We didn’t expect this to be the first Field Note.
Honestly, we thought we’d write about healthcare costs.
Or primary care.
Or some new policy.
Instead, we’ve spent the last few months talking about time.
Not because we planned to.
Because employers kept bringing us back to it.
The conversation usually starts the same way.
Somebody gets back from meeting with an employer, sends a message in Google chat, and says,
“Can I run something by you?”
At first we’re talking about the meeting.
Then, almost without noticing it, we’re talking about one sentence that somebody said on the way out the door.
It’s funny what sticks with you…The presentation rarely does.
The ordinary comments usually do.
A few weeks ago it was this.
“Our employees just don’t have time.”
Nobody stopped the conversation. Nobody wrote it on a whiteboard. We just kept talking.
A week later somebody else heard almost the same thing from a completely different employer.
Then it happened again.
Different industry. Different people. Almost the exact same sentence.
We still don’t know exactly what to do with that.
When we started Tectonic Health, we assumed employers wanted to talk about healthcare.
Looking back, that was probably our perspective more than theirs.
Employers spend their day trying to hire people, keep good employees, solve problems before they become bigger ones, and somehow make it home at a reasonable hour.
Healthcare usually enters the conversation sideways.
Somebody mentions an employee who kept putting something off.
Somebody else talks about a spouse who couldn’t get an appointment.
Someone laughs about how hard it is to get everyone in the same place at the same time.
Nobody says, “Let’s talk about access.”
They just describe their week.
We’ve started paying closer attention to those conversations than we do to almost anything else.
One meeting keeps coming back to us.
It happened with a school district, but it could have happened almost anywhere.
Somebody mentioned how difficult it is for teachers to take time off.
The conversation moved on.
Ours didn’t.
We’ve probably spent more time talking about those five minutes than we did the rest of the meeting.
Maybe because everybody immediately knew what that morning looked like.
A teacher wakes up feeling sick.
Not emergency room sick.
Just sick enough that they should probably see somebody.
Before the coffee is finished, they’re checking to see if they can get an appointment.
Nothing until next week.
For a second they think about calling off.
Then they think about lesson plans, finding a substitute, twenty seven students, and everything they’ll come back to tomorrow.
By the time they pick up their keys, the decision has already been made.
We’ve talked about that Tuesday morning more than once.
Not because we think teachers are unique.
Because we don’t think they are.
Actually…We’ve started catching ourselves using the phrase everything else.
It keeps coming up.
Maybe because that’s what employers keep describing.
Not healthcare.
Everything else.
The employee who already called off.
The meeting that’s been on the calendar for two weeks.
The parent who has to leave early.
The machine that’s down.
The customer who’s waiting.
The doctor’s appointment doesn’t arrive at the beginning of the day.
It shows up somewhere in the middle of everything else that was already happening.
The more we think about it, the more that feels important.
One of our clinicians said something after a meeting a few weeks ago.
She wasn’t trying to make a point. She was looking at her calendar.
“I wonder how many healthcare problems actually started because Tuesday was already full.”
Nobody answered.
Someone smiled.
Someone else shook their head a little.
The conversation drifted somewhere else.
We’ve probably brought that sentence up half a dozen times since then.
Not because we think it’s the answer.
Because we still don’t know if it’s the right question.
There are parts of meetings we forget almost immediately.
Implementation timelines.
Next steps.
Pricing discussions.
Those matter.
They just aren’t the parts we end up talking about later.
Instead we remember a superintendent laughing while saying,
“People think schools stop at three.”
Then he started listing everything that happens after the last bell rings.
Sports.
Concerts.
Maintenance.
Parent meetings.
Bus routes.
Cleaning classrooms.
When he finished, somebody quietly said,
“I don’t know when they would go to the doctor.”
Nobody really responded. We packed up.
Walked to the parking lot. Started driving home.
That conversation has followed us around ever since.
Something changed while we were writing this.
At least for us.
Originally we thought this Field Note was about access.
Then we discussed what had been written, and someone said,
“I don’t think that’s what you’re writing about.”
“What do you think we’re writing about?”
They looked at the screen again.
“Everything that has to happen before someone even thinks about healthcare.”
Nobody argued. Nobody agreed. We just sat there for a minute. It’s still sitting with us.
We’re not really sure where this conversation goes next.
That’s okay.
If there’s one thing we’ve learned over the last year, it’s that the conversations worth having usually don’t arrive fully formed.
They show up a sentence at a time.
Then they keep showing up until you finally decide you should probably pay attention.
We’ll probably still be talking about this next week.
If history is any indication, somebody will come back from another meeting, send a message in chat, and say,
“Can I run something by you?”
Hopefully we’re still listening.
The 60%
Field Notes from the Working Majority