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How To Structure the Medical Care Environment: The GHS Tricycle

Integral leadership challenges leaders to think beyond the limits of their authority. To go beyond the confines of their organizations. To build alliances with leaders from other organizations (even traditional competing organizations). To make one entity from many smaller entities for the service of all. The result, when successful, is overall environmental (systems) advancement and win-win solutions for those involved. This is counterintuitive for most leaders who believe that “how can working with a competitor actually help my organization gain an advantage?” Or this, “Why would I ever want to help a competitor; the game is always win/lose and I have a responsibility to win (at the expense of my competitor), right?” And, of course, that is why most leaders are not integral leaders.

If we are to balance the medical care environment and restore patient well-being as the standard, integral leadership is essential. In other words, leaders from hospitals must come to the table with physician leaders, industry leaders, university leaders, governmental leaders and insurance company leaders with the goal of advancing, or in this case, balancing the medical care environment and achieving win-for-all solutions. That includes patients. Integral leadership is never about win-lose outcomes. That is competition. It is never about lose-lose outcomes. That is compromise. Integral leadership doesn’t ask leaders to come to the table in order “to give up something.” Everyone wins with integral leadership. Short-term sacrifices are always replaced by long-term gains. And the benefit to the overall environment is invariably greater than what any one leader can accomplish without integral partnerships. Integral Leaders in Health MEDs Designation (the topic of last week’s post) asks its leaders to think and act integrally. And when they do, all ships rise in the environment. The result is a balanced environment where patient well-being is the priority.

The Greenville Health System (GHS) Tricycle

Etched on a glass wall outside of the student services office at the University of South Carolina School of Medicine Greenville building on the GHS Memorial campus, is the figure of a tricycle: the GHS Tricycle. Around 2009, then GHS CEO Mike Riordan (a bona fide integral leader) convened his senior leadership team at a day-long retreat to explore how GHS should align itself with others in South Carolina to achieve its full potential. The potential that would result in global advancement for the citizens of Greenville and beyond. He suggested we come up with a model, even an actual figure, to represent that alignment such as a stool, a tripod, an arrow or some symbol suggestive of ideal alignment. From this, the GHS Tricycle was born. The chassis of the tricycle represents the GHS hospitals. The two back wheels represent teaching and research. The front wheel represents patient care. Implied is the rider/driver of the tricycle is the doctor (and doctor faculty members). The direction of the GHS Tricycle is thus doctor-led and proceeds according to the doctor-patient relationship.

While at first glance the GHS Tricycle seemed a bit corny, it turned out to be a vital strategic compass – maintaining proportion and purpose. The alignment led with the “big wheel,” patient care, and was propelled by the “back two wheels” of education and research. Thus, patient care was always the primary objective. Teaching and research were designed to support and push patient care. Attention was concentrated on maintaining the structure of the tricycle. The model never deteriorated into a “unicycle” devoid of its academic mission. It was careful not to evolve into “a tractor” with massive “back wheels” where academics overshadowed the clinical mission. It was maintained as a “perfect tricycle.”

The GHS Tricycle had another important function. It provided a platform for Mike Riordan’s integral leadership team. While he was technically only the leader of the “Tricycle’s chassis,” (the hospital), Riordan made a seat for its physician leaders at the “handlebars.” He recruited academic leaders from the University of South Carolina to the “back wheels” along with researchers from Clemson University, Furman University and the medical industry. An academic council was formed where inter-institutional collaboration could be fostered. Joint board liaison committees were also formed for the same purpose. It was an ideal integral platform that yielded unprecedented community advancement. That included the University of South Carolina School of Medicine Greenville (North America’s 136th LCME accredited medical school) Clemson University’s School of Health Research, the Clemson University Nursing Building and new nursing program, Furman University’s health science’s pipeline programs and medical industry’s access to patients for clinical trials. In return, the hospital was able to train and retain the best talent that included gifted doctors and scientists drawn to the vibrancy of North America’s 100th Academic Health Center. Ultimately, the patients in South Carolina’s Upstate were the real beneficiaries. The GHS Tricycle catalyzed win-for-all solutions that helped bring balance to the medical care environment in support of patient well-being.

South Carolina (and America) is experiencing a Medical Care Crisis where patient well-being is no longer the priority. Resolution of the Crisis is possible only if we restore balance among its components: doctors, hospitals, payors and universities/innovators.

Integral leadership platforms are essential for this to happen. Such platforms do not form organically. They are purposeful such as the GHS Tricycle…even when they do seem a bit corny.


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