Every day we see growth in self-interest, single-issue lobbying and expansion and entrenchment of rights-based discourse at the expense of one’s sense of responsibility and accountability.

With self-reflection and honesty, one can recognize how the image we attempt to portray does not necessarily mirror the reality in which we find ourselves. Like a photographer, healthcare leaders must make several choices to capture or address the subject at hand. They must choose what to focus on, how to frame it, what elements get highlighted and the overall composition. Capturing the environment at different moments and angles demonstrates that each snapshot is its own slice of reality.

Leadership is about continuous learning from the images that capture progression – even the images that represent the negative side. Through a dissection of displeasing elements that plague us, we can come to new understandings and finally move beyond them.

A healthcare organizational system is much deeper and more complex than anything a curated gallery will ever depict. Moments of personal reflection may enable healthcare leaders to undertake their key responsibility, which is to create the conditions within to outgrow today’s healthcare challenges.

Let us peek inside five photo albums that healthcare leaders must focus on

The first photo album paints a picture of our “sickness model” and shows the following images:

• a model where hospitals with health specialists equipped with advanced healthcare equipment wait for patients to arrive,
• a business that consists of a massive labour force worth billions of dollars,
• a business that has spawned ancillary partnership foundations, councils, institutes, agencies and associations, among others – all with a self-proclaimed mandate to promote the billion-dollar business,
• a business where billions of dollars are spent on retrospective sunk cost investments on healthcare facilities including infrastructure,
• a status quo mindset and passive aggressive behaviour that blocks or undermines work to develop or use innovative approaches to render upstream wellness changes and
• personnel, many of whom are either emotionally attached or, more likely, financially connected to the old models.

The second photo album on the people who deliver care shows the following images:

• staffing variations in age cohorts and gender differences by profession,
• teams of full-time, part-time and casual staff that change from unit to unit and shift to shift,
• ever changing and growing ethnic/cultural mosaic,
• a physician community made up of independent private contractors, 
• a healthcare workforce that is on sick leave, workers’ compensation and long-term disability more than in any other business,
• a combination of workplace wellness issues, stress and anxiety, interpersonal conflicts, miscommunication, poor decision making and
• growing healthcare staffing shortages.

The third photo album on management shows the following images:

• healthcare as one of the most complex organic structures ever created and with such complexity comes power struggles, opposition, and suffocation,
• traditional top-down leadership models,
• hierarchy of professional power and professional scope of practice/turf issues that surface daily and
• decisions that are very susceptible to political influence, which are not necessarily in the best interest of the patient-resident population.

The fourth photo album on the government shows the following images:

• ongoing assessment and public polling of the political cost of fighting tough battles in the face of mobilized opposition from powerful interests,
• a “one size fits all” approach that is often more reassuring to civil servants and politicians, which affects contextual innovation and creativity,
• a highly political environment where system breakdowns require that a scapegoat must always be found,
• constant regional and provincial structural change,
• an environment where the ministry and the civil service are risk averse due to the political consequences of their actions,
• an environment of seeing and acting in linear lines, yet the entire healthcare system is dynamic and operates within circles of sub-systems and
• an environment where the media plays a major role in its ability to influence political decision making.

The fifth healthcare photo album is huge and it contains the following images:

• hundreds of provincial and national councils, institutes, associations, agencies, etc., with mandates to lead healthcare improvement efforts,
• library shelves stacked with research studies, books, articles and papers on healthcare leadership and transformation,
• inboxes with course and workshop materials from the leadership development and transformation industry,
• boardrooms with transformative ideas,
• leadership change programs, conferences and symposiums filled with thousands of brilliant minds,
• thousands of people who have completed healthcare leadership and management programs with certificates, diplomas, undergraduate and graduate degrees and fellowships with official designations,
• thousands of hours dedicated to professional coaching,
• improvement insights from care providers, patient and resident-centred care experiences from family members and
• contracts with consultants for analysis and tools to improve and transform healthcare.

Reframing the issues

The photo albums beg these questions: Why it is difficult to have performance improvement changes in healthcare notwithstanding the availability of financial firepower, requisite skills, influence and determination? How do we move beyond what prevents us from dealing with the complexity and politics of healthcare? There is no single answer to the two questions asked; however, finding a way to reframe the issues would be a good start.

Stop looking in the rear-view mirror. Start a new future-focused conversation with the public 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.

Ask why we favour cure o ver care, acute diseases over chronic and the treatment of diseases over the prevention of them? Ask how do we define patient and resident-centred care? Ask this: Are we really listening to patients and families, and do we act accordingly?

Start naming the elephants in the room – the tough issues that no one wants to talk about. Naming the elephants in the room is a defining characteristic of human systems with extraordinary adaptability.

Start conversations about reframing outdated agreements, contracts and standards that promote provider interest over “patient-resident–centred care" interests.

Start a conversation about why we tolerate preventable deaths and the harming of thousands of people in our care and why thousands of healthcare workers suffer workplace wellness issues each day.

There is an opportunity before us to transform and reset healthcare so that it can achieve its purpose of improving health. The skills, power and passion required to meet this challenge today are already present in abundance. With input from the public, let us create a new set of healthcare photo albums. 

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