Photo of the ocean from above

A Blue Ocean Awaits Us All

Oct 20, 2023

By Mick Krasner, MD

Awaken your spirit to adventure;
Hold nothing back, learn to find ease in risk;
Soon you will be home in a new rhythm
For your soul senses the world that awaits you.

(From: For a New Beginning by John O-Donohue, in Benedictus:
A Book of Blessings, Bantam, London, 2007)

One of the ideas that underscored Ron Epstein’s 1999 JAMA article, Mindful Practice, was an exploration of the attributes found among exemplary clinicians. As part of that exploration, the qualities of Mindful Practice- attentive observation, critical curiosity, beginner’s mind, and presence- were elucidated. Each of us may have versions of other attributes of exemplary clinicians, which are reflective of our collective felt sense of which qualities most importantly correlate with high-quality, competent, and compassionate care. These same qualities certainly correlate strongly with professional meaning and satisfaction.

A recent encounter with a modern hospital admission for a family member highlights the many ways in which these known- explicit or tacit- ideals run counter to the actual patient experience and how medicine “works” in all too many places. Once the chief complaint and the likely reason behind the complaint were identified, not one of the numerous care providers, from physician-to-physician assistant to nursing staff, asked a single question about the personal or social context of this family member, yet the personal and social context were quite relevant to the medical issue at hand. It seemed that once the team felt they had gathered enough medical facts, other domains of the patient were deemed irrelevant. These observations do not touch upon the missed opportunities for what we know brings professional meaning and satisfaction- in a word, “connection.” In this case, attentive observation, critical curiosity, beginner’s mind, and presence were unimportant hyperbolic ideals of those who are simply out of touch with the “real world” of medicine. It makes me curious as to why we give such primacy to the relevancy of these qualities and explore the details of the patient’s story and presentation early in medical education.

There exists a significant opportunity to distinguish oneself as an exemplary clinician, to have clinical encounters and a workplace environment that is enlivening and enriching, and to build a life in medicine where one can truly flourish. The experience described above is not a singular one. I would venture to guess that many, if not most, reading this have had similar experiences involving family members or oneself with the healthcare system. Is there a strategy whereby we can explore this opportunity to flourish better and integrate those exemplary attributes effectively in the “real world” of medicine?

I propose that those who bring the qualities of attentive observation, critical curiosity, beginner’s mind, and presence into their workplace and clinical encounters will find there is a “blue ocean” of opportunity and success ready to not only swim in but to be joined by other colleagues, healthcare team members, and the patients we serve.

Blue Ocean Strategy, a term from a book of the same title published in 2004 by W. Chan Kim and Renée Mauborgne, professors at INSEAD, is the simultaneous pursuit of differentiation and low cost to open up a new market space and create new demand. It is about creating and capturing uncontested market space, making the competition irrelevant. It is based on the view that market boundaries and industry structures are not a given and can be reconstructed by the actions and beliefs of industry players. You may ask how this relates to our work in medicine and the issues described above. Let me explain.

Let’s imagine that the prevailing experiences of many patients and many professional and non-professional staff in the healthcare system correlate with the experiences highlighted in my example (I believe it does) and that there is a great deal of dissatisfaction that exists within patients, health professionals, and other staff (I think there are). Let’s imagine that everyone, from health professionals to patients to staff, is looking for a completely different experience (I believe they are). Still, it simply does not exist or is, at best, rare and spotty. Then, it follows that there is truly a “blue ocean” out there where people, teams, and environments that create an alternative healthcare experience can establish a new environment that can only succeed. Here, success is defined as high-quality care, high-quality caring, meaning, satisfaction, and joy.

Let’s look at some of the questions that Blue Ocean Strategists ask about whether a blue ocean exists and place some answers:

What do we do well? 
Provide attentive observation, critical curiosity, beginner’s mind, and presence.

Why do professionals, staff, and patients choose us and stay with us?
Because these qualities meet the basic needs of individuals- professionals, staff, and patients, and lead to higher quality of care.

What do our competitors do?
They objectify professionals, staff, and patients and lose sight of the human being that is the object of the care.

Why might professionals, staff, and patients choose a different solution? 
Their need for high-quality, relational, compassionate, effective, and timely care is very important and is not being delivered.

Where are the red oceans (the opposite of blue oceans)?
They are everywhere- in hospitals, clinics, offices, among staff, and within leadership structures.

Which features and benefits do we compete head-to-head with our competitors?
The delivery of patient care. But we really don’t if we engage in the kind of care approach described.

What is our blue ocean?
High-quality, engaged, effective, compassionate, and timely care.

What do we provide our professionals, staff, and patients that no one else can?
High-quality, engaged, effective, compassionate, and timely care based on qualities of attentive observation, critical curiosity, beginner’s mind, and presence.

Each of us, through the cultivation of the qualities of mindful practice- attentive observation, critical curiosity, beginner’s mind, and presence- can find a blue ocean of opportunity, satisfaction, meaning, and work. May the currents take you to new vistas and new depths, and may you invite others along- the ocean is vast, and there is plenty of room.




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