Health Care Over the Rainbow

by Tom Robertson

Executive Director, Vizient Research Institute

I never saw “The Wizard of Oz” in a movie theater. The film began airing on television in 1956, the year I was born. It wasn’t until I was 10 years old that we got our first color television. Until then, I had never seen the iconic shift from sepia-toned black and white to vibrant Technicolor as Dorothy steps into Oz in what we will come to know was a dream sequence.

Based on a timeless children’s story written by L. Frank Baum, the movie features a Kansas farm girl whose house is swept up in a cyclone before being dropped unceremoniously on a witch. Dorothy and her pet dog Toto set off to follow a yellow brick road to a faraway Emerald City, where it is rumored a powerful wizard lives who can help her find her way back home. Along the way, she encounters three charmingly needy characters—a scarecrow, a tin woodsman and a cowardly lion—each of whom decides to accompany her in the hope of securing a brighter future with the help of the wizard.

The global pandemic of 2020 figuratively swept through the health care landscape like a Kansas cyclone, uprooting trees and lifting houses from their foundations. In what felt like an instant, everything was up in the air. Scheduled surgeries were postponed to guard against the possibility of overwhelming limited intensive care capacity. Personal protective equipment became the object of intensive efforts to secure desperately needed supplies.

Virtual encounters replaced in-person visits, accelerating through 10 years of growth in 10 weeks. Traditional orthodoxies—the way things had always been done—were replaced or re-imagined as creative solutions to unprecedented problems emerged. Long-time competitors became collaborators, setting aside parochial interests for the common good.

And front line workers…doctors, nurses, allied health professionals…technicians, patient transport teams, dietary workers and housekeepers became heroes, putting the needs of patients ahead of their own safety and well-being or the comforts of their own families.

In addition to chaos, the pandemic created opportunities. In its wake, it left more than debris; it left patches of clear land on which to build.

In the course of many conversations with health care leaders early in the crisis, I heard an inspirational theme again and again. A determination to implement a purposeful restart. To very deliberately decide what came back and where it went. To leverage the lessons learned and the inventiveness that surfaced in the crucible that was the pandemic.

If there is anything that I fear most as we come out on the other side, it is that we’ll put everything back just as it was before. Like a town recovering from a wind storm, we will be tempted to bring in lumber and carpenters and to rebuild everything on its old foundations rather than pausing to wonder whether previously straight streets should now be curved, or contemplating the merits of a park where a series of buildings once stood.

A sense of urgency to get back to “normal” is understandable, not just in our personal lives but in our professional environments as well. The relief that was felt when revenue-producing clinical services rebounded to volumes approximating pre-COVID levels was palpable, and came as no surprise given the economic pressures in an industry characterized by enormous fixed costs.

But it will be a regrettable opportunity missed if we do not take the time to question what we bring back and where we put it. An opportunity that may not come again for a very long time. If we put every Kansas farmhouse back on its old foundation, with a fresh coat of paint and a newly shingled roof but otherwise unchanged, we will have missed our chance.

For 82 years, since its original release in 1939, The “Wizard of Oz” closes with Dorothy back in her old bedroom, with her aunt and uncle by her side. In a stroke of cinematic genius, the colorful scenes have returned to black and white. With dusty hats in hand, three familiar farm hands, whose faces so closely resemble those of the scarecrow, the tin woodsman, and the lion, smile reassuringly…everything is back to normal. For us, in health care, a comfortable return to black and white may not be nearly as good for patients (today’s and tomorrow’s) as trying our hands with a colorful palette.