Insights (Essays)

Insights (Essays) April 2015

A Last Word From the “Balcony of Personal Reflection” With the Healthcare Ghosts of Despair, Consciousness and Hope

Hugh MacLeod

Ghosts are free spirits, observe everything and are not limited by boundaries, time or space. Many years ago we observed the creation of a concept paper about creating a series of healthcare conversations on a "balcony of personal reflection" with the  Ghost of Healthcare Despair. The concept paper was sent to Hy Eliasoph, then CEO of Central LHIN, for his feedback. We observed and listened in on his subway ride experience and his electronic response of consciousness and hope:

"Yesterday, I printed off the material sent me, and was eagerly anticipating reading it on the subway on my way home. As I settled into my seat, and took out a pen to mark things up, I quickly realized that what I was reading was a true personal reflection, rife with "Hugh-issms. "The storytelling format and the stage for the storytelling only added to the theatre.

Then something amazing happened, a mom and her two young children boarded the subway. Both I and the lady next to me offered our seats to them (that's not the amazing part, though in Toronto at this time any act of random kindness seems amazing), but the mom declined, mumbling something about getting off in a few stops.

As I continued to read, the young boy (maybe 6 years old) was watching me (he must have been about eye level with my paper) and asked me what I was reading. I told him it was my homework, and then he proceeded to tell me that he was going into grade one, and how excited he was about it. I then said to him that it was, indeed, exciting, and that he too would have homework. He responded by saying that he wouldn't be able to do his homework, because he couldn't read, to which I replied that he would soon learn how to read, and asked him if he was looking forward to this. The boy replied " Oh yes, and I'm going to be the best reader ever." I said to him that "I'm quite sure you will be too.

At that point, the conversation waned, and the boy just kept staring at my paper (or so I thought). I went back to my reading, conscious of the fact that he kept looking at the paper. As we came to the next stop, it was clear that the mom was getting ready to disembark, when the boy said to me "That's a really nice pen" (and indeed it was, it was a pen that we give to our clients). I said to him "Here, why don't you take this pen, and when you learn to write, you can use it." Well, the gleam in his eye was magical, and he took the pen, fondling it, looking at it from all angles, and finally clutching it in a firm grasp, and saying "thaaaaaank you". The mom also chimed in with a "thank you," and as they were leaving the train I said to him "Have fun in school, and make sure you learn to be the best reader you can be."

As they disembarked, and the train whisked away, I sank back deep in thought, wanting to plough through the material, but clearly buoyed by this exchange. I thought to myself, WOW!, here is a kid who is eager, indeed thirsting to learn, and remembering that we were all once like that: young, naive, innocent, impressionable, a blank hard drive waiting to get filled up with life's knowledge and experience.

Over time, we each develop and accumulate our own unique hard drives that shape and influence our perspectives, perceptions, reactions, expectations, etc. As our hard drive gets filled, we also accumulate various coping mechanisms, biases and habits (firewalls, anti-virus 'software' and security 'programs') to survive. Some of us become jaded, some cynical, or just "too long in the tooth," and some develop ego's that drive us (one way or another), yet some of us still retain that boyish gleam in our eyes, that thirst and search for greater learning and understanding that drives us.

Leaders should have some of that boy in them. Passion and intensity driven, in part, by a thirst for knowledge and understanding, and enthusiasm for harnessing that for the greater good. I would say that leaders' hard drives are far from full, indeed, they are continuously being expanded and reformatted. I believe we all can be challenged on our own Balcony of Personal Reflection. Time to  invite others to visit on balconies, and visit with others. No doubt, we will all have our own ghosts that haunt us, perhaps some skeletons in the closet, and some demons that need to be exorcised. If we are able to build a balcony, where people feel safe and secure in sharing personal reflections, we will have helped individuals grow and evolve. Its not a time to play it safe, its a time to take some calculated risks in attempting to move arguably the single most important societal agenda forward. If we are to grow and act as a cohesive team, our balconies have to be places where we can congregate and learn."

In the fall of 2012, Anton Hart, the publisher of Longwoods posted the following... "Early this year Hugh Macleod, CEO of Canadian Patient Safety Institute, created an essay for Longwoods that borrowed one of Charles Dickens’ ghosts from A Christmas Carol and set it loose upon a modern realm. He titled it: “The Ghost of Healthcare Despair.” While Hugh is not Charles Dickens, the metaphorical piece, as well as a follow-up essay, were well received and inspired a Longwoods invitation to Hugh to create a series of “Healthcare Ghost Busting Essays.” For each essay Hugh will be joined on what he calls the “balcony of personal reflection” with a special “guest” co–author. Like the first two essays, the guest and Hugh will be interrupted mid essay-conversation by a familiar voice. It is the voice of the critic / the cynic. Like one of Scrooge’s ghosts, its aim is to shock us into consciousness.”

The Ghost of Healthcare Despair essay foreshadowed what was to come...

I am bound to healthcare silod halls, stairs and ladders by weight of all decisions that have been made in the way they were made because someone did not have the courage to look, think and say the truth that was available to them at the time. Thus is the public good dammed. Only those who are brave enough to see for themselves, think for themselves and speak for themselves will find the strength to push past me.

Do you like my robes? They are a testament to my many victories! Each of these documents contains a moment of genuine insight and consensus in the healthcare system when a problem was well defined and a practical, innovative strategy was clearly articulated...but then, it was never acted upon! Ha, ha ha! I have quite a wardrobe. Each document represents hours of volunteer and paid hours of hard work, often by the best and brightest. Each document contains someones hope that he or she could make a difference. Nowhere am I more powerful than when the right idea is offered by the right people at the right time, yet, it becomes a study or report, and it dies somewhere in these halls, ending up adorning me in splendid fashion.

Do you really think you can have any impact on the way things are? Healthcare delivery is chugging along guided by vested professional interests, political realities, disconnected personal ambitions, economic forces and a host of other factors that make up the real world.

Fast forward - Longwoods' publishing of the three part essay series with us...the Healthcare Ghosts of Despair, Consciousness and Hope resulted in seventy-two (72) essays with sixty-four (64) different co-authors on the “balcony of personal reflection”. In addition, eighty-one (81) pages of feedback and reflection were received from patients, care providers, middle managers, executives, researchers and board members.

Hy, the healthcare ghosts thank-you for the "inspiration"...your words provided the motivation and courage to enter the "balcony of personal reflection".  Specifically this comment resonated...“over time, we each develop and accumulate our own unique hard drives that shape and influence our perspectives, perceptions, reactions, expectations, etc. As our hard drive gets filled, we also accumulate various coping mechanisms, biases and habits (firewalls, anti-virus 'software' and security 'programs') to survive.

Everyone endures his or her own special ghost, although similar individuals tend to experience comparable spooks. Some face a cynical, ’burnt-out, woe-is-me’ type. Others face a ‘stuffed-shirt, know-it-all’ with a little Napoleon. Ghosts yield the errors of people ways – looking in versus looking out to be responsive to those you are here to serve...patients and families.

Repeatedly we heard on the “balcony of personal reflection” that healthcare is is a very complex combination of organic systems and structures. Given that its structure is a human invention it can adapt and change.  The multiplicity of professions and the complex hierarchies present challenges but they do so in other systems and structures as well.  There is much to be learned from systems in business, the arts and even the military.  Most transformational insight will come from nature itself.

Think of a garden of flowers, all different in color, size, shape, texture, and smell. They perform varied functions in the ecosystem but if you dig underground you will see that at their foundation level, the roots are all interconnected. You can see this in a potted plant of flowers when you lift them out of the container.

If you look more closely you see that the flowers are held up by a structure of stems that reach from the shadow of the earth to the light of day. What you do not see is the real source of structural integrity, the root systems hidden in the container. 

How does this relate to the healthcare organizations and systems?

The container is like the formal structure of corporate culture. It is a containing vessel. If the content, the actual culture itself, is not nurtured through watering and fertilizing, what you see above the container will not grow to its fullest. What you cannot see directly, above or below ground level, is the level and quality of the sap that flows through the roots, the stem, and the petals sustaining and invigorating life. This sap is common throughout the plant. It functions just like consciousness. To enable the natural ‘organic’ elements of the healthcare system to foster change, the sap must flow.

We see and observe a paradox - healthcare is made up of interconnecting circles of complex activity; however, people are conditioned to see dots on a map, and think in straight lines of a road. I addition, often what people see depends on what they are prepared to see.The sixty-four (64) guests on the balcony of “personal reflection” and eighty-one (81) pages of feedback and reflection from patients, care providers, middle managers, executives, researchers and board members suggest that the sap can be accessed through seven interconnecting circles: Culture, Relationships, Communication, Values and Meaning Making, Appreciation, Accountability/Responsibility, and Learning.

Gandhi said it best, “People stand within a circle whose circumference is bounded by their fears. The circle is their comfort zone. If people stay there, they become complacent.

There are no ghosts, except the ones people create in their mind and fear as if they were real.

See essays in this series.

See essays from series 2

See essays from series 1

About the Author(s)

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



Eliasoph. H. (2008). E-mail exchange.

Hart. A. (2012). Introduction of a new essay series. Longwoods Publishing.

MacLeod, H. (2012). Ghost of Healthcare Despair. Longwoods Essay. 


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