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Bold Thinking as Crucial as Analytics to Advance Our Field
Telehealth services may be a lasting change in our field due to the pandemic. A recent JAMA article calls attention to our field for adopting telehealth “for a large share of visits.” Whatever their drawbacks, people value the convenience of video sessions. Yet why was this existing technology not already in use?
One answer is that this convenience was not prioritized pre-pandemic. Considering our chronically low care access rates, perhaps it should have been more of a priority. In any case, delays in adoption often stem from a search for proof—i.e., data showing an idea's clinical and financial value. Is it possible to be so focused on data analysis (involving research statistics and financials) that we impede progress?
Executives cannot always wait for the data. Bold thinking is sometimes essential to progress. A physicist recently suggested that “transformative leaps in science rely as much on imagination as on data and logic.” The same can be said of healthcare. However well we analyze data, it does not replace thinking big. This applies as much to improving the treatments as the delivery systems in healthcare.
Strategic vs. Incremental Steps
Our field has big problems—for example, persistent inaction on measuring clinical outcomes is as detrimental as our poor care access rates—and so we need big solutions. However, we will not find them if our orientation to problem-solving is incremental and overly focused on managing costs. We should have more of a sense of urgency about solving these problems, but urgency will not get us far if we think small.
What does it mean to think small? Consider the dramatic differences between a financial officer and a bean counter. The CFO is expected to help guide a company toward its strategic goals while achieving budgetary targets. This means awareness of many moving parts while pursuing a clear vision of success. Bean counters worry about expenditures with a type of tunnel vision.
A similar distinction exists in quality improvement. We improve companies by confronting major problems and implementing solutions at scale. Yet quality improvement leaders in a company often fall short of this. They produce small studies with statistically significant change, but this technical significance is not meaningful in scope or impact—big problems are unexplored and untouched.
We need more leaders who can balance an empirical mentality (a love for data) with a passion for strategy and solving big problems. However, an empirical approach usually comes with more step-by-step guidance and overall support than strategic thinking. It is much safer than aiming high and “thinking outside the box.”
Following the Path to Small Solutions
Fields make progress because people consider new perspectives and solutions. While our leaders should attend to research findings and ROI calculations, progress relies as much on thinking broadly across categories and data sets. However, we tend to avoid multifaceted or multidimensional solutions—not only do we work in silos, but complex solutions fit poorly into standard research designs.
Multifaceted changes in healthcare systems include too many variables to study at once. Research typically dismantles solutions into single variables for empirical testing. However, the big picture may never emerge from smaller studies, leaving us without validation for the whole—meaning that complex solutions are neither proven nor implemented, preserving the status quo.
This process may not be intentionally obstructive, but it does limit our ideas for change to smaller, incremental steps. This may be appealing in some ways, but ideally, we should be free to think and plan big. We may even want a new paradigm for thinking about our services, but new conceptual frameworks rarely emerge from studying the data—we must instead bring new ideas to the data.
Funding presents similar dilemmas. Few big problems get solved without an investment, so how is funding typically justified? Behavioral health often seems a secondary priority. A common funding question is whether our services will cut costs elsewhere. Should we succumb to this logic and search for answers in the data? Should we instead offer other ideas on what constitutes healthcare value?
Bold Thinking vs. Social Change
Bold thinking is not a form of social action but could be a step toward it. We sometimes need to redefine a situation before we can improve it. Our field’s progress may hinge partly on people breaking with existing norms for understanding and improving healthcare. The focus here is on the importance of abstract thought, creativity, and imagination in the science and delivery of healthcare.
Some people have moved from bold thinking to advocating specific social changes (e.g., funding a public option for insurance or eliminating social inequities in healthcare). Changing such norms and social structures is a separate path. The focus here is prioritizing bold thinking as highly as cutting-edge data analytics. Number crunching alone will never solve the problems facing behavioral healthcare.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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