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What Would Daniel Burnham Say?

January 10, 2009
by Mark Hagland
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The great Chicago architect and urban planner Daniel Burnham (1846-1912), who helped refashion Chicago into the cradle of late nineteenth- and early twentieth-century architecture, once famously said, "Make no little plans. They have no magic to stir men's blood and probably will not themselves be realized." Perhaps President-elect Barack Obama was channeling his fellow adopted Chicagoan when, in a speech at George Mason University in Fairfax, Virginia on Thursday, he announced that, "To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized," He added that "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests." Of course, I can already hear the howls of protest among healthcare industry insiders who will state flatly that industry-wide EMR implementation within five years is an impossible quest, and that we inevitably face disappointment and even backlash in contemplating such an achievement. After all, a recent Harvard Medical School study published in the New England Journal of Medicine found that only 17 percent of physicians have so far adopted EMRs; and on the hospital side, we're just now reaching critical mass out in the real world. But the reality is that a very strong federal government push is exactly what's needed in this area. The federal government has a unique capability to make things happen in an area involving complexity and change. This is exactly what happened when President John F. Kennedy called for the turbo-charging of the U.S. space program following the surprise space launch of Sputnik 2 (with its dog cargo) by the Soviet Union in 1957. Indeed, it is precisely presidential leadership on a specific issue that can create the momentum forward in many cases. And perhaps as much as $50 billion in economic stimulus funding wouldn't hurt, either! So whether we actually get "there" (however one defines "there") in five years or not, I believe the impetus coming from the incoming Obama administration is exactly what's needed in order to move the needle forward on this absolutely vital imperative for our industry. And perhaps we could all do a little channeling of the great Daniel Burnham as we push ahead on EMRs for healthcare. After all, though he didn't achieve every objective he set his mind to during his career, Burnham accomplished far more than anyone believed possible, leading a wave of change that created the architecture of our modern age. Given that I, too, am an adopted Chicagoan, I can only but echo Burnham's famous phrase in this case, and repeat the mantra, "Make no little plans."



Mark, It will be fascinating to see what a title draw like "Daniel Burnham" brings to this post in terms of pageviews!

If your post is about the scope of planning, then I strongly agree, although I like the BHAG, "Big Hairy Audacious Goal" focus, rather than "Make no little plans." Big goals are important. The focus on 'plans' scares me, and concerns others including folks like Obama healthcare campaign advisor, David Blumenthal.

David spoke to this point at a recent meeting.  I might be paraphrasing slightly: " we love to believe that technology will make it [the US healthcare system] right.  What follows is a wave of unrealistic enthusiasm, because technology seems magical."  He closed this point by stating that we need 'a balanced and realistic roll-out.'  The roll-out must consist of appropriate expectation setting (potentially in tension with 'make no little plans.') 

Not that I'm competitive, but here's a quote that transcends both of our points (plans and goals).  It raises visioning to the level of a dare!

Joe Bormel,
Thank you very much for your comments, and for the excellent Theodore Roosevelt quote. I think perhaps it's a question of semantics as to whether one emphasizes "goals" or "plans." The reality is that every goal, to come close to reality, must go through the meat-grinder of policy development, followed by legislative processing. It's never pretty, but if we're going to get from Point A to Point B, it's got to be done. In the end, if we as a nation can achieve some level of consensus on what we should be pursuing, followed by the how, when, etc., then we'll at least be moving in the right direction. Thanks as always for your thoughtful response!