Insights (Essays)

Insights (Essays) July 2018

Seven “STOPS and STARTS” for Healthcare Transformation

Hugh MacLeod


Three Wikipedia definitions to help set the context for STOPS and STARTS

HEALTHCARE SYSTEM…"The organization of people, institutions, and resources that deliver healthcare services to meet the health needs of target populations."

REFORM…"Reform may be no more than fine-tuning, or at most redressing serious wrongs without altering the fundamentals of the system. Reform seeks to improve the system as it stands, never to overthrow it wholesale."

TRANSFORMATON…"In an organizational context is a process of radical change that orients an organization in a new direction and takes it to an entirely different level of effectiveness. Unlike reform (which implies incremental progress on the same plane), transformation implies a basic change of character and little or no resemblance with the past configurations."

We throw the words healthcare transformation around loosely. Given that healthcare challenges are complex and anchored on politics and vested interests we gravitate towards incremental reform tinkering.

What is it about public discourse that prevents us from dealing with the complexity and politics of healthcare?

I do not have an answer to the question asked, however, finding a way to re-frame the issues would be a good start.

Seven Stops and Starts

  1. STOP looking in the rear view mirror.  START a new future focused conversation about what universal healthcare means and what can we afford.
    Such a conversation in Canada would help people understand that "Medicare" is not universal healthcare, a crucial starting point to defining a new Canadian vision. For instance, "Medicare" is now simultaneously more and less than previously. More, due to expanded scope of science and technology. Less because we are even more tightly focused on doctors and hospitals, instead of considering what keeps a population healthy. Ask why do we have a set of differing federal, provincial and territorial insurance plans with significant quality and safety coverage and outcome variances? START an honest conversation about what we as a nation value. Our Federal, Provincial and Territorial "health insurance plans" are built on a "rationing model" anchored by a uni-disciplinary fee-for-service presumption.  Intense public pressure results in rationing recalibration.  What is missed in international health system comparisons is context. A country's healthcare system is a reflection of its "National Values". What is our national value statement?
  2. STOP talking about how healthcare is broken – it is delivering what it is designed to deliver.  START a conversation about what needs to be redesigned.
  3. STOP talking about healthcare as separate sub-systems.  START talking about how we reframe the healthcare system as a complex paradox to be managed. We need both systems thinking/talking and deep dives into the complexities of specific diseases cures/treatments. Ask why we favour cure over care, acute disease over chronic, and the treatment of diseases over the prevention of them?  Ask how do we define patient-centred care? Ask, are we really listening to patients and families and do we act accordingly?
  4. STOP our polite and safe engagement processes. START naming the elephants in the room, tough issues that no one wants to talk about.  Naming the elephants is a defining characteristic of human systems with extraordinary adaptability. What will it take to strengthen healthcare’s ability to name its elephants? START conversations about reframing out-dated agreements, contracts, and standards that promote provider interest over "patient centered care" interests.
  5. STOP the relentless re-organizing and "bigger is better" mentality. START a conversation by asking does all this re-organization make a difference when managerial authority is so easily trumped by either government or medical sovereignty?
  6. STOP glossing over "people statistics". START a conversation about why we tolerate the yearly killing and harming of thousands of people in our care and why thousands of healthcare workers suffer workplace wellness issues each and every day.
  7. STOP using leadership frameworks and expectations such as LEADS as the fodder for polite leadership conversations, and abrogating responsibility to act accordingly.  START behaving as leaders as those frameworks suggest we behave.  Then transformation has a chance.

Today’s healthcare leaders must not only lead well but also lead differently. That means accepting a shift in the drivers of the healthcare from care providers to individuals and communities, from hospitals to primary/home and community care, and from an emphasis on downstream/acute care to upstream/preventive and wellness factors.

Canada’s healthcare leaders have a moral obligation based on their expert knowledge to provide the strategic thinking that political leaders can’t or won’t provide, and work together to create a new collective vision for health in Canada.

If today’s leaders don’t do it, it won’t be done. There is an opportunity before us to transform healthcare to achieve its purpose of improving health. The skills, power and passion required to meet this challenge today are present in abundance … so let’s START.

About the Author(s)

Hugh can be reached at…


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