A decade and counting


Over the past 10 years, the focus of my work has been to advance health care transformation. I have learned from countless individuals over the decade and as I reflect on my time, I would like to share the following lessons I have learned.

It was a Saturday morning in the fall of 2009. I found myself in the front row of a packed high school gymnasium in Snohomish County. Over 2,000 neighbors had come together for a town hall discussion with their Congressman to discuss the Affordable Care Act (ACA). My job, as the Community Liaison focused on health care, was to assist the Congressman should he need help answering a question. As I sat there, with a binder thick with sticky notes, highlighted sections and tabs, I watched as members of the community expressed their opinions, either for or against the bill that was sitting in my lap. 

In very general terms, those who were supportive of the bill expressed heartbreaking stories of their loved ones being denied service from the health care system . Those able to access service expressed the exorbitant costs associated with their service. Those who were against the bill expressed their concern about how this would change the already fragile system. They were frustrated about the idea of being required to have insurance and of course, they wanted government out of the decisions, focusing on the argument of “death panels.”

A lot has changed since the ACA went into law and there is still much more we need to do. There are more people covered by insurance. Preventative health care services are incentivized. Total cost of health care services for individuals are capped. But still, individuals are confused about how the system works. Total costs continue to rise. And unfortunately, the battle over the best direction to take our health care system continues in both our community and in our political dialogue.

That was 10 years ago. The question I ask myself every day as I lead the work at Cambia Grove is where do we go from here? I would like to take this moment to share some thoughts. These are not necessarily answers, rather guidance I have picked up along the way.

Definitions are key to understanding the problem

In 2017, Aneesh Chopra joined us for a special Under the Boughs. He spoke about the opportunities to transform the system citing that the low hanging fruit is no longer hanging – it’s now on the ground. He also spoke about the need to switch us from advancing solutions without a problem to solve to defining the problem and developing solutions around those problems.  

When looking at the whole health care system, we have had a hard time defining why the health care system is so broken. To define the problem, we developed the 5 Points of Health Care™ framework. The 5 Points of Health Care consists of patients, providers, payers, purchasers and policymakers – segments of the system theoretically cooperating to better the experiences of individuals and families. The 5 Points of Health Care conference is built to help define the problems within the system, given a look into why it’s so hard to transform. Please join us for our upcoming conference in February to connect, learn and fall in love with the problems that need solving.

Focus on a common goal

In college, I was a coxswain for the University of Washington men’s freshman rowing team. At practice, our coach noticed that two men on the varsity freshman eight were feuding over a personal dispute. Instead of pulling them aside to discuss the issue, he instead split the varsity and junior varsity boats apart, disrupting with the entire line up of the team before a big race. His strategy – create a common enemy to help the team gain perspective and align on a common goal. It worked, and the team won. 

The same strategy can be applied to health care. We are currently so focused on who to blame for our health care troubles. Republicans vs. Democrats, Payers vs. Providers, Innovators vs. Traditionalists.  

To make sustainable, long lasting change, we need to focus on a common goal. To fix a fractured system we can’t have a fractured goal.

Today, I would argue that the common goal we should all work towards is to create a system that is better for individuals. Time as our common enemy. The more time we take focused on disputes, sometimes personal disputes that are irrelevant to individuals, is time wasted costing us all significantly both financially and within public trust.  I hope we all can come together around this or another common goal and enemy to advance our work.

To listen you must be silent

Out of the blue, my son recently stated: “Did you know that the word listen has the same letters as the word silent? That must mean that we all must be silent to listen”.  

As we work to define our problems and determine a common goal, it takes us all to be silent to listen to one another to advance our collective work. That means giving us all time to understand each other and the impact change has on the way we work to serve our neighbors. We all come from a different perspective and so do the people we are serving. Please take time to listen to one another silently to understand the perspectives of colleagues working towards a better way to serve.

As I look back over the past 10 years, I have learned a lot about the health care system, the players and the incentives that lie within decisions. I have also learned that I have a whole lot more to learn. I am honored to be among the incredible class of accomplished health care leaders to accept one of the Puget Sound Business Journal’s Health Care Leadership awards this year.  As I look forward towards the next 10 years, my goal is to continue working with the community to advance health care transformation towards a place where we are no longer making headlines for the harms caused by a fragmented system. A place where health care is quietly serving those in need, working together to prioritize the health of individuals and their families.


About Maura Little


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