There is a lot to be done in healthcare. Systems are complex. Outcomes are suboptimal. Costs are rising. Few of us, given the opportunity to design a care delivery system from scratch, would design what we have now. There seems to be an imperative to do something, but where to begin?

Deciding where to start can feel overwhelming. The daunting pit in your stomach signaling uncertainty is familiar to me.

It reminds me of my first job.

Growing up, like most around us, my family was poor. My grandfather worked in a granite quarry and took on odd jobs to help my single Mom take care of me and my sister. One of his side gigs was to help a farming neighbor.

Each spring, Grandpa would plow a small field in preparation for the planting season. The soil was rocky and larger rocks had to moved so feed corn could be sowed.

My first job was to move those rocks.

The field was not large, but at 10 or 11 years old, it looked huge beyond belief. Grandpa said, "Tommy, any rock bigger than my hand needs to be piled off to the side or in the middle of the field."

I looked at the field, unsure where or how to begin and certain it would be an impossible task. I hung my head.

Grandpa saw my anxiety and trepidation. Then he patted me on the head and said, "Start at your feet. Pick up that one right there. Take care of it. Then do another. That's how we do it." 

I remember those words everyday.