I find myself in a very familiar spot, on the “balcony of personal reflection.” Now, I am not an authority on folklore, but throughout my life I have come to recognize that things tend to happen in threes. Therefore, our work here is incomplete. While we wait for a new ghost, let’s review how we got here in the first place.

Our conversations on the “balcony” were first spurred by the visitation of the “Ghost of Healthcare Despair,” a cynical, jaded and often fatalistic ghost that openly addressed the fragmentation within the healthcare system. Words were honed and bellowed forth with brute honesty. Insights were shared through twenty-two (22) essay discussions led by healthcare leaders pertaining to the state of our healthcare system, the foreseeable obstructions encountered and, most importantly, processes for change. We have not solved the issues that plague us, but by facing this ghastly ghost, we can break free from the despair and fear it yearns to instil. A reader’s comment said it best…“The analogy of the ghost is helpful to get readers to see what ghost they are holding onto.”

Next, we were introduced to the “Ghost of Healthcare Consciousness.” The ghost generated questions pertaining to perspectives and voices of patients, care providers and middle managers. This ghost was perplexed as to why people are often managed as though they are robots, devoid of desire, compassion, creativity and intelligence. Insights led to the development of twenty-two (22) essay discussions led by patients, care providers and middle managers. It was important to fill the “balcony” with different viewpoints from those often excluded from processes of change. Again a comment by a reader said it best…“We do need some leadership that is courageous and honest. The biggest problem, I believe, is that we have not discovered how to invite people with a real interest to change the situation - namely the patients that we are unintentionally harming. Until we make space for them at the table and then learn to hear what they are saying, not much is going to change. Of course it would also help if any initiatives we propose faithfully reflectthe nature of healthcare as a complex adaptive system.” 

Suddenly, a voice wafts over my shoulder.

“I am the Ghost of Healthcare Hope. I spend my days and nights observing, and at times it is difficult to remain hopeful. I have been subjected to my fair share of disheartening sights, conversations and contradictions within the healthcare system.

A lot of energy, time and resources are ingested by transformational plans which are designed to curb the inadequacies of current matters in question. The problem is that the delivery and execution aspect of the theory is most often shortsighted.

Is the healthcare system ready for well-defined change? I hope so.

I also hope the system is capable of comprehending or enduring bold future transformation.”

Let’s be more specific:

Imagine a customer-driven approach that emphasizes the continuum of services and health outcomes. Imagine an emphasis on seamless customer experience, elimination of gaps and consistent quality standards. Imagine an improvement in patient satisfaction while holding costs down. Imagine equitable access and public confidence. Imagine honest conversations about appropriateness and outcome variances.

Imagine passion, pride, hope, commitment, respect, trust, confidence, participation, abundance mindset and high morale being the characteristics instilled within all members participating in the system. Imagine a prevailing curiosity concerning what we know, and what we don’t know.

Imagine a NEW Healthcare Skills and Capacity-enabling Perspective:
Imagine intrinsic strategic execution, system-thinking skills, team learning, collective intelligence and problem solving. Imagine an integrated knowledge base of evidence derived from processes and outcomes. Imagine honed collaboration skills for achieving outcomes for patients. Imagine system-focused rewards and incentives. Imagine a common language framework for talking about, planning for and implementing change.

Imagine a NEW Healthcare Structural/Value-creating Perspective:
Imagine public health as an integral part of a system. Imagine primary healthcare as the focus and golden thread binding the system. Imagine interdependent services by independent silos that are focused on the needs of the system’s common customers and owners.

Imagine a NEW Healthcare Resources Perspective:
Imagine resources being allocated based on continuous capacity planning for needs and standards for appropriate access. Imagine a leveraged use of resources, evidence-based decision making, balanced budgets, complete transparency, strategic budgeting and governance oversight.

What goes on between people within the healthcare system, and interactions with those that rely upon it, will ultimately define what a healthcare system is and can be. The importance of this interaction was echoed by Roy Romanow: “the most important work in providing quality healthcare happens in every interaction that our citizens have with healthcare providers and the people working on the front lines of service delivery”.

The Ghost of Healthcare Hope returns…

“When you accept that you don’t hold all the answers, you open yourselves up to new ways of seeing.

My hope is these questions from It’s All About Me: The Personalization of Health Systems are asked over and over again:

1. Are you ready to reframe the citizen conversation and narrative from “what is the matter” to “what matters to you”?
2. Are you redefining success in terms of health and wellness outcomes that are valued by the population? Who needs to be part of this process? Is anyone missing?
3. Are you moving from the "provider as the expert" to the "person as expert”?
4. Are your care processes being shifted from “one size fits all” to “one size fits one”?
5. Are you competing or collaborating? Are you an expert in passive aggressive behaviour?
6. Are you joining the 21^st century in global knowledge exchange? Is information becoming more open and easier to access?
7. Are you working towards democratization of information to empower people to take charge of their health and wellness?
8. Are you learning from industry and customizing healthcare to the needs, expectations and values of the population?
9. Are you putting the population served in charge of defining value?
10. Are you measuring what truly matters?”

I invite readers to join my guests as we continue to create new dialogues. Over the next three months, with the help of the Ghost of Healthcare Hope, we will share, through observations and questions, potential building blocks for a future stronger image of healthcare.

Next week Leslee Thompson joins me in a conversation regarding the power of the patient voice.

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