-taking around leadership, empowering leaders to boldly redesign a model that is better suited and adaptable to where we are going, and not where we have come from. What are the skills and competencies that we need to anchor around? What perceived, but outdated, strengths do we need to jettison? Simply put, where do we need to build muscle, and how do we get the new muscle to work with the old.

This kind of change won’t just happen on its own, but needs to be led by a few brave organizations that will take it head-on. I believe that those organizations will be advantaged in the marketplace. In considering this challenge, organizations should think about the following three things:

  1. Are our leaders currently equipped with the necessary skills and competencies to navigate the changing environment?
  2. Is our leadership and shared governance model the right one for us?
  3. Who do we need to engage to help us get from where we are to where we need to be?

Issue 3 – The Role of Boards

And one final thought: who is going to be the primary catalyst for change even if the only change we focused on were the two issues above? I for one believe that it is those who govern. One thing that has NOT changed in the current whitewater of healthcare is who has the final accountability for the long-term welfare of the organizations that make up the bedrock of our American healthcare system – our boards.

Given their connection to local communities, as well as their fiduciary responsibility to do what is best for those same communities, who else is better positioned to drive the challenging, and sometimes uncomfortable changes, that must take place? No longer can boards simply rely on what they learn from management regarding the current reality. They’re going to have to move into a posture that perhaps might be a little uncomfortable for all parties and begin to truly embrace a shared governance model. This shared model will more frequently challenges the status quo and isn’t reluctant to take the organizations that they serve to places that might seem a little daunting at first. A board might ask, “How much must we own, manage or control in order to have the kind of influence that we want to have on healthcare in this (our) market?” Make no mistake, boards will have a key and critical role in how the system of tomorrow is shaped.

As you see, the list is woefully incomplete, but we have to start somewhere. Many believe that the traditional players in healthcare cannot transform an industry as large and entrenched as is ours. I respectfully disagree and believe that real transformation from episodic acute care to true population health and comprehensive well-being can and should most effectively be led by those same people.

So as for me ….

  • Transformational physician engagement partnered with a …
  • Transformational leadership paradigm that is insisted upon by …
  • Transformational boards of governance willing to push the envelope

Not a bad place to start and we’re happy to help out!

This article will also be published on the Navvis Healthways blog and appears with permission of the author.

As senior vice president for Navvis Healthways, Dr. Anderson provides strategic counsel, planning and implementation support for physician integration and alignment, accountable clinical management, and strategic planning for the organization. Before joining Navvis Healthways, Dr. Anderson served as a senior vice president and chief medical officer for Baylor Health Care System in Dallas from 1995 until 2004, and held the same position at Catholic Health Initiatives (CHI) in Denver from 2004 until 2008. Dr. Anderson’s clinical background is that of a general and vascular surgeon. He holds an M.D. from the Baylor College of Medicine and a B.S. from Baylor University.

Topics: Healthcare Medical Costs & Utilization

Men’s Health Month

Jennifer Rudloff

Men: June is all about us (ladies, you’ll have your turn). We take the time to celebrate our fathers, showering them with gifts of love and appreciation. And all month is devoted to our health. Men’s Health Month is celebrated each June in an effort to increase awareness of preventable diseases. Many chronic illnesses affect whole generations of men. Nearly 1 out of every 2 adults is impacted by at least one chronic disease, most of which are preventable. This is not only costly to each citizen and the US economy, but it also robs us of years of quality life. Education and awareness are the first steps towards action; and Men’s Health Month provides a nice opportunity to educate, reflect, and start down a path of prevention. But don’t be mislead! To actually prevent these illnesses men must take personal responsibility to make the necessary behavior changes.

It’s important to know what we’re up against. The findings in the table below from the Gallup-Healthways Well-Being Index® show the prevalence of some of the most common chronic diseases among men:

Chronic Disease Percentage of Adult Men
High Blood Pressure 30.4%
High Cholesterol 27.5%
Depression 12.5%
Asthma 9.2%
Diabetes 10.9%
Cancer 6.5%
Heart Attack 5.5%

One action every man can easily take is to get regular checkups from a medical professional. The Center for Disease Control and Prevention has reported that women are 100% more likely to visit the doctor for annual examinations and preventive services than men. Men’s Health Month implores all men to visit the doctor and seek medical advice and treatment. Men need to do this early and regularly to help combat the chronic diseases affecting our gender. The second step is to take some time to honestly assess your current behaviors. As a leader, it’s important that you lead by example. Start by asking yourself:

  • Do I smoke?
  • Do I exercise regularly?
  • What are my eating habits like? Am I eating enough fruits and vegetables?
  • Do I consume too much alcohol?
  • Do I drink enough water (8 cups of water a day is recommended)?

If you find yourself answering in the negative to any of these questions, it’s time to come up with a plan of action to make your life better. Smoking, lack of exercise, poor diet, and excessive consumption of alcohol are all directly related to the development of chronic diseases that affect men. Enlist the help of your loved ones – your parents, your partner, your children, your friends, and even your coworkers – to help keep you on track in taking the actions that will help you be more energetic today and healthier tomorrow. You are in charge of the direction of your life and Men’s Health Month is the perfect time to start making positive decisions that will redirect the course of your life.

Men’s Health Month has provided us with a great foundation from which we can begin to improve our well-being, adopt healthier habits throughout the year and encourage others to do the same. Here are few recommendations to help you and your people get started and stay on track:

  • Exercise is of key importance in the prevention of chronic diseases. Running or even walking is a great way to get active and stay active. Try organizing walking groups at lunch for your employees and track your progress with MeYou Health’s fun and interactive iPhone app, Monumental.
  • If you’re a smoker or have friends or co-workers who smoke, visit for support and tips on how to help kick your smoking habit.
  • Check out Munch-5-a-day or EveryDRINK from MeYou Health. Also, sign up for the MeYou Health Daily Challenge that will send you simple daily health challenges in many areas of well-being. Challenge your people to do the same. You might strike up a little healthy competition in the process.

So for all of our readers – I want to know, how are you going to lead by example? What action are you going to take to change your lifestyle so that you can live a long, happy and healthy life? Leave your comments below. In the meantime I am off to the mountain bike trails. Perhaps I will see your there!

Topics: Healthy Living Well-Being Health Prevention MeYou Health Mens Health Wellness Medical Costs & Utilization