Essays

Essays April 2015

The Patients Will See You Now, Are You Ready?

Hugh MacLeod

A thread running through the Ghost of Healthcare essay series is…today’s healthcare leaders must not only lead well, but also lead differently. That means accepting a shift in the drivers of the health system from care providers to consumers, from hospitals to primary care, home care, community care and a shift from emphasis on downstream acute care to upstream prevention and wellness.

Our conversations on the “balcony of personal reflection” were spurred first, 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. Insights were shared through twenty-two (22) essay discussions with twenty-four (24) co-authors pertaining to the state of our healthcare system, the foreseeable obstructions encountered and, most importantly, processes for change. A synthesis of series #1 viewed the essay collection within a complex systems lens. Five guiding principles emerged for implementing leadership to achieve sustainable health system reform: clarity of purpose; alignment of effort; credibility of leadership; integrity of organization and accountability for performance.

Next, we were introduced to the Ghost of Healthcare Consciousness. This Ghost brought questions pertaining to the perspectives and voices of patients, care providers and middle managers. The ghost was perplexed as to why people were often managed as though they were robots, devoid of desire, compassion, creativity and intelligence. Insights led to twenty-seven (27) essay discussions with twenty-four (24) co-authors - patients, care providers and middle managers. A synthesis of series #2 collection of essays identified three prominent “system level” priorities requiring attention before progress can be made on improving the patient experience: advancing the art of healthcare; shared leadership and a culture in need of change.

In Series 3, I was joined on the “balcony of personal reflection” with thought leaders and the Ghost of Healthcare Hope. Insights were shared through twenty (20)  essay discussions with sixteen (16) co-authors. Together we painted a picture of what future value-based healthcare could look like and what we need to do to get there.

The Ghost of Healthcare Hope joins the conversation…

“I hope for the following:

  1. Political leadership that places patients first and not third, after politics and finances.
  2. Ministries are “in-service” through the creation of sound public policy rather than maintaining some empty and temporary illusion of control.
  3. Healthcare governance represents the owners and customers of their organization, and not merely the narrow interests of their silo, or the narrow interests of the more powerful stakeholders within the silo.
  4. Foundations ask if their fundraising reinforces their silo. When does fundraising begin for the community at large? When will we see significant foundation dollars raised for Home Care, Primary Care, Long Term Care et cetera?
  5. Managers and leaders within local delivery systems collaborate with their community partners to ensure that consumers actually experience a seamless system of integrated care at the service delivery level.
  6. Clinical and administrative leadership development to co-lead with patients for both strategic change and professional performance.
  7. The right balance of authority, autonomy and accountability to achieve measurable improvements over the next three to five years.”

Standing on the “balcony of personal reflection” watching the storms I can see the sun shining through. The sun takes the form of family and patient faces. With all the challenges faced by the healthcare system, the light in the sky is the input and involvement of families and patients in redesigning and reconfiguring a value-based healthcare system to meet their needs.  

In 1904, pioneering Canadian physician Dr. William Osler wrote, “It is much more important to know what type of patient has a disease than what sort of disease the patient has”. If it was important at the turn of the 20th century to advise physicians to see, listen to and treat patients as individuals, it is even more important today.

One hundred and ten years later in 2014, in a paper titled: It’s All About Me: The Personalization of Health Systems, A. Snowden and team had this to say… “Traditionally health teams have been the key decision makers in most health systems and consumers are the ‘patient’ who is viewed largely as the recipient of care. Although many health systems aspire to deliver ‘patient centred care,’ health professionals primarily focus on making choices for, and, occasionally, with the patient…the traditional health systems in many countries could be characterized as patriarchal: health system leaders determine the allocation of resources to deliver health services and health provider teams determine the best treatment and therapy options for the patient populations served.”

Mark Twain said, “You can't depend on your eyes when your imagination is out of focus.” From a patient perspective: this is our health system, we are shareholders, we pay for it through taxes and we want it to be safe and reliable. Interesting thing about healthcare: just about all the programs (medicine, nursing, physiotherapy, pharmacy, etc.) are in the faculties of science, which are the “hard sciences,” the logical and rational disciplines, the ones that are based in evidence. A good thing! Yet often what gets lost in all the science and rigor is that healthcare is a people business. It is all about building relationships that are resilient enough to deal with power dynamics but adaptable enough to sustain and lead change. It’s about communicating, trusting and caring.

Creating a new patient safety future will require visionary leadership, competent and patient-safety-focused management and governance, a fully engaged workforce and a new conversation with the patient, the customer. It will also require a sound cultural and accountability change strategy.

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 are asked over and over again:

  1. What is the shared vision and purpose with those you serve, that you are working toward together?
  2. What is your starting point? What beliefs and assumptions do you hold about customer value?
  3. Who needs to be part of this process? Is anyone missing?
  4. Is the meaning of the work still clear? Is it changing?
  5. Are you becoming more truthful with each other, with the patient, the family? If not, why not?
  6. Is information becoming more open and easier to access?
  7. Where are you using Control? Collaboration? Innovation?
  8. What are you learning from working and adapting within confusion and chaos? 
  9. What does your healthcare system want to become? Will it be driven by values?”

Perhaps this passage from a white paper by the Governance Institute says it all...”stop thinking of the healthcare organization as a conglomerate of units and think of it as a system. A system is a combination of processes, people, and other resources that, working together, achieve an end. A healthcare organization, such as a hospital, could be imagined to be like a watch. A watchmaker could gather from around the world the best-in-class components—spring, regulator, bearings, and so forth—to assemble, but the resulting watch would be unlikely to run, let alone keep accurate time. It’s how the components work together that creates an accurate watch. In fact, for the watch to work perfectly it may be necessary to make compromises in how each component works; for example, a spring made of the strongest material may not be the best contributor to a delicate, accurate watch if it does not fit well with the other components.

Healthcare organizations are not watches, but the analogy applies. If we want a healthcare organization to succeed, it must be appreciated as a system, the components of which work together to create success. It is not possible to determine what each component should be and do unless it is examined in the light of the goals for the system and the rest of the system’s components.”

The Ghost of Healthcare Hope returns for a final word...

“Isn’t the primary goal to provide high-quality, safe care to those who seek its help, whether they are patients, residents, clients, or recipients of care?”

For the Patient, let’s imagine and build together a new future for the citizens of the community we are part of.

For the Provider, the skills, power, and passion required to meet this challenge today are present in abundance… so let us begin.

The Patients will see you now…are YOU ready?

This is a never-ending story…My hope is you continue the conversation.

Next week...a last word from the “Balcony of Personal Reflection” with the Healthcare Ghosts of Despair, Consciousness and Hope.

See essays in this series

See essays from series 2

See essays from series 1

About the Author

Hugh MacLeod, founder Global Healthcare Knowledge Exchange. Concerned and engaged citizen.

References

MacLeod, H. and S. Sharkey. (2013). “Self-Organizing Change,” Longwoods Healthcare Ghost Busting Essays.

MacLeod, H. and S. Jarvis. (2013). “The Winds of Change and Gathering Storms,” Longwoods Healthcare Ghost Busting Essays.

Osler, W. (1904). Aequanimitas, Philadelphia, Blakistan.

Saul J. E., A. Best and K. Noel. (2013). Ghost Busting Series I – Synthesis – Implementing Leadership in Healthcare: Guiding Principles and a New Mindset, Longwoods Healthcare Ghost Busting Essays.

Saul J. E., A. Best and K. Noel. (2014). Ghost Busting Series 2 – Synthesis – Advancing the Art of Healthcare Through Shared Leadership and Cultural Transformation, Longwoods Healthcare Ghost Busting Essays.

Snowdon, A., K. Schnarr, A. and C. Alessi.  (2014. It’s All About Me: The Personalization of Health Systems. International Centre for Health Innovation, Richard Ivey School of Business, The University of Western Ontario. London, Ontario,

Schye, P. (2009). “Leadership In Healthcare Organizations: A Guide To Joint Commission Leadership Standards.” Governance Institute White Paper.

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