Author: Shawn Whatley

When Viral is bad  

viralI did something that went viral.  It became juicy gossip, a ‘can-you-believe-it’ story.

It was stupid and made people feel bad.  I felt bad. I embarrassed dear friends, hurt old colleagues and gave some enemies fodder to slander.  Very bad indeed.

‘Viral’, not the good kind as in ‘going viral; more like a 36 hr flu that people hate but don’t put much meaning into.  No one died or lost a limb and most have much more interesting things to think about…hopefully.

I learned that

  • Messages get lost unless carried by the audience.
  • Interpretations drown messages.  If people choose misinterpretation,  good luck getting back on point.
  • People hear messages they expect no matter what you say.
  • Delivery becomes the message.
  • Poisoning the well works!

“Those who know do not speak.  Those who speak do not know”

Lao Tzu in Tao Te Ching.

But when does silence support atrocity?  At some point, silence can foster dysfunction. Society improves by speaking truth to power.

  • How can we encourage ‘people of good conscience’ to speak out against oppressive social structures and tyrannical thinking?
  • How can we empower those best able to speak to issues while protecting them from pillory and calumny?
  • Maybe hard questions need, once again, the cloak of anonymity and pseudonyms?

Silver Lining

Neuroplasticity says old dogs can learn new tricks (see The Mind And The Brain: Neuroplasticity and the Power of Mental Force).  We embrace mistakes – eternal possessions – and the humility in forgiveness given and received.  We appreciate relationship and the confidence of those who know us, imperfect frail people.

So, do not lust for going viral…even just a little bit viral.  You might get what you wish for.

“All tyranny needs to gain a foothold is for people of good conscience to remain silent.”

Thomas Jefferson.

PS Please stop reading…nothing more to see here…really boring stuff…

(photocredit: jessicaannmedia.com)

Healthcare Ecosystem – Wild & Messy

ecosystemAt coffee my brother-in-law, an architect, asked

“What describes an ideal healthcare system?  An airport? Airline?  A factory?  Something else?“

I paused.  He’d probably heard the healthcare-is-like-the-airline-industry line before…

“An ecosystem,” I said.  “Everyone loves to compare healthcare to  airplanes. You fly a plane over and over to figure out the safest, most efficient way to do it.  But healthcare is messy, relational, contextual.  Air travel serves people in high risk situations, but the similarity ends there.“

Pundits often complain, “If only healthcare could behave like airlines and embrace safety and protocols…”   Healthcare procedure should be as certain and precise as flight schedules.  Steve Harden starts his Never Go to the Hospital Alone: And Other Insider Secrets for Getting Mistake-Free Health Care from Your Doctor and Hospital with airlines and crashes.

Our love of precision might explain why patients love lasers.  Laser-anything adds credibility.  Laser surgery, laser vein treatments, laser smoking cessation…(what?)  Lasers aren’t new, but they sound precise, exact.  Humans crave certainty.

Ecosystems defy certainty.  Impossibly interconnected, ecosystems teeter such that change to one variable impacts everything.  Raise the water level and you flood burrows, nests, and change spawning beds.

Healthcare Ecosystems are

  • complex
  • interrelated
  • adaptive
  • resilient to some changes
  • delicately fragile to others
  • non-linear
  • dynamic
  • unique

Healthcare serves individuals from different communities with peculiar risk factors, varied social supports and unique genetic material.  While patterns exist and outcomes should be measured, healthcare will always resist the amount of control desired by bureaucrats and analysts.

Many physicians crave precision, too.  They see improvement with checklists (see The Checklist Manifesto) then apply lists to everything.  They find protocols improve outcomes and decide every patient needs the same treatment for diagnosis, all the time. It appeals to pundits in love with tick-boxes, check-lists and airline analogies.

Healthcare will never squeeze into rigid process because people don’t.  It will always defy utopian ideals of uniformity and certainty.  As tax dollars run short, healthcare gets asked to perform more and more like an airline or factory.  We need to remind planners and pundits that healthcare is an ecosystem, wild and messy.

(photocredit: movethechannel.com)

Organizations Help Patients?

stk120469rkePeople help patients.  Organizations, governments, unions and associations may or may not help patients.

Nick Nanos, Canadian public opinion pollster, lectured that the public holds very high opinions of healthcare workers as individual providers – as nurses, therapists, physicians, etc. – but not so high opinions as members of a particular union, association, organization or party.

I published a post yesterday about how unions do not help patients; people help patients.  Regrettably, union members missed the point and read it as being anti-provider, as though union = provider.  I took it down.

We need to debate whether the labour movement helps patients.  Columnist Jeffery Simpson in his book Chronic Condition takes aim at nurse and physician organizations:

“Nor can they [hospitals] break union rules that make surgeries happen to fit the convenience of providers instead of patients…A system that boasts brilliant surgeons…accomplished staff, wonderfully furnished facilities but uses them only a fraction of the available time in the face of unmet demand is a system straitjacketed by ideology.” p. 41

“The health-care system, being largely public, suffers from something called Baumol’s cost disease, named after the economist who demonstrated that wage growth eclipses productivity improvement in the public sector.” p. 214

We need to ask and learn how to debate:

  • Do powerful nurse unions and physician organizations help patients?
  • Should healthcare providers ever go on strike?
  • How much do union generated activities (grievances, etc.) cost?
  • Do raises delivered by arbitration cause lay-offs and decreased access to care?
  • Do unions and organizations foster the right attitudes for patient care, or the opposite?
  • Are leaders in public organizations free to implement change or are they ‘straitjacketed by ideology‘?

We need to have adult conversations about what prevents patients from getting the care they need.  We need to learn how to separate ideas from our personal identities.  We need people who can discuss big ideas without attaching themselves or their local workplace to the discussion.  If we continue to let personal outrage control Medicare, we will never innovate.

Medicare desperately needs innovation on the big ideas and people courageous enough to engage them.  It would be helpful coming from people working on the inside.  How about you?

Please leave a comment!  I cannot post comments from deleted posts (gone with the post!) as some have requested.  I love to hear from folks who see things differently.  Looking forward to reading your comment!

(photocredit: thewinanews.com)