Author: Shawn Whatley

Hospital Beds vs Bureaucrats

eric_hoskinsA friend’s dad scolded me years ago.

“Don’t ever say you don’t have time,” he said. “It’s a lie. You always make time for what you value.”

“Same thing for money,” he continued. “Don’t ever say you can’t afford something. You always sacrifice for what you want.”

Some grownups are really dumb, I thought. I can’t afford a motorbike. What’s he talking about?

As an adult, I realized the truth in what he said. We find time and money for what we value most.

Hospital Beds vs Bureaucrats

While voters hope logic drives tax spending, politicians just pay for what they value, what they promised to deliver. Government is not a business.

So when it comes to healthcare, what does Medicare value more: beds or bureaucrats?

Bureaucrats are generally smart, well-intentioned people who serve voters in good faith. Most people agree we need hospital beds AND bureaucrats. But how many of each?

Ontario closed 17,000 hospital beds between 1990 and 2013. Ontario has not cut a similar number of bureaucrats (If you know otherwise, please share it in the comments).

In Ontario, there are 1.7 acute hospital beds per 1000 people, ½ of the average for other OECD countries.

According to a recent presentation by Matthew Lister, there are 32,000 healthcare bureaucrats in Canada. That equals 0.9 healthcare bureaucrats per 1000 population. He also wrote about it in the National Post: Canadian Healthcare Needs to be Leaner.

Ontario has 1.7 acute care hospital beds per 1000 population.

And Canada has 0.9 bureaucrats per 1000 population.

Sweden has 0.4 bureaucrats per 1000 population. Australia has 0.255, Japan has 0.23 and Germany has only 0.06 bureaucrats per 1000 population.  Looking at it differently, Japan has 30,000 healthcare bureaucrats for 130 million people. Canada has 32,000 bureaucrats for 35 million. Does it make sense to have so few beds and so many bureaucrats?

Expensive Bureaucracy?

Steve Paikin of The Agenda asked whether $50 billion for healthcare was going too much to bureaucracy and not enough for health care in Ontario.

Others have said similar things:

Voters do not mind the cost of bureaucracy as long as public services perform. That changes quickly when politicians choose austerity.

Accountability?

Why does Canada have so many healthcare bureaucrats? Absent a convincing rationale, it seems politicians simply spend on things they value. And for now, they value bureaucrats, not hospital beds.

photo credit: thestar.com

Gen Y Changing Healthcare Associations

Doctors get away with comments about young people’s behaviour, motivation and performance. Similar quips about gender, race or religion would guarantee political suicide, if not formal complaints.

Author Sarah Sladek wrote two books about the next generation and how they change professional associations. Dr. Chris Jyu assigned Sladek’s books as homework and threatened to ask us questions about them.

With a huge grin he promised, “There will be a test!“

Chris does a great job as caucus whip for the Ontario delegation to the Canadian Medical Association general council.

The following quotes and thoughts stood out. They are raw, unedited and attempt to capture a sense of the general theme.

Book 1

Knowing Y: Engage the Next Generation Now, Sarah Sladek 2014.

Chapter 1

  • Association demographics are changing. We should pool or profile members according to what they value rather than by their demographic characteristics.
  • Too many associations are stuck in a rut and deliver the same old program.
  • Associations are built around traditions that cater to the needs, values and interests of baby boomers.
  • Generation Y hates to be sold anything and will actively research prices and read reviews
  • Gen Y expects exceptional service, values customization and remains detached from institutions.
  • They want easy access to information. They are not especially politically savvy but are very socially aware.

Chapter 2

  • Generation Y has become known for instant gratification.
  • It is a review driven, socially networked generation that hates to be sold anything.
  • It ignores advertising.
  • They take risks and bend the rules.
  • They value innovation, connectivity and convenience.
  • Generation Y values access over ownership. They like to be close to where they live, work and do business.
  • They will join your association to purchase access as opposed to owning membership.
  • They are not owners.
  • They value sharing. They don’t praise value propositions, but they do appreciate value statements that are intended for sharing.
  • Gen Y is driven by quality, popularity, price, adventure, tech connectivity, convenience, access and sharing.

Chapter 3

  • Membership used to be anyone who pays dues, however, Generation Y wants to have an emotional commitment or relationship with an association.
  • They want to be inspired by their involvement in the association’s work.
  • They tend to get involved when someone they admire invites them to attend. They need to feel energy within the association.
  • Membership must provide an opportunity to do something influential and meaningful. The outcomes of their work must be apparent.
  • They need invitation to continue to be in a relationship with the association.
  • The association and its leaders need to be forward thinking and be able to share their passion with Generation Y.
  • They are looking for relationships and relevance.

Chapter 4

  • Google built on the premise that people want meaningful work, knowledge of what’s happening in their environment and the opportunity to shape that environment.
  • There are only two ways to influence a person’s behaviour: manipulation and inspiration.
  • Great organizations don’t sell things; they stand for things.
  • We need to improve our membership experience.
  • The new generation is inspired by personal happiness.

We must understand that our association is in the service business.

  • We should focus on what we want to change.
  • Generation Y shares their opinions on just about everything.
  • They are willing to listen to a leader that offers a genuine, inspiring sense of purpose.
  • We should do what are members want not what we want.

Chapter 5

  • They have an extreme dedication to – and comfort using – technology .
  • Technology is a defining member benefit.
  • They must have a great digital experience.
  • Technology is expected.
  • They are drawn to convenience and connections with people not institutions.
  • They struggle to prioritize which job title to place on their LinkedIn profiles. They are serial entrepreneurs.
  • Associations tend to breed homogenous cultures.
  • We should consider a 360 degree view of our association. Many of Generation Y have unrelated pursuits which could make associations much more relevant and balanced.

Chapter 6

  • Generation Y is an experience generation and have created the experience economy. Consider Walt Disney World, Apple, Cirque du Soleil, Dave and Busters.
  • Experiences are more memorable and considered to be more valuable than goods and services.
  • Generation Y uses social media and will talk about their experience. Your association does not control the message anymore. Generation Y does.
  • Associations need to focus on creating great experiences, content, and opportunities that ultimately help people feel good about themselves.
    • For example Starbucks “Exists to inspire and nurture the human spirit – one person, one cup and one neighbourhood at a time.“
  • Great organizations exist to make the audience feel smart, important and happy.
  • Generation Y values sharing, inclusivity, interaction and wants to have something to talk about. They want to share, like, post, and retweet.
  • Generation Y tends to have great relationships with their parents, and they seek out the same relationships in their careers. Associations need to build meaningful relationships with their audience.
  • Association should seek to make a difference globally.
  • Generation Y wants to be involved with something bigger than themselves. They tend to value improving education, ending poverty and saving the environment.
  • They value community, positive change, and happiness.
  • The old way of hosting events: interruption, reaction, attendees, big promises, observers, and traditions.
  • The new way of should be focused on creating experiences. Engagement, interaction, fans, personal gestures, participants, and innovation.

Chapter 7

  • This generation is more comfortable with the idea that advocacy and governments cannot solve people’s problems.
  • Government isn’t the solution.
  • Generation Y puts being a good parent, having a successful marriage, and helping others in need as their top priorities.
  • An association should focus on the greater good and to engage members in the process.
  • Social entrepreneurs are action based, purpose driven, engage grassroots, build on relationships, use digital technology and communicate continuously.
  • Barack Obama demonstrated an excellent engagement of Generation Y.
    • He had a special logo with a clear call to action.
    • He used social media extensively.
    • A training and support program was set up through Camp Obama that included fellowships.
    • He highlighted volunteers at rallies.
    • He asked volunteers to perform specific functions whenever they engaged with the campaign.

Chapter 8

  • Kodak went bankrupt because it resisted change and possibly because it had the oldest workforce.
  • Associations will need to learn how to engage Generation Y as employees to. Why aren’t associations taking the lead to help prepare for this demographic shift in the workforce?
  • Associations are perfectly positioned to train and support.
  • Generation Y came of age in a recession and will find it difficult to bounce back. They carry large student loan debts bills, increasing responsibilities and are feeling stressed.
  • Associations need to meet these practical needs of their membership.
  • Generation Y demands more from employers.
  • Generation Y leads in evaluating people based on skills and performance not experience.  They tend to value quality over quantity.
  • They expect a very mobile career.
  • Gen Y wants to lead and are entrepreneurial.
  • Leadership training and coaching could be a valuable offering from associations.
  • Knowledge does not offer a competitive advantage anymore. Critical skills include vision and foresight.
  • Work before Generation Y was based on experience. It was controlled, long term, ladder driven, including stability and tradition.
  • After generation Y, work will be based on skills and performance, transparency, short term, project driven including change and innovation.
  • What is the average age of our membership?

Chapter 9

  • Zappos shoes was built on an outstanding customer experience. Generation Y wants something that’s meaningful, motivational and memorable.
  • Associations need to ask
    • Why did our association organize in the first place?
    • What can we do to keep our why relevant to generation Y?
  • Generation Y wants to know how our association makes a difference in their lives and the lives of others.

Chapter 10

  • Over the next 30 days association leaders should spend 30 conversations with 30 different people between the ages of 19 to 32. We should not assume we have all the answers.
  • We could ask Generation Y the following questions:
    • What organizations do you admire and why?
    • What are your greatest professional challenges?
    • If you could create an ideal association experience what would it be like?
  • We need to ask why our association exists. We also need to ask what can we do to keep our Why relevant considering all the changes and opportunities that have emerged with Generation Y.
  • Associations need to find out where service could be vastly improved. We should ask, Are we investing in the right things?

Book 2

The End of Membership as We Know It: Building the Fortune-Flipping, Must-Have Association of the Next Century (ASAE/Jossey-Bass Series) 2011

Chapter 1

  • For years, membership associations were like monopolies and dominated their culture.
  • Technology and demographic shifts force us to change.
  • There is an increased demand for work life balance.
  • There’s been a societal movement away from conformity towards individuality in in the past.
  • Younger people seek and demand a return on membership it includes tangible Member Services, high levels of accountability, identifiable career advantages, a sense of professional community and opportunities to serve within the associations.
  • Associations need to have a definable niche with expertise. Younger generations are driven by personal happiness. Associations must eliminate negative and accentuate the positive.
  • Associations must be able to prove their worth if. Younger members are associating themselves with a cause and want to be inspired to make a difference.
  • Networking is not a member benefit.
  • Know exactly how your association brings value.
  • Determine your cost to value ratio for membership.
  • Guarantee a return on membership investment with specific outcomes.

Chapter 2

  • Many in associations refuse to change until the end is facing them.
  • Leadership of at-risk associations can sometimes adopt an entitlement syndrome believing that the problem really isn’t as bad as it seems. They often blame someone else for the association’s decline.

Chapter 3

  • Focus on the outcomes of membership.
  • Young members want much more then a listing to a car directory.
  • They need practical solutions to problems.
  • Track the return on investment for membership.
  • The secret to your association success hinges on member benefits.
  • You must solve a problem for members.
  • Make your members more successful because they are members.
  • The under 45 crowd does not care about your associations history, insurance discounts and annual conference.
  • They want to lead learn and an opportunity to make a difference.
  • Generation X & Y will sit on the board for a shorter time with the intention of doing something that makes a visible difference. It should be enjoyable and rewarding. If not, they will move on.
  • Associations should expand the professional development offerings.
  • Baby boomers sometimes referred to as the Me generation sought to gain accomplishments and material possessions. Generations X & Y put salary and prestige behind a great work-life balance.
  • Survey members or host focus groups.
  • Take a serious look at what you offer. it needs to be the most valuable, exclusive, problem-solving, people-loving membership you can offer.

Chapter 4

  • Generation X puts more demands on the organizations they support.
  • Generation X & Y are turned off by hard pressure sales.
  • Younger generations hold all the power. Whether you realize it or not, they have the power to make or break your association.
  • People don’t really need associations to build relationships anymore.

Chapter 5

  • Associations must relinquish control.
  • Younger members don’t want the same old hierarchy.
  • They don’t want to come to a program, watch a speaker present, and then leave.

Chapter 6

  • Associations could consider five different types of membership models.

Chapter 7

  • Your association leadership must define with absolute clarity your association’s reason for being and its nice.
  • What differentiates your association from its competition?
  • Determine your guarantee.
  • What is your core benefit.
  • Focus on outcomes not features.
  • Measure success whenever possible.
  • Target your market.

 

How Doctors Can Fix Healthcare

Parliament-OttawaPeople 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:

  1. 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.
  1. 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.
  1. 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.

  1. 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