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Contemporary "Big Bang"In a universe of rapid change, associations are looking for a friendly place to land. By Jerry Ash The dramatic political, social and technological changes that are taking place in the professional, working and personal lives of our members can be likened to a contemporary "big bang." Gases are congealing, galaxies are forming and we don't know where earth is. Worse yet, we don't know where we are. Or, what we are. Associations, reeling through space like uprooted organisms from another existence, look for a friendly place to land. There is none. At least, there is no place for an organization like the one we so comfortably and routinely operated "on the other side." Much is said about the changes the new millennium will bring, but if the Year 2000 is to be a meaningful benchmark at all, it will reveal that "the big bang" has already occurred. Look at your membership. You may see entrepreneurs who are becoming employees through consolidations, mergers and acquisitions. Or professionals who no longer have an exclusive lock on products or services; or who have been forced to diversify. They may be manufacturers who have come to understand that the knowledge (not the widget) is their most important product. They may be cottage industries whose geographic bounds have been broken by the global economy. You may even see once-powerful CEOs facing the prospect of becoming middle managers in a changing marketplace. So, in all this sudden chaos, can you find historic guidance to help your association find its new life and remain relevant in a new world? Yes. Explosions appear suddenly, but they were quite long in coming. The healthcare field has been pushed along by a contemporary "big bang" for at least 20 pre-millennium years. It began with a sustained public clamor for healthcare cost containment and led to the development and rapid growth of managed care organizations (MCOs). Until MCOs were formed, hospitals and doctors held blank checks upon which they could write just about any amount and insurance companies would cover the cost by raising premiums. Healthcare providers were in solid control and hospital CEOs fancied themselves at the top of the food chain. Hospital associations were their exclusive club. But as MCOs began to decide how much would (or would not ) be spent on healthcare, the authority of the healthcare executive began to decline. While MCOs did not yet own the facilities, they were beginning to "run" them. It caused one state hospital association executive to repeatedly tell his members - hospital CEOs, every one - "If this trend continues, you will be the middle managers of the new healthcare system. MCO executives will be at the top of the food chain." The CEOs and their association had some lifestyle decisions to make. Would they become a brotherhood of middle managers, or would they prefer to stay on top? The CEOs decided they'd get in the managed care game through vertical integration; creating health systems that would join hospitals, doctors and MCOs together as collaborative enterprises. To remain relevant, logic followed that the association would also need to vertically integrate -- become an association of hospitals, physicians and managed care organizations. It was a heretical concept. Logic doesn't make sense, sometimes; certainly not to those who are rooted in the past. Board members (all of them hospital CEOs) approved bylaws changes offering full voting rights to their traditional adversaries -- doctors and managed care organizations. But it was a difficult pill; harder to swallow than their own business strategies because it was not exactly forced on them and meant dismantling a beloved club, steeped in tradition. Doctors, on the other hand, were incredulous and highly suspicious. MCOs were pleased but they cautiously embraced the opportunity. Ultimately, the strategy should prove successful because it not only preserves the relevance of the association and its traditional members, but establishes a meeting place where all the key players can lay aside their unproductive hostility and cooperatively work on answers to the healthcare dilemma. At the time, it seemed as though health providers and their associations were the only ones facing such necessary shifts in position and purpose. But today there are few fields that are not involved in a contemporary "big bang." Members are reeling through space, looking for a friendly place to land. To remain relevant, their associations will have to travel with them. Better still, associations should lead their members to a new and better place. Not to do so would mean eternal limbo somewhere in outer space. |
