People fix systems, not techniques or master plans. People build creative solutions to benefit other people. Attractive solutions usually fit real life. They look obvious after the fact, even intuitive. We wonder why no one thought of them before. But bad process leaves us wondering why something simple has to be so hard.
Doctors carry tremendous power to shape healthcare. They could fix it. Access, inefficiency and perverse incentives could disappear. Patient frustration could decrease while quality increased. Doctors spend a tonne of time with patients. They know common irritants, useless waste.
If seventy-five thousand practicing physicians decided to improve care, could any political party, stakeholder group or legislation stop them?
It would require doctors to agree on an approach. Not issues, an approach. They would need to think beyond issues and agree on a bit of political theory. If doctors remain mesmerized by issues, politicians will continue to bend issues towards their own political vision; at least until voter sentiment demands they abandon their vision to win re-election.
Doctors need to work through obvious, but exacting, steps to solve Doctors’ Political Blind Spot.
Complexity theory defies master-plans. Ignorance or stupidity makes us assume we could design a rigid plan that didn’t harm the people expected to live by it. Looking through complexity goggles, we might consider the following steps to build a political platform.
How doctors can fix healthcare
Physicians should:
- Admit we practice in a political sandbox. This sounds easy. Physicians spend hours trying to convince someone they have a simple addiction. In the same way, it can take years to realize that nationalized healthcare, by necessity, makes doctors stakeholders/players/pawns in a political match.
- Acknowledge that political theory informs political issues. Docs need to study a few classics of political philosophy and history to appreciate where astute politicians hope to shape the system.
- Make implicit assumptions explicit. Doctors hold some basic beliefs but often adopt political positions that go against those beliefs creating contradiction, not just paradox. Doctors believe things like: only those who got all the answers correct should get 100% on an exam. Or, hard work should be rewarded. Or, everyone who wants to try to become a doctor should be given the chance to try.
But many political views grate against these assumptions. Who says students who do not answer all the questions don’t deserve 100%? Who says we should reward the efforts of those who work all night above the valuable work done by others in the daytime, between coffee breaks? And what’s this nonsense about ‘trying’. Those who want to become doctors should not be discriminated against. It has nothing to do with effort or performance.
- List patient expectations. Providers, patients and providers-who-have-been-patients have written stacks on what must be part of great care. They highlight things like: respect, compassion, freedom, honesty and much more.
Emergent Platform
Political platform emerges in the gap between the current healthcare system and #3 and #4 above. It emerges between people – patients and providers – and current reality. Doctors could create a platform by advocating for change in the way current design insults values held by physicians and patients.
Such a platform must be fluid. It must adjust as issues change. It could not be an ideology or ideal plan because it’s based on a gap. Gaps are relative. The platform cannot be simply the values held by physicians and patients, nor can it be the current state nor some utopian perfect state. The platform is always the gap that results between the performance of the current in light of the values and principles accepted by those most concerned.
If we assume the gap is between the current issues, processes and policies and some realm of idealized policy/process, we will always be forcing the current state into some pre-conceived vision of the ideal.
If we assume the gap is derivative or relative to principles and not issues, we maintain the ability to adjust and correct. If we gap the current state against a utopian plan, we will drive for more and more forced fidelity to the plan. In this second case, failure indicates lack of effort, not faulty process.
Living Ideas, Reforming Traditions
Doctors should advocate for ideas and processes that fit with modern, lived experience. They should build on the best parts of traditional care and adjust to meet patient needs as seamlessly and invisibly as possible. Doctors should seek to provide care that fits into patients’ lives, not force patients to fit into a master plan of ideal care.
[Of course, we’ve over-simplified. Some patient needs will overlap and appear to cancel each other out (e.g., the desire to be taken care of and the desire for autonomy), and some physicians’ beliefs will overlap too. These will require debate beyond the space allowed here.]
If we really want excellence, innovation and true, patient-centred care, we should unleash the creativity of patients and doctors working together. Progress scoffs at perfect. Perfect is a dream that tomorrow proves out of date. Let’s couple the best of the past with the creativity of innovation to create a future system that fits patients, not some utopian design.
photo credit: https://upload.wikimedia.org/wikipedia/commons/2/22/Parliament-Ottawa.jpg
I love this sentence, Shawn:”Who says students who do not answer all the questions don’t deserve 100%?”
That seems to be the current version of modern grading e.g. can’t fail a student even he doesn’t hand in an assignment.
🙂 I think this is one place where doctors’ beliefs fall well outside the cultural norm. And for good reason. We should celebrate that. No?
You can never get everyone to agree. The basic philosophies of different groups of physicians are not all reconcilable. Also, as well as patients, a lot of Canadian physicians are afraid of change as they have never practiced without governments’ as paymaster.
I agree. But aren’t there a few basic beliefs that all doctors hold? Meritocracy is one. Another one might be that to function as the most-responsible-physician requires the freedom to act out that responsibility. We could make a short list for patients, too.
Even a very short list of basic beliefs would provide a reference point against which to measure the current system. I think it’s worth a genuine attempt.
I think physicians need to explore what they believe right now, before they can stomach a conversation about change.
Thanks for sharing your thoughts!
Shawn