Welcoming 2018 with a Challenge


2017 has been an unprecedented year.

Powerful forces are at play – both in our nation and beyond. Our sense of community is in crisis. Fractured along lines of identity, status, and ideology, Americans are increasingly at odds.

This is the national climate we healthcare change agents now face. And if advancing health and navigating complex systems isn’t difficult enough, far too many of us are also running on fumes, struggling with our own sense of isolation, and weighed down with existential questions: Can the provider-patient relationship be preserved? Is it possible for patients to receive the kind of holistic care that addresses social determinants of health? What will the growing rates of clinician burnout and exodus mean for patients, systems, and the future of our professions?

These are difficult questions.

But I am hopeful.

As I’ve worked alongside so many of the leaders in the Primary Care Progress movement, I continue to be struck by the realization that the change we need in healthcare today won’t come about solely through compelling data or new policies; it will come from committed people working together in new ways – people like you.

I’m amazed by the leaders in our network, tirelessly diving into this change work. Interprofessional teams of students, in partnership with patients and community advocates, harnessing community health needs assessments to address social determinants of health. That’s powerful. So is our student hotspotting work that’s expanded to 500 health professions schools. Who thought learners could make the difference in the care of so many of our most complex patients? And your leadership development work with fellow providers and learners is inspiring – like at Oregon Health and Sciences University, where a local leadership learning collaborative is spreading advocacy and leadership skills to individuals at all stages of training and practice peppered throughout the institution.

These stories of connection, collaboration, and engagement are a powerful antidote to the dominant healthcare narrative: individual providers burning out – on their own, silent, and disappearing. Instead, we’re building a new narrative: stories of clinicians, care team members, learners, and patients coming together to say “enough is enough,” as they work collaboratively to advance a system of care that works for every one.

This is timely. At a moment when 82% of quality improvement project failures are chalked up to “people issues,” and over half of clinicians are reporting burnout, the Relational Leadership practices you’re modeling and spreading are filling a critical gap, giving more people the tools and agency to be the change makers we need. That’s a game-changer.

Bottom line – the ingredients for a revolution in healthcare are all here. We have the pain of the present. We have a hopeful vision for a new future of interdependent, collaborative care. And we have people – a huge community of healthcare people with the values, grit, and commitment to accomplish big, bold things, as well as an ocean of patients who are poorly served by the status quo. That’s power, friends – untapped power.

So here’s my proposition to our Primary Care Progress network for 2018.

Let’s try an experiment: the launch of local mini-movements. Thousands of ‘em!

What’s one thing that you’re passionate about, angry about, or driven to take action on? It might be the local health insurer who just dumped your practice from the network. Perhaps a new policy requiring additional evening and weekend hours without additional support and resources. Maybe the marginalized status of primary care in your curriculum. Or you may be frustrated with a lack of social services in your local community.

Find a few others who feel similarly – not just people like you, but six or seven individuals with diverse backgrounds and with stake in the issue. Start your movement by breaking bread over dinner. Share stories – including your own. It won’t take long before your connection to each other turns into a commitment to take action to advance the cause.

Imagine if a thousand of us ran such experiments over the next year – or even just a hundred? How exciting and impactful would that be? How many others would it inspire to jump aboard?

And if you think it sounds impossible, just think of the of the healthcare coalition in Wisconsin who engaged police officers in their effort to address youth homelessness. Or the medical residents in Colorado who worked with local health activists to establish a free clinic. Or the group of grocers and health professionals who came together to create healthier food options for patients. In every case, there were some unlikely allies at the table, but their shared insights, resources, and untapped social networks were collectively leveraged to make an immense difference. That’s the change we need presently.

Now I know you may be looking for something bigger and bolder to do at this crazy national moment – an opportunity to take on some of the people and policies now dominating the national discourse. To be sure, we’ll eventually get our chance. But for now, the fact is that your greatest opportunity resides locally – in your community, at your school, or in your clinic. This is where your power is. This is where your relationships reside. And this is where your impact will be felt definitively, with ripples spreading nationally as others follow your path.

So be bold and dive in. And also be humble, realizing you can’t do this work alone. Remember, you may not be able to change the world overnight, but you can change your own world quite quickly, and the worlds of patients and colleagues in your midst.

Let 2018 be the year of our collective experiment. Of rebuilding local teams to fix our systems from the ground up. Creating new communities that connect people from diverse backgrounds to bring to bear untapped resources to change things for the better. And by doing that, let us shine a bold light of hope and belief in ourselves and each other that cuts through the darkness and division.

Let that be our collective gift back to a divided America.


Andrew Morris-Singer

Dr. Morris-Singer, board certified in internal medicine, is President and Founder of Primary Care Progress, as well as a practicing clinician, medical educator, and leadership consultant. With nearly twenty years of experience in advocacy, he regularly writes and speaks on current trends in primary care, community organizing strategies to advance primary care reform, and the emerging model of Relational Leadership™.

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