Trimtabs Applied to Health and Health Care Reform

By Cyndy Nayer, May 21, 2013

I’ve been reviewing some of my saved quotes and notes, such as the notes on trimtabs, as the airwaves heat up with IRS, AP and all things HCR (health care reform). The road to repositioning health as the goal can be a long uphill struggle, and as I continue to speak around the country and counsel employers large and small, the strain is showing. It’s time to discuss trimtabs.

It’s certainly no secret that I’ve lived most of my life in St. Louis, home to the Missouri Botanical Gardens, a world-renowned horticultural center and leader in rainforest research and environmental change.

The centerpiece and brand of the Mo. Botanical Gardens is the Climatron, a geodesic dome, the building with the smallest footprint and the largest capacity. This is the building of Buckminster Fuller, who has built many geodesign domes, which, according to his research, is the strongest building on earth, withstanding hurricanes, tornadoes, and earthquakes. You’ll note from the picture that it resembles a honeycomb curved into a shell-like structure. The intersection of the cells means that, like a honeycomb, the physical stress on the structure is equalized across all of the cells. This I learned many years ago when the Climatron was built. Bucky understood that design signals the human intention, and his intention was to live well and leave the world better when he was gone.

Buckminster Fuller was a scientist and a man who loved sailing. He understood trimtabs as the mechanism that cause rudders to move. Trimtabs are small surfaces connected to the trailing edge of a larger structure (such as a rudder) that stabilise the boat or aircraft in a particular desired attitude without the need for the operator to constantly apply a control force. This is done by adjusting the angle of the tab relative to the larger surface. In simple terms, it means that by adjusting the trimtab, or tabs, the rudder on a boat can make a series of small adjustments with less effort than trying to push the rudder against the enormous force of the water.

In Bucky’s own words:

“Something hit me very hard once, thinking about what one little man could do. Think of the Queen Mary — the whole ship goes by and then comes the rudder. And there’s a tiny thing at the edge of the rudder called a trimtab. It’s a miniature rudder. Just moving the little trim tab builds a low pressure that pulls the rudder around. Takes almost no effort at all. So I said that the little individual can be a trimtab.”

Bucky takes the concept of trimtabs further, by noting, “Society thinks it’s going right by you, that it’s left you altogether. But if you’re doing dynamic things mentally, the fact is that you can just put your foot out like that and the whole big ship of state is going to go.” He was determined to use design to improve lives; he used the familiarity of culture to make change feel familiar, less threatening, and easily adoptable. He developed solar panels to heat the geodesic domes, and even these have morphed to many more uses, including protecting turtles where they nest. In many ways, his description of the enormity of a small bit to move the Queen Mary is the embodiment of all of his work. Each of us, in our own way, has the ability to affect the course of boats, of ocean liners, of our hometowns, and of health care in America.

I’ve had the honor and good fortune to address health plans, small businesses, and large businesses over the past few weeks, literally from coast to coast. The travel is tiresome, but the amazing need for information on patient and employee engagement, health care reform, and, most importantly, WIIFM (What’sInItForMe) is never-ending. Sharing the stage or the panel with other innovators is such a pleasure. Yet, sometimes we forget in our enthusiasm to share that those who are listening need us to slow down just a bit, walk away from the acronyms, and catch them up on what we know.

It’s that rare moment when any of us can be trimtabs to the audience, to change their course and their affect from one of powerless victim (THEY are doing this, and THEY have no idea of the kinds of hassle and money this is causing me) to one of expert seafarer, with a new and clearer eye on the horizon. I love those moments.

On the road or in the air back to home base, I have the chance to review notes and consider concepts that will help attendees and readers of this blog to manage the stress that occurs with substantive change.

• Moving from a sick-care system to a true health care system is not easy. Neither is changing the course of the Queen Mary.
• Moving from incentives to intrinsic behavior change is not easy. Neither is pulling lobsters behind a trawler when the wind is in your face.
• Identifying key components of change and then enacting the changes through legislation is not easy. Neither is turning those beautiful white sails on the sailboats at the beach.
• Finding that there were items left unconsidered, or, finding them with gaping holes or costs that were unanticipated is not easy. Neither is moving great seas out of the way in order to make it home safely.

We are on a journey for better health outcomes in this country. We are creating a platform where more people can access health insurance and, in the end, health care. We trust that by creating a wider group of engaged, healthier people, our businesses and our communities can stabilize and grow to productivity and prosperity again. And our course causes some to fear, some to claim “this is mine and cannot change,” much like the wild seas attempt to claim the sailboat.

Paramount to our efforts must be engaging folks across the spectrum of health care interventions, from exercise and purchasing healthy foods to trust in a safe-care system delivered with consideration of the patient and the family. As Dr. Toby Cosgrove, CEO of Cleveland Clinic said in an IOM post recently, “We must do everything transparently and with the patient fully engaged. We must provide value and pay for outcomes.” This is a fundamental shift in how we pay for health care; it’s new and unknown, and therefore causes tension that we may not have anticipated. But it’s the course we are on so that we can get home to health and safety.

So as I have traveled these past few months, and I’ve seen the weariness and, yes, the fear, I’ve thought about Bucky and went back to my notes that I keep for inspiration. Trimtabs are a fantastic frame for the work occurring across this country, and, if we can remain committed to getting home–creating a healthier person, healthier businesses, healthier communities–then we will have succeeded. We can identify the gaps and fill them with innovation and purpose. We can take the steps, singly or in concert, and embrace the change in course so that we can achieve our goals.

The man who designed geodesic buildings to save the environment, who invented the word “synergy,” said, “Call me Trimtab.” And R. Buckminster Fuller considered the role of trimtabs and his work (you can see a video of Bucky here and here). He thought trimtabs and the efforts each of us can contribute would lead to a better course for the better lives of all. He liked the concept so much, he had it engraved on his headstone.