In the mush.

Approaching change, we cannot really know who we will be when we come out the other side. We can envision, plan, and sed goals, and these exercises will make a difference in how the process turns out, but we can never know exactly. When we have come through a profound change, we will have difficulty remembering how we could ever have been anything else. In the midst of profound change, we cannot see with certainty how it will turn out. We are "in the mush." Every change creates a need for learning. This change-induced learning has four phases: (1) Unconscious incompetence, (2) conscious incompetence, (3) conscious competence, and (4) unconscious competence. Health care--not just the industry, but the whole way in which we manage our health, our birth and death, our wellness and comfort--is at or approaching not just one strategic inflection point, but several at once. Physician executives need to guess correctly about this strategic inflection point, and position themselves and their organizations to take advantage of it.