Shawn Whatley, Author at shawn whatley md

Medicare: We Want a Quiet Life, But Need Disruptive Change

Leaders facing dysfunction must make tough decisions. Too often, they unconsciously choose consensus. They talk. They argue. But, they rarely hold convictions that require extended engagement. Usually, they think and speak the same as other leaders in similar roles.

We long for a quiet life. We seek harmony and peace over rigour and truth. We find conviction bothersome, disruptive.

These days, people tolerate opinions as long as they sound mainstream. We forget how to debate. Desire to engage and debate is thought unsociable, even uncouth.

Change requires vision, conviction. Conviction requires thought and opinion. Opinions need to be discussed and debated.

Status quo survives on compromised consensus.

We need leaders to debate healthcare: front-line care, middle management, and overall system governance. We need articulate convictions presented from all angles. For too long, Canadians have valued peace and quiet over progress and excellence. We stopped doing the hard work of engaging in change, of improving our system.

It’s like we designed a system to provide very high frequency television (VHF), with ‘rabbit ear’ antennas, and expect it to handle modern communication: online movies, video streaming, high definition TV, cable, PVR,…everything.

Medicare remains fundamentally unchanged for 40 years: just bigger, more expensive, and more wasteful. The basic structure of Medicare is the same providing first-dollar-coverage for all medical services. Our feeble response to change has been to add more management, more bureaucracy, and more unions.

We must re-learn how to debate, and we need men and women of conviction to tackle healthcare, with will and determination. Compromised consensus must go.

(photo credit: tvlift.com)

Overregulated Medicare Stifles Innovation

Renovation nightmares entertain us on TV with stories about incompetent contractors working without a license, permit, or inspection. It scares us into believing only government regulators can protect us.

Devotion to government regulation pervades Canadian thought. Our respect for institution and authority makes us believe that bureaucrats and politicians know more about service than industry professionals. We think regulation and inspection keep us safe.

Long before our overreliance on government, tradesmen, professionals and merchants formed guilds and associations. They created cutting edge standards to identify the best in their industry. Standards helped customers identify tradesmen and professionals who operated by a higher set of values.

Members applied to guilds and associations voluntarily. Membership outlined qualifications and performance. Loss of membership ruined reputations and income. Over time, most guilds became bloated and wasteful, out-living their usefulness, but many influential associations survive today.

Canadians live with unreasonable faith in big government to provide and regulate healthcare. Governments disappoint with cancelled hydro plants and mismanaged air ambulances, yet still we hold faith that big government will meet our healthcare needs.

Guilds have a vested interest in promoting innovation and excellence. They want progress.

Government appointed regulators have a vested interest in preventing change, maintaining the status quo. They want to crush outliers.

Guilds push the performance bell curve to the right; regulators keep the bell curve narrow, tall, and fixed.

Government regulators, by their very nature, cannot drive excellence and change. They exist to limit variability. They limit progress and adopt change reluctantly, years after everyone else.

Without excellence, average is terrible. Only a heavy right hand side of the performance bell curve can make average tolerable.

If we want a truly great healthcare system, we need government to step back and provide space for professionals to make it happen. It’s time for us to break faith with over regulation and make room for innovation and excellence.

(photo credit: blogs.telegraph.co.uk)

Medicare Dilemma: Equality or Excellence, But Not Both

Who wants average healthcare? We want the best for our children and loved ones, not average. Canadian Medicare can never deliver excellence, because it’s made to deliver equality.

Excellence does not occur by chance. We design systems to produce and reward excellence. But, Medicare hates reward based on performance.

Medicare delivers equal pay and equal performance, but not excellence.

Most big healthcare organizations are unionized in Canada. Unions discriminate on seniority; the longer you work, the more you make. Volume or quality of work does not change unionized income or job status.

But, we DO discriminate by punishing the very lowest performers. Gross negligence will get you fired, or sent for remedial training.

So, more accurately, Medicare just refuses to reward excellence. In fact, Medicare finds distasteful the idea that some perform better than average.

Every Olympic race has a few speedy people out in front, a pack in the middle, and a few of the slowest at the end. Medicare denies that bell curves exist; that there’s any race at all.

Excellence requires effort, exposure, and risk. Why reach for excellence to earn weak kudos from your boss and disdain from colleagues for making them look bad? Inspiring leaders can squeeze out extra effort, but always backed by the promise of rewards: better pay, better positions, or better intangible benefits.

When we remove the concept of excellence, all measures of excellence, and refuse to reward excellence, we leave nothing for management to lever. All that’s left is process and structure. Management defines work that needs to be done and relies on punishment if it’s not done. Punishment invites union scrutiny. Performance management gets tried, found difficult, and left undone.

Refusal to reward excellence drives revision to the mean. Everyone clusters around the average; the bell curve becomes narrow and steep…equal and safe.

When everyone’s performance is average, patients get average care. Unless we have unlimited budgets, excellence can never show up, except by chance or revolution.

Do we care about excellent patient care, or provider equality? In times of fiscal restraint, ideologic commitment to equality cheats patients of excellence by offering only average healthcare.

(photo credit: blog.ubc.ca)