The 90/30 Conundrum: How To Change The World Of Medicine

Guest post by Aaron Schenone

Is it possible to make actionable change in the healthcare industry?

I recently read an article entitled “Rebels at Work: Motivated to Make a Difference” a conversation with Lois Kelly. In her research she refers to the 90/30 conundrum where 90% of respondents agreed activating creative thinking can improve culture and drive innovation, yet only a third of those respondents were satisfied with innovative individuals’, the so called rebels, ability to provide that outcome.

Her research goes further defining these innovative individuals as creative, curious risk takers that aren’t driven by monetary gain, but by the ability to make a difference. They aren’t afraid to call out problems or be the first to do things differently. She also found people are uncomfortable with these individuals who challenge the status quo, circumvent the rules, question organizational leaders, and initiate projects without permission. Too often leaders react by throwing these habitual truants into the trapped box with the label “Rebel” on it.

It’s no surprise that innovative individuals gravitate to the world of entrepreneurship, starting their own organizations where they can create a culture that not only understands their purpose, but more importantly can provide an outlet for their ideas to make a difference in the world. We intuitively know some of these types of individuals such as Steve Jobs, and Richard Branson, but these individuals are in every industry and industry leaders are starting to recognize their value. People like Carmen Medina, former CIA Deputy Director of Intelligence, who supported the creation of a novel and dynamic approach to searchable actionable intelligence through a program affectionately called Intellipedia.

In medicine many of our innovative medical students and residents have had similar frustrations often being misunderstood and thrown into the trapped box with the label “Cowboy” on it. We feel misunderstood, locked out and all too often make an early exit from the very organizations and patients who need our ideas the most. I believe the 90/30 conundrum is a reflection on the challenges innovative people and organizational leaders have had in attempting to build trusting, productive relationships. It’s something that as innovative minded medical students and residents many of us have been battling since we sat in our first years of didactic lectures. We continue to ask whether actionable change is possible in such a large numbers driven industry.

Today, I believe it is possible to make actionable change in the healthcare industry. But to get there we must first gain the trust of our leaders. We must prove we’re not just cowboys without a cause; we’re passionate activists ready to drink H. Pylori to prove there’s a better way.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology

Medschool + Sharing

Two years ago I sat with my fellow students in the auditorium like newly minted pennies, fresh, enthusiastic, bright eyed and ready to mount up on our journey into the unknown world of medical school matriculation. Our enthusiasm was our armor against what we all felt, the fear of god raining from the sky smiting us out of medical school with the doomed possibility of failure.  We had all heard of at least a story of the mishaps or misfortune of a poor medical soul lost to the abyss. It was a thought we couldn’t entertain, our enthusiasm alone would will us past our insecurities.

The all mighty validation of medical knowledge affectionately called the mean, ruled whether we were on track to medical success.  Below the mean meant a darker sky, less enthusiasm, more pessimism. By the end of first year we were so good at reading each other, we could split the class in half by disposition alone.

While reflecting on first year, I took the the time to explore medicine outside the semi lit lecture hall. I read case files, sat in on tumor boards, attended grand rounds and visited patients. I saw the lives of residents and innovative leaders share their latest medical research. I saw a collaborative world where patients were put before board scores, publications, edging out peers and politics. They were candid about limitations and honest about missteps in treatment plans. I couldn’t help, but wonder if there was something intangible in medical practice that we all shared that went beyond valid assessment by neatly organized test scores.

Returning to second year the stakes were higher, the work load larger and of course our time more limited. We weren’t shiny matriculated pennies anymore, but our armor was still intact. After all we had survived first year, we could do anything. But as second year took hold, fatigue crept in and boards loomed, our armor began to crack. Enthusiasm wasn’t sustaining us anymore. We became more candid and open about missteps and limitations. We started to share study guides more openly, and compensate for each other’s missteps to save our friendly simulated patients. As our armor continued to break down we had only one thing left in our arsenal, we shared our gifts.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology.