As the reality of health care reform begins to sink in and the various elements of the new laws go into effect, health leaders across the nation and in every conceivable health related enterprise are beginning to ask where they can get the direction they need to respond to the opportunity that we have been told is once in a lifetime. From community clinics to professional groups, to health plans, to hospitals, and across the various clinical and non-clinical professions, everyone seems to be looking for the operating manual. It is not there. Jokingly, I posed this point in a talk last week, and in an off-handed way indicated that I had found the instructions for implementation on page 256 of the Patient Protection and Affordable Care Act. I was not encouraged when about 15% of the audience took the time to write this down.

One of the most important responsibilities of any leader in any organization and any place within that organization is seeing and advocating for the larger interests. I realize that such a view might be seen by some as an outdated collectivist perspective, but I believe that every successful individual, team and organization has as a fundamental part of its make-up the ability to sacrifice for the greater good; the well being of the whole. In fact, if such sacrifices are not made and they do not lead to enhanced success, then what possible value could we derive from associative action? Over the years I have asked the same question to hundreds of teams in development workshops: What were the key elements of your most successful team experience? I hear lots of qualities, but I never fail to hear individual sacrifice as one of the efforts that is essential for teams to work.

The competencies I proposed last month as important considerations for beginning the work of remaking the US health care system met with a great deal of positive reaction. Many responders asked that I expand a bit on the idea of developing and managing partnerships, alliances and acquisitions across organizational and sector boundaries. As the system of care moves toward the creation of Accountable Care Organizations, such work will become increasingly important. If you are a leader who is engaged in broadening the work of your organization or you are just beginning to recognize the need, here are five steps to consider as you develop your leadership strategies.

Last month I raised a few questions about team competencies in a reforming health care system. I heard from several readers asking for a more general set of leadership competencies that this same environment would likely demand. Here are five general leadership skills that will need to be particularly refined, if health care institutions, practices, and professions are going to adequately meet the demands of a rapidly changing health care world. 

Recalibrating the U.S. health care system for different performance will undoubtedly have a big impact on the health care workforce. Here are some of the workforce issues that will be important as we move forward.

As I write this month’s installment of “As Health Care Turns,” I count six states’ Attorney Generals who are threatening or preparing to sue the federal government on behalf of their citizens over the Health Security Act. This strikes me as more partisan politics than good policy, not because these acts conflict with my political views, they do, but because Ronald Reagan’s Solicitor General, the imminent Harvard Law School faculty member Charles Fried, has called such attempts “frivolous.” This is not to say the law is perfect; it isn’t. But it is a beginning and a framework for us to engage in the serious work of remaking health care in America. If we don’t take this opportunity seriously and roll up our collective sleeves, our children will pay for our shortsightedness throughout their lives.

The U.S. now faces a health care challenge of such consequence that it reaches well beyond the physical and mental well-being of the nation. The cost of care now endangers the economic well-being of the next generation and beyond. While the proposed health care reform has advanced a significant development, it has not been able to identify politically viable recommendations that could shake the health care institutions at their very foundation and leave the nation with a remade arrangement for providing for its well-being.

The US economy and society continue to suffer from an overbuilt, under-performing and too costly arrangement for the organization and delivery of health care services. The costs of this policy and market failure now amount to as much as $700 billion annually, approximately the cost of the banking and financial liquidity crisis and remedy of the past two years. The only difference is that the financial fix was a one-time expenditure and has seen nearly two thirds of the funding returned to the Treasury, while the health care overpayment is an annual expenditure with no end in sight. The uncontrollable costs of health care delivery are now driving deep structural deficits at the state level, the steady evaporation of benefited health coverage by employers of all sizes and the direct exposure of individuals to the financial risks associated with irrationally priced and under-performing health care services. In the medium and long term the growth of health care costs will bankrupt the nation.

 A lot has happened -- or not happened as the case may be -- in the past month. At the time of writing this it is unclear what, if anything, will be advanced in the health care reform bill. Bets and suggestions run the gamut from pushing ahead with everything, to selecting those parts that are most important and least controversial, to starting over. Any piece of legislation is a balance of policy and politics, and this one has been fully swimming in this soup from its first day of consideration. Undoubtedly something will happen, even if the happening is a deep reconsideration. Regardless, with or without a health care reform, a change is needed simply because it costs too much, produces too little, and leads to too much dissatisfaction among providers and consumers alike.

The US Senate has just met the challenge of bringing the health care reform legislation to the floor for a vote. It has endured a month long assault from the right for not having enough detail, being far too lengthy, and endangering America’s health; none of these attacks have been accompanied with constructive alternatives. There were many ways that policies from the right side of the aisle could have strengthened this bill had they been offered. For instance, the nation would be better off with a plan for engaging more individual responsibility around health behavior and financial prudence. But because the right chose to work toward a political defeat for the administration rather than a better bill, these contributions are absent.