Of Flags & Windmills

I’m sure today’s contribution (one of two hopefully) will come as a great relief to those (both) of you who have been waiting patiently for a new post to the PolicyPub. I hadn’t planned on taking such a long hiatus, but the further it went along the easier I found it to escape the self-prescribed responsibility of producing blog content. I do truly enjoy writing, but I have to say I’ve also very much enjoyed some other distractions in the interim. Maybe I will write some about that down the road.

Anyway, I haven’t decided yet whether to still focus only on healthcare policy or expand the Pub’s spectrum to include general policy interests that appeal to a much broader audience. If anyone is still out there reading, perhaps you can give me some feedback.

I thought I might start back by dipping my toe in the water with a timely, non-healthcare policy issue.  And in keeping with the soggy great lakes summer this has been, as long as I am choosing to get my toe wet why not get entirely sucked into and soaked by the whirlpool of controversy surrounding the Confederate flag. Not only is the issue timely and more widely of interest than ICD-10 implementation, but so is my perspective having just returned this week from an annual trip to Gettysburg with my twelve year-old son.

Having been a student of the Civil War since his age I could easily turn the Pub into a daily diatribe on that subject alone. Whether it would be interesting or not – well, let’s just say there are fortunately many others who know quite a bit more about it and have both the time and artistic ability to cover it better than me.

But what I have learned over the years is the connection between slavery and the Civil War is as complex a study as you could hope to find in American history. Those having just a smidgeon of that understanding will admit candidly at least to themselves that the Confederate battle flag stands for a lot more than the institution of slavery to a great many people – then and now.

For starters, a fair reading of soldiers’ diaries on both sides of the conflict will quickly help one understand that slavery was not in the least a primary motivation that caused men on either side to risk and experience death in very often the most horrific fashion imaginable. The same could not be said for the powers that be responsible for starting the war – and hasn’t that always been the case throughout history. 

This is what to a historian is fascinating, complex and confusing. As the author Shelby Foote said, “people who say slavery had nothing to do with the war are just as wrong as those who say slavery had everything to do with the war.” But if you take slavery away as an issue then there most likely would have been no war. So it’s ultimate role cannot be diminished even if not fully understood.

That 19th century perspective of the flag notwithstanding, the 20th century was witness to countless occasions when the confederate battle flag was carried as part of protests and rallies that were blatantly racist, vitriolic and bigoted in both foundation and intent. And so to those generations alive today it is understandable their symbolic association of the flag is one of hatred, intolerance and fear. From this perspective I find it impossible to argue against removing it from government properties as was done yesterday in Columbia.

But to and for the memories of the thousands of men who died on the wrong side of history and morality I hope we will remember that symbols can mean many different things to many people. One cannot meaningfully judge history without being able to walk in the shoes of its actors.

Walking the battlefields and reading and hearing about the tremendous sacrifices that were made by all of the men who died in Gettysburg the Confederate battle flag has served as a symbol for a great deal more than the unfortunate place it occupies today in the hearts and minds of many.

I think there is more to this story, however. Beyond all of the symbolism and rhetoric that has provided salable content for media outlets in a manner and fashion normally ascribed only to sausage making is a very scary reality: we are becoming a country with a phenomenal ability to tilt at windmills. Not only have we become overly adept at tilting, we do so now at full gallop whilst trying to pass the horse ahead of us in order to be first off the cliff.

We have lost our common sense, balance and perspective – our ability to have intelligent, factual and candid debate. Social media has become a sadly expedient venue for pretending to express individual thoughts and ideas while the substance supporting those ideas is void.

So what does all this mean from my perspective on the Confederate flag issue? I think South Carolina made the right call to remove the confederate battle flag from statehouse grounds. No brainer. But the National Park Service removing items for sale containing the Confederate flag from its book store in Gettysburg? Just another example of more lemmings not wanting to be left at the station.

  ~ Sparky

Healthcare Strategy Lesson From Gettysburg

GThis past weekend my son and I traveled to Gettysburg to partake in the 150th Anniversary celebration. It was our third trip together there, the last being four years ago when he was six. I have been there at least eight times myself dating back to when I was his age.

You have to be of a certain ilk to enjoy returning to a small town in the summer sweatbox of southern Pennsylvania so many times expecting it to offer more than the time before. Yet for me it has – and did so again this time. Now, I am admittedly one those individuals whose interest and fascination in the Civil War has been manifested in owning more books on the subject than I should ever hope to read.

That perceived restriction is in good part due to the other areas of interest that compete for my attention. Chief among those, I am particularly interested in most all aspects of military strategy. The word, strategy, after all is from the Greek word, stratēgia (στρατηγία), meaning the art of the troop leader or general – to command and provide generalship.

To be sure, I have learned a great deal about organizational strategy and strategic planning from contemporary writers such as Porter, Mintzberg, Ansoff and Chandler to name but a few, but in due time I have found most of their thinking reflects new ways of viewing the foundational principals of strategy that can be found in the works of military strategists such as Sun Tzu, Alexander, Napoleon, Bismarck – and Robert E. Lee.

On my visits to Gettysburg what I enjoy most is walking the battlefields and just looking at the surrounding countryside. Beyond its purely aesthetic benefit I try to imagine what faculties, training and experience it would have taken to translate observation into action (i.e., if I were a commander, how would I have deployed my forces). What makes that three-day conflict so intriguing for the military historian are the strategies employed by both sides in seeking tactical advantage through positioning. Who familiar with the Civil War has not heard of Little Round Top?

If you are an organizational strategist, you cannot help but appreciate the dynamic relationship of planning and positioning. Effective planning is measured by the ability to achieve a future position while being developed based upon current position. And this is where very often strategic planning at healthcare organizations falls well short of its promise. In my experience, the inability – or perhaps unwillingness – to develop a comprehensive and realistic understanding of their organizational current state before engaging in planning efforts is the single biggest mistake healthcare organizations make. It is also the singular key to successful planning efforts.

Too often healthcare organizations get caught up in the chaos that defines their environment. They spend significant amounts of time and effort trying to understand what is happening around them, unfortunately at the expense of understanding what is happening within their own organizations. The old saying of, “if you don’t know where you are going, any road will get  you there” has recognized validity. But the blinding attraction of imagining a better future can also serve as a siren to organizational leadership causing them to lose sight of practical realities.

The key lesson that was reinforced for me on this latest trip to Gettysburg was that while the ability to envision how infrastructure and topography could be utilized to establish tactical advantage, in order for underlying strategies to be effective the commanders of both armies had to first understand the capabilities of their forces. They had to understand the relative effectiveness of munitions based on distance, angle and elevation. They had to understand how and when troops could be deployed and redeployed between positions. They had to understand why holding a position is ultimately critical to being able to achieve a position.

From a strategic planning perspective, these are lessons I think have tremendous applicability to healthcare organizations, particularly as they seek to make sense of the ever changing regulatory environment in which they operate. If I were to borrow from the old adage, “measure twice – cut once,” I would offer that in organizational strategic planning it is wise to spend one hour envisioning where you want to be for every two hours assessing and understanding where you are right now.