​Some of the most brilliant minds and compassionate people go into healthcare. So why do we still see over 440,000 preventable hospital deaths every year? Question: do most healthcare leaders have a vision for their organization’s future? And have they “operationalized” it, as Dr. W Deming would say?
 
Vision separates “good enough” from “excellent.” Vision gives inspiration when the job gets tough. Vision makes the impossible, possible.
 
History shows this pattern: Vision comes first. Success follows.
 
In his research on the power of vision, Joel Barker came across a Dutch scholar’s work on successful civilizations. In Barker’s words, the scholar found this sequence of events, over and over: “First a compelling vison of the future was offered by leaders. Then that image was shared with their community and [the community] agreed to support it. Then, together acting in consort, they made the vision a reality.”
 
Today we see the same thing happening. Watch this video, about the difference between Detroit after it began to deteriorate in the late 20th century and Hiroshima, which was totally destroyed in 1945 and has been completely restored today.

​Hiroshima emerged from tragedy because its leaders promoted a positive, forward looking vision for the city. As the auto industry declined, American leaders abandoned Detroit’s future and its decay followed.
 
Lean gives us the tools to start setting our visions for healthcare. Imagine a future with zero wasted medicine, zero wasted steps to and from supplies. A future where doctors and nurses are able to spend more time with patients and less time on logistics. A future where healthcare is both financially solvent for healthcare facilities and affordable for the patient.
 
We need leaders to present the bold visions that lead to huge transformations. Change happens step by step, and commitment to the goal falters without clear inspiration. Healthcare needs a vision.
 
This isn’t fiction—lack of vision affects healthcare around the world today. Consider the recent cutbacks by the NHS in England.

​Here’s the reaction from a U.K doctor about the rollback, and it’s spot on: “The CCG is trying to make short-term savings, which may have major consequences for patients. While patients wait for treatment, their conditions could deteriorate, sometimes making treatment more complex and costly. In addition, standing down surgeons and their teams is inefficient and a waste of scarce resources.”
 
Instead of doing the work to use their resources more efficiently, the NHS is making cheap cuts to their system, harming patients and employees.
 
So what would a positive vision for healthcare look like? I want to point you to the work of Atul Gawande, M.D., best-selling author of The Checklist Manifesto, Better, and Complications.
Gawande lays out the only sustainable vision for healthcare I’ve seen to date:

Our healthcare system has a good product; our doctors and nurses on the front line deliver the best care with the best medical technology available. But systemic waste gets in the way of their jobs. Healthcare leaders have got to invest in operations that streamline the care process with the priority of eliminating preventable deaths and mistakes with no compromise.

For example, head physicians in the U.S. military during WWII chose to ignore their colleagues’ calls from the frontlines to transition from plasma-only to whole blood transfusions. War is hell. It’s not easy to lead during a war. But had the management culture been more receptive to continuous improvement, battlefield physicians wouldn’t have had to fight so hard to implement life-saving technology.
 
There were several factors that contributed to the use of plasma rather than whole blood for transfusions at the outset of WWII. In the North Africa campaign there was no such thing as a blood bank where whole blood could be refrigerated and stored until it was needed. Then, no one had developed the means to send refrigerated blood to the battlefronts where it was needed. Lastly, physicians believed that plasma was better than whole blood.
 
However, as the war progressed it became clearer to frontline physicians and surgeons that there was a better outcome for severely wounded patients when whole blood was used. In this case the change agent was a physician, Colonel Edward D. Churchill, surgical consultant to the U.S. Army in the Mediterranean theater. The Colonel presented a new medical concept for the treatment of hemorrhage and shock: whole blood.
 
He started lobbying for change and hit several brick walls. He was swimming upstream against a long held notion that plasma was better, contrary to the evidence from battlefield physicians and surgeons. He quickly realized change could not come from within the military system. Even after a U.S. Navy Surgeon (Lieutenant Henry S. Blake) invented a special box to hold and transport refrigerated containers of blood, the Navy’s Surgeon General didn’t think it was that great an idea and refused to have the box used regularly in navy medicine.
 
Blake didn’t give up on his invention, and Churchill took the case for military use of whole blood to the New York Times. The Times wrote an article on August 26, 1943 titled, “Plasma Alone Not Sufficient.” The American public was upset when they read the article, fearful for the lives of its sons at the front. Finally, the U.S. Army Surgeon General felt pressured enough to quickly accept whole blood for Army use on the battlefield.
 
Look, I’ve seen firsthand how well the medical system works and how thousands of soldiers lived because of the expert care and miracles performed by surgeons, physicians and nurses on the battlefield. During my second tour in Vietnam, I was medevac’d back to the states. I was loaded on a string of medevac’d flights starting in Saigon, from Saigon to Guam, overnight then to Hickam Field, Hawaii, five hours parked in the heat on the tarmac because we were all infected, then to San Francisco, VA Medical Center, overnight, then to Madigan General in Tacoma, WA, and hospitalized for 30 days.