How to Fix Healthcare: Let Leaders Lead

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

Popular solutions include:

– Build a hybrid or blended system

– Pay doctors and nurses less; put them on salary

– Limit services provided

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.

 

Dreaming of Patient Appreciation Events in Public Healthcare

Love our patientsWhile waiting for a complementary movie to start at a huge patient appreciation event, I read a few pages of Andre Picard’s new book on Canadian healthcare: The Path to Healthcare Reform.  

My kids’ orthodontic clinic puts on an annual patient appreciation event renting out an entire Cineplex centre showing 2 popular movies on 12 different screens.  The clinic staff serve popcorn and drinks and host a Christmas food drive at the same time.  A few thousand kids and family show up to enjoy the event.

Before the movie starts, the staff get up in front of each packed out theatre to tell everyone how much they appreciate being part of our lives.  And they mean it!

Picard’s book provided a stark contrast and suggestions for change.

Patients in Publicly Funded Healthcare

Public systems see patients as costs, not customers.  Many view them as entitled expenses in an inefficient, union dominated, government-run, tax-funded system.  For many providers, life would be great if it wasn’t for all the patients.

Imagine the 200 providers of a large Canadian emergency department volunteering to host a patient appreciation event.  Could you see them talking with patients:

“Thanks so much for coming to our department!”

“We are so honoured that you chose us to help out when you needed it.”

“We wanted to give back just a tiny bit of what you’ve given to us.”

“We know you could have gone elsewhere.  Thanks for choosing us!”

“Because of you, we have great jobs!”

Pretty far fetched?

In Canada, we risk seeing patients as undeserving recipients of our altruism.

What needs to change?  How can we put patients back at the centre of the system?  (I’ll share my thoughts in the next post.)

(Photo credit: http://www.divinedentalworks.com/)

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

Sherlock Holmes

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/)