The tectonic plates are shifting: cultural change vs. mural dyslexia.

In response to a rapidly changing healthcare marketplace, a variety of new business models have arisen, including new specialties (hospitalists), selective care (concierge medicine), and joint ventures (ambulatory surgical centers, specialty hospitals), some with hospitals and others with independent vendors. Since both hospitals and physicians are feeling the squeeze of rising expenses, burdensome regulations, heightened consumer expectations, and stagnant or decreasing reimbursement, the response to global economic competition and the need to improve clinical and financial outcomes can bring physicians and hospitals together rather than drive them farther apart. In response to perceived threats, physicians and hospital executives can engage in defensive reasoning that may feel protective but can also lead to mural dyslexia, the inability or unwillingness to see the handwriting on the wall. The strategies of positive deviance (finding solutions that already exist in the community rather than importing best practices), appreciative inquiry (building on success rather than relying solely on root-cause analyses of problems), and structured dialogue (allowing practicing physicians to articulate clinical priorities rather than assuming they lack the maturity and will to come to consensus) are field-tested approaches that allow hospital leaders to engage practicing physicians and that can help both parties work more interdependently to improve patient care in a dynamically changing environment. Physician-hospital collaboration based on transparency, active listening, and prompt implementation can offer sustainable competitive advantage to those willing to embark on a lifetime learning journey.