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The U.S. health care industry has long been beset by seemingly intractable problems: incomplete and unequal access to care; perverse payment incentives; fragmented, uncoordinated care that threatens patient safety and wastes money; and much more. These challenges are particularly vexing to the people who oversee or set policy for health care organizations. The disconnect between health care in its intimate, real-world setting and the distilled information delivered in the boardroom or policy discussions is a key barrier to responsive governance and policymaking. Sometimes seeing with new eyes can lead to transformational understanding.1 At Mission Health in Asheville, North Carolina, we’ve developed one potential solution: we ask board members, journalists, legislators, and regulators to put on scrubs, and we immerse them in our daily work.
Our board views its responsibilities soberly: we operate the region’s only tertiary and quaternary medical center (763 beds), five small community hospitals (each of which is the sole hospital in its community), and a post–acute care organization. We are the region’s safety-net provider, and 75% of our patients have governmental or no insurance. Our board focuses on governance and critical issues — quality, safety, community needs, physician relationships, behavioral health challenges, employee engagement, and organizational sustainability. Regionally, the buck stops with us: if we fail, nearly 900,000 western North Carolinians will be without a provider.
Yet until 2013, none of our lay board members had ever been afforded the opportunity to see the complexities of care delivery, except when they were patients, visited someone in the hospital, or watched a TV show like Grey’s Anatomy. Like most boards, we did our work in the boardroom. There, management and our four physician board members did our best to paint accurate pictures of our system’s complexity: the workflows and the choreography, the opportunities for error, the forces behind increasing costs, and the good derived from serving all patients regardless of ability to pay. We shared our struggles and successes using PowerPoint presentations, graphs,...