Cover: A physician’s view from the capitol
Top 10 rules for effective advocacy from a political novice
by Jandel Allen-Davis, MD, vice president of Government, External Relations and Research, Kaiser Permanente Colorado
Public policy and advocacy are viewed by some as the third rail: done well, great aims can be achieved; done poorly, fairly narrow interests are served that require more work and are loaded with hidden costs.
I have seen awesomely good political advocacy. I have come to know a cadre of men and women who do this work as a profession, aided by content experts, whose role it is to educate, sometimes persuade, and help shape the best proposed legislation that works in the interests of most people.
I have seen some pretty bad political advocacy as well, the kind that has given the profession of government relations a bad name. I have seen my colleagues rail against people whose self-interests are laid bare, whose tactics and strategies require that you shower before, during and after work!
And I – a policy and political novice who spent most of her career caring for patients – have seen everything in between. Here are my top 10 lessons and observations for effective advocacy, having worked alongside some of the best since 2006.
Number 10: Compromise
You aren’t going to get all you want. Life is lived in the grey. Don’t be so married to your perspective that your side wins a battle and loses the war. The art of compromise will almost always be required.
Physician’s view: Just as in medicine, wherein we create differential diagnoses, hopefully based on a constellation of signs, symptoms and evidence, every policy issue has multiple sides, perspectives and evidence, both seen and unseen.
Number 9: Be on watch
Bills and issues can take on a zombie-like quality. That is, they tend to come back, sometimes exactly in their former body, but more often are either shaped by the last fight or hidden in other issues.
Physician’s view: The clinical equivalent of this lesson is found in chronic disease or multiple co-morbidities. The good clinician, like the good political strategist, is on the lookout for how, when, why and where those new manifestations of chronic illnesses or complications are likely to present themselves and must be prepared for “Round Next.”
Which leads me to my next lesson or observation.
Number 8: Pay attention
The most skilled government relations specialists have big ears, an ability to appreciate all sides of an issue and can quickly prioritize the most important elements of any position, while discarding the less important ones.
Physician’s view: As clinicians, we spend our lives listening to spoken and unspoken words, signs and symptoms, and then triaging, prioritizing and discerning. The outcomes of this essential skill include cure, risk mitigation and optimization of the incurable, not to mention excellent patient engagement when done well.
Number 7: Know the nuance
The reasons why any given legislator, lobbyist or advocate takes a given position is not always apparent, logical, reasonable or even moral/ethical. This work requires an innate ability to read people. You have to know what matters to those involved in an issue and what competing and conflicting priorities may be at play. You have to know who is with you and who isn’t and, most importantly, why they are positioned the way they are.
Physician’s view: Back to the exam room. Patients walk into our spaces wearing an invisible backpack. The skilled clinicians are good archaeologists. They are able to intuit what may be in that backpack and/or are skilled at creating the space for patients to unpack it themselves and share its contents. It is through this practice that we diagnose correctly, avert harm, improve the likelihood of adherence to treatment and create the kinds of rich relationships with our patients that build trust.
Number 6: Look for the big picture
Government relations is mostly a game of influence and good political strategists are translators. They have an innate ability to take a pretty disparate set of participants, observations, concerns, issues and emotions, and distill them into a comprehensive, cohesive set of actions that work to either kill or pass a bill.
Physician’s view: By the same token, we have known and are slowly coming around to the reality that medicine is a team sport. We know that some of the most complicated and complex conditions are also the most deadly. We have to be able to step back and see the big picture and rely on the facts, the nuance and others to get the best outcomes.
Number 5: Pursue policy with caution
If we started from the perspective that a need to promulgate laws and regulations should be viewed as a failure of communities to solve their problems, perhaps we would use this particular club in our political golf bag MOST sparingly. Some of the worst enacted laws and regulations are a reflection of the clash between politics and policy.
The politics side: bare, bald self-interest at all costs, whatever those interests may be. The policy side: a carefully considered understanding of all sides of an issue coupled with good judgment and a keen sense of whether an issue requires a legislative fix. This requires slowing down long enough to do the work and to sit in conversation with folks to determine if legislation is in fact the best way to approach a problem.
Physician’s view: My best clinical analogy for this is the work ahead of us in dealing with end-of-life issues; our opioid overuse, misuse and abuse; and overtreatment that is informed by all sorts of considerations that are irrelevant (e.g., the ability to pay, a given patient’s stature in the community or concerns about malpractice).
Number 4: Follow the chosen path
There are few monoliths or absolutes in this world. The medical community or the health care sector is hardly one sector, including the physician community. This requires the ability to come to a decision/position and support it (or be quiet) until or unless changes of such grave or great significance happen that a different direction is required.
Physician’s view: How many times have you uttered, “Some patients don’t read the textbook?” After all the distillation of facts, figures and evidence, we have to choose a path and follow it, paying close attention to know when modification of a treatment plan is required.
Number 3: Know your role
Check your title at the door (or as one political strategist commented about doctors, which was admittedly hard to hear, “I don’t care that you save lives with those hands!”). Know your role and play it well. Over a lifetime of clinical practice, doctors can come to believe that we are the smartest people in the room. Actually, we are the smartest doctors in the room! This is a critically important tenet to remember. Lobbying is not a game; it is a profession and we have to defer to the experts, play our role and be willing to learn – or be prepared to be humbled in the process! Our biggest contribution to helping pass good legislation is to be the voice of patients and communities first, and to focus on our profession second.
Physician’s view: I don’t know to whom the following quote is ascribed, but someone said, “There are some patients we can’t help. There are no patients we can’t harm.” Keeping patients and families at the center in all that we do helps. We have to know and understand our limits as well as medicine’s limits and work within them. The same is absolutely true of our role in this business.
Number 2: Foster good will
At the end of the day, we have to be able to go out and have a beer with our opponents. They are not adversaries, they simply have a different view of the world on a given issue and a different set of beliefs. And on the next issue, those same folks may be your friends.
About beliefs, singer-songwriter John Mayer cynically asks, “Is there anyone who ever remembers changing their mind because of paint on a sign?”
Physician’s view: At the heart of all human commerce, relationships matter. We know this is the most sacred part of the work we do as physicians. Relationships must be tended gently, constantly and consistently. The best outcomes, even when they end in death or disability, have good relationships at their heart.
Number 1: Be respectful and respectable
Political capital is earned, spent and lost based on the manner in which you conduct yourself. Under that dome, all you have is your reputation. Lose it and it is gone forever. Think in terms of the long game as well as the short game. Never ever celebrate in the building. Resist cynicism. Keep your promises. Take meetings with almost anybody. Collaborate (never go it alone). Compromise. Keep your fights quiet and appropriate. Always be kind, honest and respectful. You win today – you lose tomorrow – based on how you hold yourself. Build trust. And we know who you are whether you recklessly or carefully spend capital, as memories are long.
Physician’s view: The parallels of this tenet to our hallowed profession are too many to describe and are as obvious as the day is long. The best doctors are professionals, healers, great diagnosticians and good people. We are perfectly positioned to serve in the role of advisor and advocate and perhaps over time, government relations professionals. n
Jandel Allen-Davis, MD, is vice president of Government, External Relations and Research for Kaiser Permanente Colorado. She leads the organization’s government relations and regulatory affairs, community relations and community benefit investment, clinical research activities, stakeholder engagement, communications, and advertising and marketing functions. Allen-Davis is board certified in obstetrics and gynecology, and after 25 years of serving patients, transitioned from a physician leader to Kaiser Permanente’s Health Plan Leadership team.
Dr. Allen-Davis gave this presentation as part of the CMS CPMG Section/CMS Medical Student Component Society Public Policy Leadership Forum on Feb. 3. Read more about the forum on pages 10-15 of this magazine.
Posted in: Colorado Medicine | Cover Story | Initiatives | Advocacy