Each year, my family has a tradition of writing down and sealing resolutions for the coming year and reading our prior year’s resolutions to evaluate the progress we have made. As it is for most people, these resolutions most often concern health and activity goals as well as commitments to relationships or creative and intellectual pursuits.
Through the Affordable Care Act and related delivery system reform programs, our publicly-funded health care system is undergoing the same exercise with resolutions to reduce the need for acute, high-cost care. These resolutions include getting more people to sign up for and keep health insurance, to have an annual physical exam, and to use alternative care centers and services rather than hospitals and emergency rooms. Behind these priorities is another: to attend to the presence of behavioral health disorders that frequently complicate physical health and social problems.
By the way, on top of all those annoying infomercials and spam emails that tell us what’s wrong with us and what we need, you can also expect to be hearing more from our insurance and managed care companies about what we should be doing more of, or consuming less of, in 2015. So as the new year unfolds and our elected officials at all levels start their work, will the evaluations of these resolutions from past years reveal that these new commitments in and around our new system of health care really make a difference to our nation’s overall health – and not just its health economics?
Dr. James Prochaska from the University of Rhode Island theorized that we go through “Stages of Change” in achieving positive resolution: Precontemplation, Contemplation, Preparation, Action, and Maintenance (to prevent relapse).
Whether addressing personal or organizational change, most “change thinkers” and motivational speakers apply their own spin on one or two of Prochaska’s stages – expanding on the art of making a commitment, applying creative focus on the rewards or pay-off of the desired change (such as visualizing success to help justify the exercise), or using coaches and external supports to stay on track..
Personally and professionally, I have come to see a different element as most critical to achieving successful change – personal courage. The greatest gift in my career has been that of being around thousands of people who have achieved great, often heroic change in the face of personal or systemic adversity. I sometimes find myself saying to people, “I’m not sure if I would have had the same courage to do what you’ve been able to do under such difficult circumstances.”
More recently, the good fortune to be around many military Veterans and service men and women has provided me with further evidence regarding the role that courage plays in the ability for one to push personal boundaries in order to survive, perform, and even excel in the face of danger.
In an age where our public discourse is dominated by social media, reality TV, violent video games, and political posturing, we often confuse courage and determination with gamesmanship But if we can, as individuals, cultivate our own sense of courage – learn from what worked when we had no choice but to face up to our most difficult life challenges – perhaps we can fuel a little more determination, and build our own resilience to change that which holds us back.
As far as achieving the health system changes we seek, perhaps the focus of our energy should not just be in the incentives – such as the money that system reform holds out for health sector companies and institutions, and for savings in public budgets or even for political points in eliminating progressive reforms – but in the our courage to really do better for the long-term health of our families and friends who count on us.