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Final thoughts from a leader

I remember the first time I met Dr. Dan Rahn. He was taller than I expected, distinguished and had a handshake that could crush a cue ball.

I watched him over a two-and-a-half-day period in late 2013 as he and 60 other health care leaders debated and discussed the issue of obesity in Arkansas. Dr. Rahn was passionately cool, if such a thing exists. He addressed each complexity of the issue with pointed thoughtfulness. He was careful not to dominate the conversation, though when he spoke, people listened.

Through his leadership and that of many others – like Dr. Joe Thompson of the Arkansas Center for Health Improvement and Dr. Joe Bates, now retired from the Arkansas Department of Health – a plan to combat obesity was born.

The plan was formally drafted here at the Winthrop Rockefeller Institute throughout 2014, and in 2015 we sought and received the endorsement of Gov. Asa Hutchinson to launch Healthy Active Arkansas, a statewide initiative to increase the number of Arkansans who are at a healthy weight.

Throughout that process and since, my impression of Dr. Rahn hasn’t changed. He’s often the smartest person in the room, but he treats everyone he encounters with respect.

Today is Dr. Rahn’s official last day as chancellor of the University of Arkansas for Medical Sciences. When I met with him a couple of weeks ago, his shelves were already empty, his desk nearly bare. I encountered that same strong handshake, and Dr. Rahn eased from pleasantries and salutations to a succinct assessment of the origin of Healthy Active Arkansas.

“The starting point was specifically focused on obesity,” he began with the kind of energy one would expect from a leader just stepping into his role, not leaving it. “In Arkansas, we have a strategy for the health care sector. That strategy is insurance expansion, promulgation of electronic health information through incentives, and payment redesign. We’re gradually shifting from a volume-based structure to a value-based structure.”

He continued to explain to me the problem that UAMS and other health care systems face when trying to address obesity.

“If one looks at the drivers of ill health in Arkansas, there is an uneven distribution. The majority of the factors that contribute to ill health are not due to access to high-quality health care services. The majority are due to social and behavioral factors. The general concept is about 80 percent of the determinants of health care outcomes are external to the health care delivery system.

“Through our strategy for health care, we can deal with the consequences of obesity, but we can’t deal with the root cause.”

He says his support for Health Active Arkansas was borne of a desire to “move upstream” and work on strategies to prevent obesity from occurring in the first place. That decision starts at birth with a mother’s decision to breastfeed, he says, and continues through the child’s life with their intake of healthy foods and their level of physical activity (which, he notes, are both often affected by access).

I ask him about the state of Healthy Active Arkansas today, where we are and where we’re headed. I’ve learned over the past several years that Dr. Rahn is not a man to talk around a topic. He keenly analyzed our current organization, identifying that the HAA board is weighing a decision of whether to approach the initiative with a top-down management approach or a bottom-up system of encouragement. Faced with a decision between these two approaches, “the answer is likely ‘yes,’” he says and laughs.

He acknowledges the challenges of motivating players from various sectors to commit to the same ideals, especially if it involves instituting new policies or limiting choices, such as reforming the way vending machines are stocked.

I’ve long thought that Dr. Rahn is a prime example of someone who embraces what Jim Collins called the “Stockdale Paradox” in his best-seller Good to Great. The concept, broadly defined, is that the best approach to problems is to always preserve hope of a positive outcome while always honestly confronting the challenges that are in front of you.

In our conversation, swift on the heels of describing some of HAA’s challenges, Dr. Rahn follows with what has been encouraging to him.

“I think we’ve progressed well with no new funding,” he says. “I think it has been an effective, inclusive process. I think we’ve done a good job of raising awareness of the importance of the issue … and that we need to take control of our own health and our own future – at the family level, at the community level, at the employer level.”

Looking to the future of Healthy Active Arkansas, Dr. Rahn cautions against taking an all-or-nothing approach.

“We don’t want to get stuck saying ‘if we can’t do everything, then we can’t do anything.’”

Another challenge will be determining measures of success that will effectively determine whether our efforts are making a difference.

“This is a generational thing,” he says. “Change occurs across generations. So what will be our measures of success that will provide encouragement to stay the course?”

He also points out the importance of the collaborative nature of Healthy Active Arkansas.

“It’s important for each party or participant to not become something that it isn’t, but to bring its strengths to the table and to be working in collaboration and partnership with other individuals and organizations that have complementary strengths.”

I ask him about health literacy. As someone involved in the marketing aspect of Healthy Active Arkansas, health literacy comes up often as a key issue in the battle against not just obesity, but diabetes, hypertension, heart disease and a host of other health-related issues.

Dr. Rahn points out that health literacy is not about whether people understand technical words about health care, it’s whether they understand important concepts, getting to the “why” of health care and moving to a level of understand beyond just the “what.”

As we move toward that future, preparing to take on those challenges, it will be a little harder without Dr. Rahn involved. Healthy Active Arkansas is losing one of its original champions. Two of his colleagues on the Healthy Active Arkansas board gave their thoughts on the outgoing chancellor.

“Dan provided critical leadership in both articulating and committing both his institution and encouraging others across the state to join together to address this environmental threat to our future health, productivity and economic well-being,” Thompson said.

Dr. Nate Smith, state health officer and director of the Arkansas Department of Health, had this to say:

“Under Chancellor Rahn’s leadership, UAMS has been an invaluable ally in the statewide efforts to reduce obesity and chronic disease. Our progress in obesity prevention and reduction wouldn’t have been possible without Dr. Rahn’s support as chancellor of the state’s only academic health center. Arkansas is a healthier state because of UAMS’ commitment to public health, and Dr. Rahn has been at the center of that commitment for the past eight years.”

Many people know Dr. Rahn better than I do. I can’t share personal stories of fun memories or tell you what it was like to work with him day in and day out. But I’ve watched him lead from a close distance. He hasn’t always led by being in front of a group, but he’s always led.

From my vantage point, Dr. Rahn has been the type of leader Arkansas needed at the exact moment he was here. He leaves Healthy Active Arkansas in good hands, but he will be missed.

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