As Bob Dylan sang so long ago, The Times They Are A-Changin’. Some like change; some do not.

Consider these change scenarios:

* One of the important scenes of change for health care providers is the national debate on health care coverage currently playing out in Washington D.C. Some are very vocal in their support. The media covers many of the vocal opponents. Certainly some sort of change will come out of this debate.

* A newly diagnosed diabetic patient needs to adopt new habits—changes in diet, monitoring glucose levels, change in exercise, and so on. Adopting these changes will certainly improve the quality of life and extend the life of the patient. Some will change but many will not.

* There are many new changes being advocated for the primary care practice site. Among them are the patient-centered medical home model, adoption of E-prescribing, adoption of electronic medical records, and adoption of Lean Quality Improvement initiatives. Some practices will change; some will not.

In my opinion, change can be very difficult for most people. Some embrace the challenge. Others will want to hang onto present habits and patterns because doing so is comfortable.

My awareness of the challenge of change was greatly sharpened recently when I read C. S. Lewis’s short story The Great Divorce.

The story opens in Purgatory with the main character at a bus stop. He hops on the bus along with fellow passengers and is whisked to heaven, a destination he did not expect. Soon after arriving there he is met by the great Irish poet George MacDonald. As MacDonald leads him about heaven the main character experiences great discomfort as the blades of grass cut into his ghostly form. Yet he knows what a wonderful reward will follow his present pain if he only preservers with his mentor. In his journey the main character sees many of his fellow passengers encounter glowing spirits of those who have already taken residence in heaven. Each spirit is trying to convince one of the bus passengers to leave his old earthly habits and take the difficult journey to the promised land, which can only be reached by sacrificing one’s old self. Most object, laying out various reasons why they do not want to; they are just too comfortable with their old selves to risk reaching a better place which they have not yet experienced. Most of the bus passengers opt for taking the bus back to Purgatory.

I look at the three scenarios above and see this same pattern played out over and over. In each of them there is a possibility of great reward but only after much difficult work and effort. A new health care system enacted by the Federal Government might solve many problems. Certainly new diabetics will be richly rewarded for life changes. Health care providers can find many benefits in adopting new ways of delivering care.

Thing is, many will not make the changes because it is hard to do so and the present state is not that bad, or so they believe.

Donald Tex Bryant is manager of Bryant’s Healthcare Solutions, LLC.

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