How do they get birds out of Costco?
My kids love to see birds fly around the warehouse. Costco must hate it.
No doubt, birds in Costco break a list of public health rules.
There are three ways to get birds out of a warehouse: kill them, trap them, or encourage behavioural change (see more here and here).
The first two options offer military solutions: dispatch or take custody. Neither approach works well with humans, outside of war or totalitarian control. Does government know this?
Behavioural Change
All leaders work to influence behavioural change. Everything else that they do is wasted effort or should be done by someone else.
Leaders work to change behaviour, not to write policy manuals, discipline protocols, or to file reports to regulators.
Leaders must understand behavioural change, or they are not leaders.
People in positions of leadership often do not understand what they are supposed to do and have no idea how to get it done.
Impossible to Manage
Humans find ways to break rules and turn the most well-intentioned incentives into perverse behaviours.
We can follow the letter of the law but deny its spirit.
We cannot be forced to act, any more than we can think or believe as instructed.
Humans are frustratingly free and complex.
Only people with damaged brains think, believe, and act exactly as told.
Given people’s tendency to make up their own minds, how can leaders change behaviour?
Not Rocket Science
It’s actually quite simple, if we think like a pre-teen. How does an older sister get her brother to play along with something he does not want to do?
She could offer a bribe, but that often ends poorly.
Her brother is young, not stupid. The bribe becomes a quest. He will anchor on the bribe and negotiate to the death. His sister will sacrifice more than she hoped for, or abandon the task.
Every older sister figures out how to manger her younger brother shortly after she learns how to skip rope. If we asked, she would tell us:
First, you need to catch your brother’s interest. Show him something shiny or dangerous.
Then, build on the excitement and invite him into relationship. Hint at the opportunity for more, bigger, shiny things: This sets the hook.
Invite him on a quest. Build a description of the destination together, in vivid detail. Let him shape what the destination looks like to him.
Set him loose with a title and a mission to accomplish.
Then, work together, offering encouragement and praise until the job is done. Remind him of how fun this quest was the next time you need him to do something.
Doesn’t government know this? They find doctors impossible to manage because they forget the basics. They should try to the following:
Catch doctors’ interest: show them an opportunity to fix a patient care problem that frustrates doctors, not accountants or Ministers of Finance.
Build on the interest by fostering relationship. Hint at the opportunity to solve bigger problems together.
Invite doctors on a quest. Let doctors shape and define the destination together with government.
Empower doctors to tackle the quest. Encourage them. Give them the materials they need to get the job done.
Work alongside doctors until the job is finished.
Offer praise liberally. Hint at the next exciting job to tackle.
Is this too simplistic? Probably, but that’s the point. It’s so simple that doctors can see what’s going on. Politicians should want doctors to see through what government is doing and get excited about it.
Politicians need to build trust with dozens of small projects before trying to change all of primary care at once, with something like Bill 210 (see Will Medicine Survive in Ontario).
Entice Change
Birds fly out of Costco when someone attracts the birds to leave. The only other way is to trap or kill them.
Government, regulators, and system managers need to take a new approach to ‘managing’ physicians. Regulatory and legislative traps do not work. System leaders cannot manage doctors like the military. They must entice docs to change. All other options kill doctors’ professional spirit.
photo credit: pbs.org
The problem is the utter contempt and mistrust that the government has of physicians, in general, because they cannot manage them the way they want.
Unfortunately, the media has little understanding of the complexities of the relationship between government and physicians and simply parrots the government lines with splashy stories and front page headlines. This has the effect of diminishing the trust that patients have in physicians.
Effectively, this relationship is circling the drain…something has gotta give or we are going down that drain together…
As usual, I think you are correct. It sure feels like ‘utter contempt and mistrust’ most of the time. Media needs information for their stories. Government has an army of propagandists ready to share ‘facts’. The OMA also has a group of experts, but the media believe the government (assuming it’s a Liberal government) is less biased.
I also agree that something has to give. Even if/when we get a good relationship, I am not convinced relationships can prevent an underfunded system from circling the drain.
Thanks so much for sharing your thoughts!
Shawn
Unfortunately I don’t think any of these points will carry any weight with Wynne or Hoskins. I have come to believe that Wynne has her own personal vendetta against doctors and intelligent reason and leadership has little to do with her actions. And, given her performance in other areas of “managing” (I use the term loosely) this province, by bringing doctors into the solution process she would cut out any opportunity to place her cronies into well-paying positions of power – e.g. LHIN’s and sub-LHIN’s. The more layers of administration, the more opportunity to “seed” the system with those who will dance to her tune. I honestly don’t believe she cares much about an effective health care system. And sadly, that puts doctors, hospitals and other segments of the health care system in a very precarious position – not to mention patients.
GREAT comments, Valerie!
I don’t think anyone could disagree with you.
Thanks for sharing this!
Best
Shawn
Frustrating how people preech what they dont understand. People sitting in their offices with guaranteed high pension and decent salary with clean nice environment with no hazards try to force doctors to do more and put the blame on physicians for shortcomings of thier bad management. The system will fail sooner or later due to poor political management.
Multiple layers of management creating data to justify the existance of their jobs and adding to the costs of health care system. Majority of people working in our health care system are on salaries working under unions protection with no accountabilities for mistakes delays etc
Doctors are very frustrated with foul mouths talking about physicians.
Wow. Very clear. Well said indeed!
The only way to improve our system is to remove the bureaucratic bloat. Doctors are a strange breed of smart, hard-working, driven people who will go to the end of the earth for their patients when system incentives are aligned to do so. Right now, the system has been set up to make everyone incentivized to work at cross purposes to maintain rationing of care. If everyone pulled in the same direction to benefit patients, the system could not afford all the care delivered.
Thanks so much for taking time to share a comment!!
Shawn
Medical doctors respond to authentic leadership , they get inspired and so become motivated.
Managers ,in the soon to be imposed Patient First Bill, will be overseeing their medical doctor widgets , cudgel in hand, to ensure that they achieve the manager’s and the system’s goals which will only generate resentment and animosity which will guarantee that the goals will not be met.
As always, Andris, you see through this to the conceptual level . I don’t think that even the managers understand their faulty vision. They’ve been raised and trained to think that they need to manage people who have more expertise and training than themselves.
When will we wake up from this dream?
Thanks for taking time to share a comment!
Shawn
Shawn, a very thought provoking post!
Playing off the military management theme, there is a very relevant quote attributed to Rear Admiral Grace Hopper: “You cannot manage men into battle. You manage things; you lead people”
In your post you’ve clearly outlined the difference between a leader and a manager. So long as the ministry and the LHINs keep thinking of us as cogs in a machine or resources to be managed, any plan they create will fail. What they actually need to do is show some leadership.
And you’re absolutely right that that begins with building trust.
The people running the health care system should ask themselves if they can actually influence and inspire the majority of physicians to achieve the “patient first” goals without resorting to legislation. If they cannot, I have serious doubts that they deserve to call themselves “leaders” at all – and that makes them extraneous.
Well said, Alex!
I love the quote, too. We will see how long it takes for the MOH to figure it out, if ever….
Thanks so much for taking time to read and share a comment! For some reason, my notifications of new comments have turned off with my latest upgrade. I end up missing comments for days. Sorry!
Best regards,
Shawn
As a physician working in a province where a doctors’ strike 50-odd years ago has poisoned relations with government ever since, I will attest to the difficulties we face in our attempts to promote positive change. However, to paint administrators as “the bad guys” and physicians as “the good guys” seems just too simplistic.
So let’s stop moralizing and get on with the hard work of leadership. We will find there are people who really do want the best for our patients, and who do not devalue the work we do. But that will require a little bit of humility.
Thanks Randy!
After many years in administration at a very large hospital where we achieved province-leading improvements in wait times, I have worked hard on the inside. Also, I have almost 15 years serving in medical politics. I am sorry you find this note to be moralizing…only offering a perspective. Thanks so much for offering yours!
Best regards,
Shawn