Can the health system survive?
It comes down to the people. It is not about their work, but how they feel: feeling valued, feeling their work is valuable to those they serve, and feeling valuable doing the work. It is work as an extension of what you believe, what you love and how you want the world to be reflected back to you.
For 22 years, I have watched systems work to chart their way into the future. It is a difficult future. The Baby Boomer generation is such that it is going to be a costly future as well. It is not a problem; problems can be solved. This is a predicament, it is inevitable, it must be managed. To manage a predicament people must bring their best, give it and do that repeatedly.
Finding our “why” is how we do this
How do you get the very best from people? Simon Sinek outlines this in “Start with Why.” Find your “why,” and work to connect that “why” with everything and everyone doing it. For Goodyear Tires, it is safety; Apple it’s personal empowerment; Coke it’s happiness. So, let’s take a thought experiment, let’s imagine the “why” for a health system.
Taking care of sick people
This misses the boat of prevention. It focuses on acute care. Acute care and sickness are difficult and expensive. This system would invest in emergency response, lots of doctors, lots of support staff and lots of hospitals. That is where the sick work occurs — in the trenches, in crucial moments. Get them well and get them home.
Here we lose sight of the acute, leaving the sickest out of the mix. It has lots of disease prevention strategies, messaging about prevention, incentives motivating lifestyle change. Instead of the sick, it would focus on preventing illness in the first place. More nurses and educators, fewer physicians more incentive and emphasis on taking care of yourself, and more cost if you did not. This system needs lead time to work, and time is short.
What is a “why” that encompasses all we have to do? Caring for the sick, preventing illness, and getting ready for the demographic push coming our way? What if the why is healing, how would that system work?
Healing is not curing
When I think about healing, it is not “curing.” Healing is working beyond the disease, problem, acute issue and is more than prevention. I have worked to help people prevent illness; it is difficult because change is hard. We have behaviors we do not understand driving our choices, driving us nuts, and making change difficult. I see this in my life and the lives of people I care for — watching them struggle to change on the outside without first changing on the inside. Healing is changing the inside first. And when you do, everything else begins to fall into place. Healing focuses on meeting people where they are right now and helping them change. It is working together, extending a hand and saying we can do this.
Health care systems — be they corporate, not for profit, military or governmental — share a singular design with a singular problem. They are focused top down. Whether the top is a general officer, a CEO, head physician or minister of health, they are focused this way; someone has the “ultimate” responsibility for outcomes of the system. Beyond responsibility, power and decisions flow top down. And this is where the healing needs to happen. It is those on the ground, delivering the care who need to feel engaged, valued, met, they need to feel like what they do matters. Decisions roll down from the mountain like commandments, landing in the messy mix of illness, people, fear, and doubt, feeling like “just one more thing to do, one more box to check.” They feel disconnected from what is in front of you, they feel like the people in charge do not know you, get you or care. This has to change in order to bring the best solutions to the predicaments coming our way. This has to change now before the crisis arrives.
Change begins at the top
So how do we do this? How do we change a health system? It begins by caring, by leaders stepping outside their comfort zone and caring about the people doing the work as much as the work itself. Demonstrating this care with actions, actions that may not make headlines, may not make them grander/greater, but change the lives of those doing the work. Leaders who value the most important asset, the people providing the care. Making them the best people they can be, working to give them freedom to do their best work, encouraging them to take risks, try something new, to show up bringing their best. By encouraging others to bring their best to the table, we begin to heal the ones doing this work, and they pass that healing to the people they serve, and that is a “why” we can all be proud of.
So, what would this system look like? I have never seen one in action. I have caught glimpses here and there in small teams working together within the greater system. In those moments, it looks like one person deeply caring for the person in front of them. It is the doctor who cares about the nurse as well as the patients. It is the ward clerk remembering a birthday and getting something special sent up. It is the pharmacist realizing the patient cannot read, working to get picture labels, so medications get taken at the right time. It is feeling like the work you do is valuable and valued, willingly doing a little bit more without being asked, and feeling appreciated for all that you do. It is this kind of system that will find a way through the troubles ahead, and at the end of the day when you return home, you feel like you have given your all for something that is worth all that you can give.
Gil C. Grimes is a physician and can be reached at Doc Grimes.
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