The Journey of Transformation

"Change is the law of life. And those who look only to the pastor present are certain to miss the future." -- John F. Kennedy

The Journey of Transformation

We are all on a journey. It never ends. Every day along this path there are transitions. Every step we take is a movement placing us someplace new.

Most transitions are incremental. Transitions can be so small that we may not even notice them. On the other hand, transformation can be monumental. It is far beyond a transition, and therefore, far more impactful. It is a major change. It is to become something else. Like the caterpillar to the butterfly.

Transformation can occur suddenly, or slowly over an extended period. Major transformations are all around us. They are a part of our lives, culture, values, country, organizations, employment and environments. If a major change happens relatively quickly it can be indelibly imprinted upon our minds. Sudden change is immediately realized as impactful. Incremental change, which is not so sudden and indeed may take years to be realized, can be equally impactful but may not be noticed. If we pause to look back and reflect, we are aware of the significance of the change. So, reflection, and even introspection, can be a valued aspect of understanding transformation.

An Indelible Transformative Moment in History

An example of this latter type of transformation occurred at the time of the assassination of President Kennedy. This egregious act was transformational in its own way. It was tragic, shocking and riveting. It was the end of the American Camelot. It was the beginning of a string of assassinations and murderous attempts at some of our most respected idols. It changed much about how we interact with our leaders. But, there was another transformation that occurred at President Kennedy's death. Media consumption.

Prior to the day our nation watched the black and white replays of Jackie enveloping a collapsed JFK in Dallas, or John-John's salute at his father's funeral, we tuned in to black and white newsprint.

Everyone followed current events from a newspaper. One of the authors of this book, Peter, had a grandfather who was a journalist, and taught journalism for 40 years. He was proud of the printed word. News had been shared this way for centuries, since the advent of the printing press. As Americans were glued to TV sets to understand the unthinkable, it was the beginning of the decline for newspapers. While his grandfather was a friend of television newscasters, he saw the new medium as simply an additional type of communication in the journalistic armamentarium. He missed the transformative impact of countrywide television broadcasts. He never saw the shift from regionally based communication to one more national in scope.

What happened that day in Dallas affected all Americans. And the world. It helped reshape how we not only received information, but also how we processed it and understood it. From a linguistics standpoint, network broadcasting helped diminish our regional differences in speech and language and interpretation. In short, television news helped to usher in changes to the national culture itself. For those born since the assassination of President Kennedy these changes are not a change; but they are-in fact- a transformative moment, a historical moment, now made into a new reality.

Change is a part of life. As important and as subtle as the shift to the TV screen may have been, transformational events have surrounded us; and they continue subtly as well as dramatically. TV moved from the airwaves to cable and now to the internet. The internet itself has transformed communication and connection to each other in countless ways, but particularly through what is called 'social media'. Changes are ever present ... and coming at ever increasing numbers and accelerating rates and frequency. From McDonald's first fast food diner to the advent of the "pill," we respond to our primal needs in ways that may have been considered alien to our ancestors. But we respond.

From the Flush Toilet to the Polio Vaccine

Medical care is no exception, and since the dawn of the 20th Century its evolution has been exponential. The changes in medical care are almost too numerous to mention. Most have been due to technical improvements in anesthesia, pharmaceuticals, surgical techniques and tools, vaccines and increased genetic understanding.

But, interestingly enough, more lives have been saved by two, now totally ignored albeit technical developments: the flush toilet and potable water. These advances are perhaps the greatest generators of health in this country ... if not the world. Today, our society takes clean drinking water and sewer systems for granted. The same with extraordinary medical treatments. We too are now taking these for granted. As a result, we believe we are invincible and modern medicine can save us from every calamity. A medical miracle system for some, but a costly quagmire for others. Unfortunately, most of us still have an acute disease mindset in a chronic disease world. We can "cure" acute disease but we cannot "cure" chronic disease; we can diagnose it earlier, slow it down and palliate the symptoms, but not cure.

Indirectly, this cultural shift in attitude may have contributed to the significant funds that have flowed into medical technology and medical research. The medical community shares some culpability for this cultural shift as characterized by the reliance on drugs versus lifestyle modifications. As Pogo said, "We have met the enemy and he is us."

Over the past several decades, there have been many transformations in the healthcare arena. Post WW II, driven by the Baby Boom, the Hill-Burton Act started a building boom in hospitals. Employer-based health insurance coverage followed and medical schools grew in number and size to support the need for qualified medical staff. The establishment of Medicare and Medicaid as major sources of payment for medical services was a significant milestone in the provision of medical services for the elderly and the poor. These two payment systems dramatically influenced how payment formulas developed for similar services, but different populations, by commercial insurance carriers. Structural changes to delivery systems (the...