system Archives - Page 3 of 6

Medicare Without Debate Will Fail, From JS Mill

We weaken Medicare by refusing to debate it. When’s the last time you saw opposite opinions on healthcare presented fairly, without bias? Silencing contrarians does not protect our system. Suppression of opinion creates thoughtless prejudice.

JS Mill gave 3 reasons to stop suppressing debate in, On Liberty, 1859.

1. Suppressed opinion might be true.

“The opinion which it is attempted to suppress by authority may possibly be true.”

“All silencing of discussion is an assumption of infallibility.”

2. Refuting contrary opinion reveals truth.

“Complete liberty of contradicting and disproving our opinion is the very condition which justifies us in assuming its truth for purposes of action…”

“Truth gains more even by the errors of one who, with due study and preparation, thinks for himself than by the true opinions of those who only hold them because they do not suffer themselves to think.”

“The fatal tendency of mankind to leave off thinking about a thing when it is no longer doubtful is the cause of half their errors. A contemporary author has well spoken of ‘the deep slumber of a decided opinion.'”

3. All conflicting opinion holds some truth.

“…Conflicting doctrines, instead of being one true and the other false, share the truth between them, and the conforming opinion is needed to supply the remainder of the truth of which the received doctrine embodies only a part.”

“Truth, in the great practical concerns of life, is so much a question of the reconciling and combining of opposites that very few have minds sufficiently capacious and impartial to make the adjustment with an approach to correctness, and it has to be made by the rough process of a struggle between combatants fighting under hostile banners….”

“Not the violent conflict between parts of the truth, but the quiet suppression of half of it, is the formidable evil; there is always hope when people are forced to listen to both sides; it is when they attend only to one that errors harden into prejudices, and truth itself ceases to have the effect of truth by being exaggerated into falsehood.”

Mill makes a final point: “…truth; unless it is suffered to be, and actually is, vigorously and earnestly contested, it will, by most of those who receive it, be held in the manner of a prejudice, with little comprehension or feeling of its rational grounds.”

Silence

Politicians fear losing votes, providers fear losing their jobs (or promotions), and voters fear losing medical insurance by allowing debate on Medicare. With Medicare using 50% of tax dollars and growing at 6.5% per year, will this change before it’s too late?

(photo credit: images.betterworldbooks.com)

Enough Engagement, Healthcare Needs Partnership

Engagement is over-used; we don’t need more of it. We need partnership, not engagement. Leaders want supportive followers, but do not want to give up command and control for partnership.

Engagement

Leaders talk about people being engaged, how to engage, lack of engagement, and otherwise use engagement to explain all kinds of operational failure and success.

Engagement, for leaders, means interested, positive followers. Interested, negative people are labeled irritants, not engaged. Leaders love engagement, but change requires more.

Partnership

Peter Block writes that partnership is

Exchange of purpose
Absolute honesty
The right to say No
Joint accountability
No abdication of responsibility

Engagement means support for a pre-defined purpose. Partnership exchanges and builds purpose together.

Staff engage, but hold back criticism or gossip, whereas partnership demands absolute honesty.

Partnership gives others the right to say No. It requires vulnerability, humility, and willingness to give up command and control.

Followers enjoy complaining about leaders’ decisions no matter how much they engaged. True partnership eliminates complaint through joint accountability.

Engagement fizzles when parties walk away. Partnership means parties keep their commitments.

Medicare needs partnership

Government needs to embrace partnership, and providers must follow through in all it demands. True partnership would lessen the turmoil of election driven change, allow us to build on success, and create meaningful change for patients.

(photo credit: smallbusinessbc.ca)

Myth: Physicians Lead Medicare

Bureaucrats and nurses lead Medicare. Aside from a few CEOs, and a smattering of administrators, physicians do not lead Medicare. Most of the MDs in hospital admin positions do not have signing authority, cannot hire and fire, and have no budget.

If we include all paid leadership positions, non-physicians out-number physicians by at least 15:1, if not much more.

Physicians bear final responsibility for medical care. Until we figure out how to give other providers final responsibility, physicians should represent at least 30-50% of paid, senior leadership positions.

We need to train physician leaders and attract them to take leadership positions. Physicians won’t apply for leadership roles for a fraction of clinical earnings.

40 years ago, Medicare bureaucrats assumed leadership and fought physicians for control when necessary. This must change. Medicare will not run well without physicians holding many of the top positions. I said ‘many’, not ‘all’.

Once we create opportunity, physicians must not abrogate their responsibility to help run the system. Physicians need to value system involvement and not see it as ‘going to the dark side’.

Patients assume physicians run hospitals. They stare in disbelief when they hear physicians have almost no role in administrative hospital function.

Without a majority, or substantial portion, of physician members, leadership teams avoid decisions that might anger medical staff, or they make poor decisions for lack of physician leadership input.

Physicians do not lead Medicare; the myth has to change.

(photo credit: net.acpe.org)