How to Fix Healthcare: Let Leaders Lead

Everyone knows Canadian healthcare cannot continue without significant change. No one debates the need for it.

People Look at Two Things:

Inputs: funding, expenses, cost cutting, efficiency, policy change, contract negotiations, etc.

Outputs: quality, performance, results patients get from the system.

Inputs get most attention, but more sophisticated observers have started focussing on outputs. A few inside the system talk about ways to remove waste (LEAN, Gap analysis, etc.).

No one talks about control inside the system.

Funding Should Follow Governance

People make the imminent demise of our bloated healthcare system an issue of funding or spending, but it’s neither. Whether money comes from taxes collected by the government or ‘taxes’ collected by insurance companies, the issue is not about money.

The debate must shift from how money comes in to who’s in control of how money gets spent.

Everyone demands accountability from the system, but no one gives those in the system the freedom or authority to truly change outcomes. There are too many self-interested outside stakeholders trying to control the system all at the same time. They all think they know what’s best for patient care, but very few actually provide care.

Authorities make major decisions outside the system and then expect those within the system to operate after all the rules have been set; all the room to lead has been removed.

For example: the government negotiates contracts with nurses and then tells hospitals to be accountable to quality and efficiency within a contract that has zero productivity incentive.

We can still rescue publicly funded healthcare if we look at pockets of innovation where providers are given the chance to structure creative incentives that encourage clinicians to work differently.

We need to give the professionals inside the system a chance to show what can be done to improve patient access, quality, and service. You can’t demand accountability without giving people freedom to control and deliver what’s being asked of them.

Physician Influence: Not Just What You Say, But How You Say It

Physicians spend years learning how to make an accurate diagnosis with speed and clarity. They take decades honing their ability to pronounce treatment. Patients expect this and go to their physicians for the experience.

But, system leaders do not ‘go to the doctor’ for diagnosis and treatment. A physical exam approach with other leaders creates resistance, not change.

We need something different.

It’s elementary, my dear Watson…

Modernism prized clear, logical, concrete thinking. Telling it like it is, being straight forward, and efficient with words used to be something to model.

Today, people know that the ‘right’ approach isn’t always right, and ‘terrible’ outcomes aren’t always terrible. We live more complex lives now; life isn’t so simple; authorities aren’t always right.

Influence is more than giving the right answer. Physicians often pronounce their ‘diagnosis and treatment’ for the healthcare system and wonder at the lack of engagement from their audience. At a large meeting of physicians recently, members wondered whether they should ever speak up having had bad reactions to their approach in the past.

Ideas are useless if they do not effect change. If we can’t figure out a way to apply our diagnosis and treatment so that the system improves, we waste time and frustrate others. Influence starts with relationship, shared objectives, respect, and a commitment to work together.

It’s not just what we say, but how we say it.

(photo credit: http://files-cdn.formspring.me/)

How to Lead Using Complexity Theory in Healthcare

Healthcare fails when good people apply the wrong kind of solutions to the healthcare system.

This post highlights concepts that will improve your leadership using complexity theory. (see Edgeware: lessons from complexity science for health care leaders by B. Zimmerman, C. Lindberg, and P. Plsek)

Use a New Metaphor

Military and machine metaphors dominate healthcare thinking (e.g., cog, mesh, direct, follow, limit, leverage, tune, ramp up, etc.). These metaphors shape our solutions. Complexity offers something different:

Simple is like following a recipe to bake a cake: anyone can follow the instructions and get a good result.

Complicated is like sending a rocket into space: a team of smart people, improving process with each attempt, can figure out the best way to fly in space.

Complex is like being in a romantic relationship or raising a child: success with one is no guarantee of success with another.

Features of Complex adaptive systems:

Non-linear
Adaptive
Distributed control (central control slows system’s ability to react)
Size of input produces unpredictable effect (small input might create huge impact)
Large numbers of connections between a wide variety of elements

Leadership Principles

1. Focus on Minimum specifications / Good Enough: Don’t even try planning all the details before you start; it’s impossible. Get a clear enough sense of the minimum needed and get started.

2. Find Attractors: Learn which patterns or areas draw the energy of the system. Imagine how to attract a bird to leave your room vs. How to roll a marble down a track.

“Complexity suggests that we create small , non-threatening changes that attract people, instead of implementing large scale change that excites resistance. We work with the attractors.” p. 11

3. Get Comfortable with Uncertainty: Solutions need to be rapidly adaptable. They must be comfortable with both data and intuition, planning and acting, safety and risk.

4. Use Paradox and Tension: lead by serving, keep authority without having control, give direction without directives

5. Tune to the Edge: Don’t be afraid to stray from the centre. Go to the fringes for multiple actions ; let a direction arise.

6. Be Aware of the Shadow system: Gossip, rumor, informal relationships, hallway conversations

7. Use Chunking: Grow complex systems by connecting simple systems that work well

8. Mix Cooperation and Competition: don’t think either/or

(photo credit: www.nytimes.com)