Au Contraire – The Health Care Blog

By KIM BELLARD

Last week HHS announced the appointment of its first Chief Competition Officer. I probably would have normally skipped it, except that also last week, writing in The Health Care Blog, Kat McDavitt and Lisa Bari called for HHS to name a Chief Patient Officer. I’ll touch on each of those shortly, but it made me think about all the Chiefs healthcare is getting, such as Chief Innovation Officer or Chief Customer Experience Officer.  

But what healthcare may need even more than those is a Chief Contrarian. 

The new HHS role “is responsible for coordinating, identifying, and elevating opportunities across the Department to promote competition in health care markets,” and “will play a leading role in working with the Federal Trade Commission and Department of Justice to address concentration in health care markets through data-sharing, reciprocal training programs, and the further development of additional health care competition policy initiatives.” All good stuff, to be sure.

Similarly., Ms. McDevitt and Ms, Bari point out that large healthcare organizations have the staff, time, and financial resources to ensure their points of view are heard by HHS and the rest of the federal government, whereas: “Patients do not have the resources to hire lobbyists or high-profile legal teams, nor do they have a large and well-funded trade association to represent their interests.” They go on to lament: “Because of this lack of access, resources, and representation, and because there is no single senior staff member in the federal government dedicated to ensuring the voice of the patient is represented, the needs and experiences of patients are deprioritized by corporate interests.” Thus the need for a Chief Patient Officer. Again, bravo.

The need for a Chief Contrarian – and not just at HHS – came to me from an article in The Conversation by Dana Brakman Reiser, a Professor of Law at Brooklyn Law School. She and colleague Claire Hill, a University of Minnesota law professor, argue that non-profit boards need to have “designated contrarians.”

They propose:

We believe nonprofit boards should require their members to take turns serving as “designated contrarians.” When it’s their turn for this role, board members would be responsible for asking critical questions and pushing for deeper debate about organizational decisions.

Their idea draws upon research from Lindred (Lindy) Greer, a professor of organizational behavior then at Stanford GSB and now at Michigan Ross. Her research suggested that teams need a “skilled contrarian” to improve its effectiveness. “It’s important for teams to have a devil’s advocate who is constructive and careful in communication, who carefully and artfully facilitates discussion,” Professor Ross concluded.

Her research, conducted with Ruchi Sinha, Niranjan Janardhanan, Donald Conlon, and Jeff Edwards, found that teams with a lone dissenter outperformed teams with no dissenters, or teams where everyone dissents. The key, they believe, was not to create conflict but to help identify differences and resolve resulting conflicts in non-confrontational ways.

Professors Reiser and Hill worry that “board members often fail to ask hard questions and challenge the organization’s paid staff – especially when there are more than a dozen or so people serving as directors.” They might assume everyone shares their “good intentions,” or they might just be uncomfortable “rocking the boat.”

I would argue that the same is true throughout most organizations, whether in the C-Suite or in the rest of workforce. Who is asking the hard questions?

Professors Reiser and Hill believe they have a solution:

We propose that trustees take turns being a designated contrarian, temporarily becoming a devil’s advocate obliged to challenge proposed board actions.

To be clear, they wouldn’t be naysayers out to block everything. They would instead ask probing questions and offer feedback on reports by executives and officers. They would also initiate critical discussions by challenging conventional wisdom.

The goal, they say, “would be to encourage debate and reflection about the nonprofit’s decisions, slowing – or halting, if necessary – the approval of business as usual.” Again, there’s nothing unique about non-profits or even about boards here.

If you have a team, a management staff, a C-Suite, a board (non-profit or not), or a federal agency, you need a contrarian. Someone who is not afraid to point out when, as they say, the emperor has no clothes. Who is not afraid to ask those hard questions, to rock that boat. Who realizes the status quo is not only not good enough but also never is going to last.

Organizations whose boats don’t get rocked enough are likely to capsize sooner or later.

Picking the right person(s) is crucial. Someone who is too abrasive will just create more conflict and will eventually get frozen out. On the other hand, as Professor Reiser points out: “Serving a term as contrarian will not magically transform a passive and deferential person into someone who actively challenges dominant voices or forcefully advocates alternatives. And directors wearing the contrarian hat may be too easily discounted if others perceive them as merely mouthing their assigned lines.”

It’s not a role that anyone can fill, or that everyone should, but a role that is important which someone does.

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It has been said that organizations that need innovation units or a Chief Innovation Officer aren’t truly innovative; it needs to be baked into the culture. Similarly, needing a Chief Customer Experience Officer means customer experience is not integral to the mission. If HHS needs a Chief Competition Officer or a Chief Patient Officer, it is validation that HHS has been coopted by the special interests that healthcare is full of, and those interests aren’t primarily about patients. We need to reflect upon that; simply naming those Officers won’t be enough.

By the same token, if your organization needs a Chief Contrarian or designated contrarians, that means it doesn’t encourage healthy dissent or seek ideas that don’t reflect existing paradigms. That’s a problem.

I am, I have to admit, something of a contrarian by nature. I never had an official role as such, but I never shied away from speaking up (even when it wasn’t in my best career interests).  But, boy, if I’d had the chance to be a Chief Contrarian or a designated contrarian, I’d have loved it!

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor