Insights (Essays)

Insights (Essays) July 2014

World Cup and Posing the Wrong Questions

Hugh Macleod

Soccer as a metaphor for healthcare

Consider this . . .

  • The soccer ball is round, it rolls, it bounces it is always in motion.
  • Soccer is an organic game. It is a fluid ever moving web of conversations, decisions, teachable moments/learning between players of the same team and the other team.
  • Soccer is all about learning in relationship. In soccer the relationship between the players is what creates the win or the loss.
  • Soccer has a COACH.
  • Soccer is about building the right team, constant practice, studying yourself and the other team, learning from failure, repeating/fine tuning what works and abandoning what does not work.
  • Soccer is about executing a game plan, recognizing the unpredictable, harnessing the emergence of unplanned opportunity and seizing the moment. It’s about creating momentum first.
  • Soccer players find themselves in a complex game situation where a map is useless. There are game rules and rules of conduct for fairness and safety, but due to the circumstances within the play, their pre-game map is insufficient.
  • The outcome of the game is unpredictable and uncontrollable. The whole situation on the field is self-organizing and non-determined. No one in the bleachers or on the field knows how the game will be played out or what the final score will be.
  • Soccer players self-organize according to the micro-interactions between, within and among them in the living present. Constraint as power and free will are inherent within their interaction and participation.
  • There is also micro-diversity and fluctuations in how players experience and find meaning within the competition. Because constraint and freedom, articulated as conflict and cooperation, are simultaneously acting on the play action, the game is held within a paradox of stability and instability at the same time.
  • The future of the game is continually under construction in the living present due to the political, social, physical and psychological freedom players bring to their micro-interactions and participation. The dynamic of the game is emergent within the context of micro-diversity and small fluctuations in play.
  • Soccer players continually choose and intend for themselves in each lived moment at play. Being seasoned players, they recognize the emerging patterns of play; they differentiate between similarities and differences from other soccer games.
  • The patterns that they are acting within are emergent, arising from all players’ continual interaction. And, these patterns of micro-interaction are continually forming and being formed by themselves. Essentially, all are engaged in a process of simultaneous intuitive and reflective practice: that is, they are sensing and reflecting on and in each play – participants and observers at the same time.
  • Meaning, choice and intention all emerge in the living present. Therefore, teammates and teams are continually forming the game while being formed by it, perpetually constructing and reconstructing the future.
  • No one player can decide for another or for his team. But, the interplay of expertise, diversity, power, constraint and interaction has the potential to produce unexpected and often unwelcome outcomes. The centrality of self-organizing interaction causes new, novel variations to emerge within the game action and potentially the game of soccer itself.
  • As every player is choosing for himself alone within the play action, another paradox inheres: every player is simultaneously in a process of continuity and change, as are the teams, coaches/managers, spectators and game.
  • In essence, each player and team is in a place of potentiality wherein their individual and collective identities and differences are being continually expressed, but with no guarantee of continuity or transformation of those identities. If transformative change occurs, the players and the teams remain paradoxically the same, yet different.

Soccer, like healthcare, involves a lot of running around often without clear outcomes. Games are usually low scoring. Recent global studies suggest Canada scores low on multiple indicators. Fans, the customers take the game of soccer seriously. To the point there are riots in the stands by those backing one team. Our healthcare customers are passive but becoming restless. Our healthcare players have become experts at passive aggressive behaviour to protect the status quo. Healthcare has various interest groups calling for either the saving of Medicare or the scrapping of it.

Redesigning a healthcare system with its complex organic properties, powerful interest groups, political game playing, is more challenging than the transformation of the auto sector, housing sector and the financial sector combined.

If you look at a health care map, you will see an aggregate of isolated institutions. The problem is that most health system leaders at the governance and managerial levels view themselves as “governors or managers” – not as “system architects or system designers” focusing on the public interest, as well as their organization’s interest. The role of government should be that of an architect, through the creation of sound healthcare policy not as a manager. The delivery system on the other hand should be an “accountable” operator and innovator within the architecture set up by the government. This is a very different way of thinking about a service delivery system that has traditionally been designed by politics, not evidence about what works. This has for many, created a status quo mindset as the preferred route in healthcare.

There is no single “Game Book” outlining the steps to follow to guarantee successful reform. Why? Because every province and territory has its own history, plurality, community, state of readiness and most importantly, recognition that a healthcare system is a reflection of their values.

Learnings from the Global Financial Meltdown

The global financial meltdown that we are slowly emerging from has raised new conversations in corporate board rooms about return on investments, outcome not outputs, consumerism, ethics, codes of conduct, public transparency, baseline measurements, quality improvement, risk management, third party validation, rewards and consequences, etc. Why is it that the powerful interest groups whose board of directors come from the corporate world, lobby hard to maintain the status quo when it comes to healthcare? What are they afraid of losing? How many healthcare related organizations, both private and public, thrive off of the lack of transparency, consumer value consciousness, accountability for costs, tracking and reporting to the public on health outcomes including safety?

Three observations:

  1. The healthcare system should be organized around the different patient groups not professions and bricks and mortar. In an environment characterized largely by chronic disease, this is the only reasonable way to coordinate and integrate care delivery.
  2.  Politicians shouldn’t debate individual cases, they should get objective evidence based on transparent advice regarding what to do and leave the doing up to the managers.
  3. Often fixes fail because a final plan becomes a negotiated settlement at the lowest common denominator. The focus should be on common areas of real value creation: transparency, reduction of variation, greater coordination across the continuum, use of evidence and obligations of the citizens themselves not to abuse the system or their personal health status, etc. This will raise necessary conversations and questions about bilateral accountability.

More Money Mantra

Data from multiple sources paints an alarming picture. Are we using our money wisely? What are the health outcomes for the investments? Why do we have such a variance in care, spending and outcome performance by province, by geographic area? The architects need to ensure that the assumptions underlying their long-term plans reflect both the real economics of the market and the healthcare performance outcomes of the provider organizations.

Ask the Right Questions

If you agree there is no "status in the quo", leave you with these questions. Can deeper government involvement lead to: universality, accessibility, without compromising the good things like personal choice and access? Are these two really reconcilable or are these the trade-offs? Are we willing to make them? This takes us back to the first beginning of this essay… “Every Healthcare System is a reflection of its Values”.

About the Author(s)

Hugh Macleod…Concerned Citizen

References

MacLeod, H.B., Kitts, J. 2013. Shaping Canadian Healthcare Alignment. Longwoods Ghost Busting Essays.

Meuser, E. MacLeod, H.B. 2013 Lessons from the Stanley Cup Playoffs. Longwoods Ghost Busting Essays.  

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