"Mankind are so much the same, in all times and places, that history informs us of nothing new or strange in this particular. Its chief use is only to discover the constant and universal principles of human nature." - David Hume
If there is an industry that is in desperate need of innovation and innovative leadership, look no further than the healthcare field. From functional payment systems, to new technologies, to ethics, to distribution and delivery, virtually every feature of the healthcare system needs substantial change and improvement. Nowhere is this more dramatically apparent than in the arena of payment systems and delivery.
Who are the leaders who will cause the transformations we need in healthcare, and what can we do to educate young people to take on the challenges of healthcare delivery? What might be a course of study and learning that would help prepare a leader to navigate the complexities of the healthcare system?
One area of study just might be 17th century French history. And Dr. David Lansky just might be the model.
David Lansky is the president and chief executive officer of the Pacific Business Group on Health (PBGH), an organization focused on improving the affordability and availability of high-quality healthcare. He leads a coalition of fifty large employers and health care purchasers representing over three million Californians, including CalPERS, Wells Fargo, Intel, Safeway, Chevron, and the University of California. In addition to working through the PBGH coalition, he also serves on various health policy boards, such as the Congressional Budget Office Panel of Health Advisers and the federal government’s Health IT Policy Committee.
Dr. David Lansky’s path to this leadership role was hardly linear, nor was it entirely intentional. The intersection of the study he engaged in to acquire a Ph.D. in 17th century French history and his ultimate career path is a glimpse into the mystery of how one prepares to lead. And his story provides insight into the role that the Humanities can play in the world of business.
I spoke recently with David about his work, his commitment to innovation leadership and the relationship between his academic background and his life's work.
Henry Doss: Your career path is an interesting one, to say the least, progressing from taking a Ph.D. in 17th century French history, to serving as the CEO of a healthcare organization. How did this happen? How would you counsel young people who are thinking about “career planning,” while pursuing their own degrees?
David Lansky: Well, honestly, I’ve done almost no career planning. The only exception was a point in my early 30s when I figured the most interesting opportunities to influence society in my lifetime would be in either education or healthcare. So I went out and talked to people in both worlds and picked healthcare. Even then, I never contemplated formal training as a way to advance my career.
Doss: So, luck, more than planning? What do you say to a young person –or anyone for that matter – who is engaged in actually planning a career path?
Lansky: The positive elements of my career have been 70% luck and 30% taking advantage of opportunities. I think all of us are exposed to “serendipity” and each person’s challenge is to be aware of and choose opportunities to latch on to and exploit.
Your education can and should help you to better understand what you value, so that you are prepared to make those decisions. The importance of my academic training is less about the skills that I acquired, and more about shaping my values and what I wanted to achieve in life. Too much of an emphasis on job or skills development, too soon in life, I think can lead you away from understanding and codifying your personal value system.
I studied a lot of social history and felt a lot of sympathy for the “little guy” who is tossed about by the great figures and forces that we read about - kings, wars, famines, bankers. As a historian, I was taken with the question of how social institutions and their leaders can make life better or worse for most people. I got pretty deep into the life of one 17th century French city - their courts, hospital, city council, church life, and so on -- and felt a lot of empathy for those people. It was a great experience to step back to 30,000 feet and look at the life of a whole society and then think about how we still operate like that today, but are rarely able to look at things dispassionately and comprehensively.
So, as a result – at least in my case – my in-depth study of social history led me to develop a value system or point of view that in turn prepared me to jump at the opportunities that chance or luck or randomness threw at me in due time.
Doss: So, your education prepared you to be consistent in a value system, but maybe not so much in terms of the raw skills you need for a leadership role in healthcare?
Lansky: Well, “yes,” to the first question, but “mostly no” to the second. Let me explain a bit.
For me, it has been important to know what I value. I like to be ready to say "yes!" to opportunities that are consistent with my values and might move me forward towards my goals. If my goal had been maximizing income, or academic standing, or political power I would have responded to different opportunities. What was important about my own education, and what I would not want to have missed, is the opportunity to gain self-knowledge and an ability to place contemporary challenges in a historical context. As part of my learning process while studying history, I concluded pretty early that I’d rather make history than write about it. But I didn’t have the courage or hubris or charisma or brilliance to be a political leader or inventor. So I just took the “lessons of history,” my own political and social values, and my particular, limited skills and applied them to a contemporary problem as best I could. And when I did this, I learned very quickly that being a “leader” may just be hanging around long enough and learning from some very wise people.
Doss: So, now you find yourself in a position of leadership in a business setting. But you started out preparing yourself to be an academic/scholar. Looking back, would you change anything about what you studied, in order to better prepare yourself for business leadership? Or, asked differently, what would you say to all those students out there who are studying in the Humanities, who are also worried about what they’ll “do with their lives” when they graduate?
Lansky: This is a hard question, and it’s highly individualized. But there are two, distinct parts to this question. There’s the values learning that can support leadership development, and there’s the skills learning. I want to talk about them separately. When it comes to skills, I think anyone who begins to grow in their career, and to take on significant leadership accountability is going to feel “skill constrained.” That is, you are simply never going to master all of the skills you need or want to have, as you take on more and more responsibility. In my case for example, I sometimes wish I knew more about basic business – the kind of things that are routine for someone who takes an MBA. I’d like to know more about the law. And clinical medicine. But I don't. The lesson for me is you should surround yourself with really smart people who do understand these domains, and who can provide leadership themselves, teach you, and collaborate with you. You can’t think you’ll become a technical expert in every area you need to lead.
Doss: Then the next question gets us to innovation, leadership and how the Humanities can inform your creativity and strategic thinking in an area like healthcare. Do you see any specific parallels between the meta-issues you face today and those of 17th century France you studied? That is, are there things you learned that are unique and specific to your area of history that might give you unique and highly pragmatic insights into business challenges of 2014?
Lansky: There are parallels between 17th century France and 2014. Most of those are probably obvious – as people are people and western culture, at least, has been fairly stable over the past few hundred years. As a student, it was sobering for me to realize that the way people perceived and solved problems four hundred years ago – in post-feudal France – was not much different than how we address them today. Most actors belong to interest groups, make choices to protect their economic interest and class position, and then offer rationales to deflect the discussion from those particular interests.
Doss: Yes. And that sounds like a very precise description of the political struggles we see in healthcare today!
David: I think policymakers and business leaders understand this well. Most successful day-to-day policy initiatives involve moving past these deflections, understanding the underlying interests, and negotiating among the competing interests. It’s hard to move past something you’re not aware of and I think – in my case at least – a deep inquiry into history helps me navigate toward practical solutions.
Doss: So you learn that structural and economic forces drive the bulk of big, national conversations. How then do you navigate through a force or forces that are that powerful?
Lansky: Well, as I’ve worked in the world of healthcare, I've noticed something else, something that runs counter to my academic training: that is that relationships between individual people can trump structural and economic forces. You don’t see that very often because most people form relationships with other people who already share their interests. In any era, it seems that running a city or country is hard work involving lots of concessions and negotiations and patience – regardless of whether it’s a post-feudal kingdom or a 21st century global information economy. Individual leaders matter a lot – they do set the tone for consideration of important issues; people do pay attention to them; and a strong leadership vision can motivate amazing behavior. But for me, learning this in the context of training in history enabled me to better understand how to move past large-scale social forces and engage in leadership relationships. I think this is really important.
Doss: So, in a very real sense, you are attributing your success as a leader, not to technical knowledge in any particular domain, but to a highly developed generalist view of history, culture, economics, and politics.
Lansky: I think that’s mostly right, except for the implication that technical knowledge is somehow not leadership-oriented. I encounter many people with valuable technical knowledge – and we really can’t get a lot done in the real world without their great skill, passion, and sheer hard work. But sometimes deep technical skill in one domain can obscure the larger context, what we often call vision. I observe that the teams that get important work done have both someone who communicates vision in a way that motivates people to pursue it, and they have people with passion and skill at applying technical skills towards achieving it. Conversely, and this is true of my own career as well, even a strong technical direction is very hard to fulfill if there isn’t a larger convergence around a vision.
Doss: That makes a lot of sense from the leadership perspective. Now, more specifically, how do you go about leading, encouraging and developing innovation in the healthcare space?
Lansky: It’s interesting. I sometimes fret that my organization isn’t innovative enough. We aren’t developing apps, we aren’t exploiting social networks; it seems like we’re slogging away to encourage change among the giant insurance companies and government agencies and hospital systems that still actually control our $3 trillion in annual health care spending. The visible “innovations” – which are wonderful – are just fleas on the elephant’s back. But my colleagues remind me that our efforts to provoke and redirect the US healthcare elephant are themselves “innovations.”
In that context, the innovation challenge is not to get a lot of people brainstorming the next cool app to solve a persistent health care issue. It’s to look for the little cracks in the vast healthcare ecosystem that might respond to a tactical disruption, and to help people locate them and wriggle into them in a way that gets a reaction. I need to give people hope that the system will respond if we provoke it in the right way, that we have thousands of allies wanting to see the system be transformed. Then, our organization's job is to guide them to develop the right kinds of evidence, communications, and advocacy strategies to maximize their impact. What’s innovative, for us, is the process of instigating change – more than the change itself.
Doss: So, to continue the thread of this conversation, do you see your educational background – professional historian -- playing into innovation and new/better ways of doing things, in ways that a more traditional business training might not?
Lansky: Hopefully, because I’m trained as a historian to think about longer periods of time, I’m less likely to sub-optimize my evaluations of innovative products and services by only asking whether there’s a market for it today, and instead looking at it in a larger economic, political, and cultural context. When I think of innovative ideas or approaches, I try to ask this: “How can we help this innovation navigate the strong crosscurrents of the healthcare system so that it ultimately helps more people and is economically viable?” And my training as a social historian leads me to always ask: “How will each group respond? Who sees this as a threat or who could become an ally? Are there policy roadblocks or facilitators?” So, in a way, I think I tend to conceptualize problems in broader terms and in a values-driven context.
Doss: So, you’ve had the benefit of both a broad, and intense education in the Humanities and a broad and deep exposure to the world of business and healthcare. There are quite a few young students and young professionals out there who are thinking about how to prepare themselves to be better leaders, and to have as broad a set of opportunities as possible. What would you say to them about what to study, what to read, what to take time to write about, in order to be on a long-term leadership path?
Lansky: Well, first and most important, I would say to anyone who has the ambition to lead other people towards challenging goals that their path will be easier and perhaps more successful if they have a broad understanding of human psychology and behavior. I’m certain that most transformational initiatives in the real world must overcome the routines and comfortable preferences and economic positions of the society they seek to affect. And to do so requires a combination of forceful leadership and sensitive accommodation. Many great leaders discovered the combination of skills that was effective for their era, so understanding how they were able to detect those cultural drivers and adjust to them is very valuable.
The leadership of a vision requires something else as well – a feeling for what inspires people to follow. For that, understanding culture and religion and social movements is really valuable, and in that context, anthropology, psychology and sociology can teach a lot. But it’s not about reading, necessarily. These lessons are all around us today and everyone is your teacher. So engagement in the world of give and take – participating on non-profit boards and government committees, volunteering in communities different from your own – those things can help you internalize the lessons of the “Humanities” just as much as academic training. I guess I’d say learn broadly, but also be engaged in meaningful ways in the world.
Doss: And on that note, David, thanks for taking time to reflect on History, healthcare and leadership!
