Hi, my name is Richard Wilk and I'm a Chief of Hip Preservation at Brigham and Women's Hospital in Boston. And I'd like to thank Dr. Stubbs and Dr. Christopher Reddy for inviting me to be part of the faculty at this HIP meeting. Unfortunately, I'm not going to be able to be there with you in person. And I'm sure you all have a great opportunity to learn from the excellent faculty who will be joining you for the weekend. Those are my disclosures. In addition, you should know that I don't have an MBA, Master of Health Sciences, a PhD or other specific educational experience in leadership or managing change. But that said, I was the Vice Chair of Department of Orthopedic Surgery at Laney Hospital Medical Center for 12 years and served as the interim chair for one year. I'm also admittedly not necessarily a creature of change, more a creature of habit, as I spent 26 years at Lahey before making a change to come here to the Brigham and join the department. Like many surgeons, I like things a certain way and can be a bit of a creature of habit. But as I like to remind my kids, or they remind me, I should say, even though I'm kind of an old dog, I still like to learn new tricks. And for me, hip arthroscopy has really helped to change my career pathway. There are a lot of people smarter than me who've really kind of embraced the concept of change. Heraclitus, a Greek philosopher, noted that there is nothing permanent except change. Albert Einstein offered that the measure of intelligence is the ability to change. John Kennedy said, change is the law of life. And those who look only to the past or the present are certain to miss the future. And lastly, Maya Angelou said that if you don't like something, change it. And if you can't change it, then maybe you need to change your attitude. So why are you all here for this weekend course? Well, you've each made a commitment to change. And whether it's to learn for the first time how to do arthroscopic surgery of the hip or to enhance your skills, you've made a commitment to change and to improve the quality and safety that you can offer to your patients to hopefully improve their outcomes and potentially at the same time, help grow your practice. In 2002, Dr. Vernon Tolo, the first vice president of the American Academy of Orthopedic Surgeons in his address said that change is really something that as orthopedic surgeons, we need to consider. And he came up with challenges back in 2002 that he thought were really the critical ones that we needed to face as orthopedic surgeons. Those being unity in orthopedics, leadership, diversity, patient care, quality and outcomes, advocacy and politics, knowledge, education, research and competency and technology. Almost 20 years later, we're really kind of facing many of the similar changes in health care as we look at the organizational, financial, technological, knowledge and education, quality and safety, workforce, advocacy, work-life balance and COVID changes that have been thrust upon us. But as much as we have embraced these changes, we still have a lot of work to do. The nature of health care and orthopedic surgery has changed dramatically to a world where many physicians and surgeons are employees. And every day we hear news about various health care systems that are merging, practices that are being acquired by hospital systems or multi-specialty groups that are aligning together to form maybe these so-called super groups. And most recently, practices that are being bought out by private equity groups. It's no surprise that many physicians are pursuing MBAs in an effort to try and help navigate the complex business of medicine. The economics of medicine is in the midst of radical change as physician practices, hospitals, and most organizations struggle to increase revenue, improve margins and decrease costs. While the government and insurance companies have made it their mission to pay us less to do more. COVID has completely disrupted the finances of every sector of health care with the CARES Act and other government programs, saving countless patients, physician practices, companies and organizations from bankruptcy. Most of you probably already know this. As of January 1st, 2021, the hospital price transparency rule has come into effect, which requires hospitals to display on their websites gross charges, payer specific negotiated charges, discounted cash prices and de-identified minimum and maximum negotiated charges. I wish I could get such transparency when I go to buy my next car. Technology innovations have completely changed the nature of medicine between EMRs, digital imaging and telehealth, as we are unfortunately spending more and more time in front of a screen clicking our way through patient encounters and through our days. As orthopedic surgeons, we crave new devices and instruments that offer the promise of better patient care, including implants and robotics, while we acknowledge that there's a gap between the excitement and the science that may or may not show better outcomes for our patients. We're on the threshold of a healthcare world where artificial intelligence may dramatically change ways that we approach healthcare. All these things pose challenges to the economics of healthcare because of significant costs. There's been an explosion of educational content created since I finished training 30 years ago, including print and electronic sources that create challenges for all of us to keep on top of. We have to balance the need for evidence-based medicine with the temptation to try the latest and the greatest advances that we see published in all the journals and on the podiums of all the meetings that are out there, while making our best effort to stay on top of requirements for maintenance of certification. For those of us involved in teaching, the methods have changed from rote memorization and the see one, do one, teach one mentality to case-based learning and virtual reality simulators as we focus on trying to do what we can to improve quality and safety in the delivery of our patient care. The care we deliver now is being carefully measured and analyzed to help patients and payers understand more about the quality and safety with a focus on lowering costs, delivering value-based care and reducing medical errors. At the same time, the peer review process has been re-engineered to give organizations more leverage to address problems of competency and bad behavior that would typically have been tolerated in the past. For better or worse, patients now have access to hospital physician rating systems that may help them choose where to seek care. As a growing proportion of our society has begun to embrace the importance of recognizing racial, ethnic, sexual orientation, gender, and demographic diversity, organizations need to prioritize equity and inclusivity in all layers of the healthcare workforce. This has become an even bigger challenge as we now confront staffing shortages in the backdrop of COVID. Unfortunately, our political system has become mired in partisan attitudes and beliefs that often make it very difficult for the government to function. As orthopedic surgeons, whether we like it or not, we need to participate in the political processes that directly impact the regulations and revenue of healthcare in the U.S. It's critical that we participate, or as they say, you're either at the table sitting there or you're on the menu as a pie of healthcare dollars gets divided. With all the changes at play in modern healthcare, it's not surprising that there's been a dramatic shift in how younger physicians approach the balance between life and work. Unfortunately, there's an epidemic of physician burnout and healthcare worker burnout that has reached a crisis level where the rate of physician suicide is twice that in the regular population around us. It's critical that organizations recognize this reality and offer support and assistance to those who are suffering. As we all know, nothing in the past 100 years has done more to change the world of healthcare than COVID-19. Across the globe, almost without exception, everyone has been impacted in some way and been forced to change their lives. Obviously, healthcare organizations and workers have faced the challenges of the health of patients themselves and their families while adapting to limited supplies, equipment, and staffing that have impacted the ability to deliver care. As individuals, we can choose how we embrace change. My former chairman at Lahey started a tradition where every year around the holidays, he would give everyone in our department a book, and this was actually the first book that he gave us. It was about 20 years ago. Some of you may have even read it, and it's a quick read that offers a perspective about how to handle change that inevitably comes in life. It's based on the perspective of four mice, Sniff and Scurry, Hem and Haw, and how they each adjust to the concept of their cheese being moved. In simple terms, it's just an acknowledgment that no matter how you look at life, change happens. You can anticipate that that's going to be the case and get ready for the change when it occurs. You can be aware of the things that may be changing around you, or you can kind of bury your head in the sand and be totally oblivious, but the keys to being successful in life and in work are going to be to adapt to change quickly, to make the changes that you need to be successful, and to really embrace the change and enjoy it as an understanding that this is the way things are and recognize that just when you finish changing, you're likely going to have to change again. For those of you involved in leadership and management, you may be familiar with John Cotter, who is a professor at Harvard Business School. He put together this approach to managing change in the workforce and in business after realizing that in his research, 70% of companies that try to embrace change failed. He came up with these eight guidelines that he felt were really keys to help organizations make the steps that they need to do to embrace change. Those are to establish a sense of urgency, form a powerful guiding coalition, create a vision, communicate the vision, empower others to act on the vision, and then make plans to have little short-term wins while consolidating the improvements that are likely going to help with more change in the future, and then institutionalize everything to make it successful across the organization. The world of orthopedic surgery is fortunate to have an abundance of leaders, including the faculty and lab instructors who will be offering their knowledge and expertise to everyone this weekend. As I said earlier, just by being here at the Orthopedic Surgery Learning Center, you're embracing change, and you are giving yourself a chance to offer more to your patients. Let's not forget that the importance of humor, a sense of humor when embracing change, because it's all going to be part of the inevitable forces that we face every day, and you might as well make the best of it. I hope you all enjoy the course. Thank you very much.

change in healthcare

physicians adapting to change

leadership in healthcare

patient care

technology in healthcare