My dog stood, body frozen stiff, yet ready to lunge. His eyes fixed on the only object in his world, the squirrel eating seeds off the ground 14 feet away.
The squirrel matched the stare, glanced at the tree about four feet distant and then, continuing to eat the entire time, turned his back as if he were the only one who would be doing any eating that day.
Many medical groups do the equivalent turn of the back in regard to the risks within their business environment.
In a complex system, there are who-knows-how-many unseen risks. But there are many significant, obvious risks as well, risks that may be acknowledged intellectually but ignored as unimportant either because the observer is lying to himself or is unprepared to deal with them.
Group governance issues, merger integration messes, compensation plans that incentivize for the wrong behavior in a patient-satisfaction-and-value-based-care-world, and the lack of any cohesive plan to retain, let alone develop new, business, are just a few of the gnawing issues relegated to neglect in favor of billing another unit. But as in other problems of induction, at some point, past results don’t have predictive value and your group is someone else’s lunch.
That day, the squirrel’s bet was a good one. My dog’s never caught one. But maybe one day he will. For the squirrel it will be low odds times high potential damage (death) equals high risk, ignored.
But it’s not that the risk wasn’t there every time. It was; it’s just that the odds came out in the squirrel’s favor that day. For the squirrel in the yard, the odds of being eaten had come out in his favor his entire life.
Medical groups that have had successful 20 year or 30 year or even longer runs have benefited from a similar run of the dice. So far.
Let’s talk now before the run of the dice turns on you.
Years ago, I had another dog, Showlow. I had the task of removing squirrel parts from the back yard on a regular basis, even once having to tell her to drop the head as if we were playing the Addams Family version of fetch.