Healing healthcare: It’s a fundamental human question
I experienced a problem this week that almost all mechanically challenged folks encounter at some points in their lives. An unusual and intermittent noise emanated from my car. I did the natural human thing and sought the services of an expert skilled in addressing the malady. He asked me to mimic the noise, describe where it came from and when it occurred. Although the sound was clearly distinguishable to me, I was nevertheless unable to effectively communicate the problem to him. Only when the mechanic experienced the issue for himself did he 1) believe me 2) know where and how to isolate the issue and 3) provide a potential solution. Between the time I tried to communicate the issue until the point where it was clear he understood, there was awkwardness in the relationship. I expected him to immediately know what was wrong. He thought I was a naïve customer who really should know more about the machinery I rely on.
When the diagnosis was complete, the mechanic explained the cause and the cure. I did not truly understand the prescription (even though I nodded as if I did) because nothing in my experience helps me understand how cars work. I have to rely on the trust I have with him or his company to determine whether the response is reliable and an efficient use of my financial resources.
What we have here is a traditional struggle between humans with diverse backgrounds to effectively communicate. This same malady afflicts physicians and administrators as they embark on significant change. Each party realizes that something is broken and wants a fix. Yet when one party attempts to communicate the problem and prescription to the other, they fail to hear one another. Unfortunately their separate education and work experience limits their ability to truly understand the other. The miscommunication leads to a tension that often feels irresolvable because there is little trust between the two sides. Both parties look at the same organization, but each sees and wants something else. The obvious solution for one is less so for the other.
Overtime callouses develop and each party is less able to really hear the other. The result, duplicated at most healthcare institutions, soon becomes a significant contributor to the healthcare crisis. Neither party is able to effectively address the issues so a referee, the federal government, is called upon to intercede. What results is not a negotiated settlement, but one that is imposed on the parties. As always happens in such cases, neither party is pleased with the outcome.
The reality is that administrators and physicians are so much like the blind men in the Sufi tale. Each sees a part of the system that no one, because of its complexity, can truly comprehend in its entirety. Both parties need one another but fail to comprehend how to work through the dilemmas.
Unblocking administration and physician relationships
Stop the judging
The two sides have become hardened to one another because they project negative intent into the actions of the other. Each side sees itself as well meaning…and the other as nefarious. For example, a few years ago I was working with two healthcare systems. One is a very large physician practice (more than 700 docs) which despite its size made decisions through consensus. The other system had a more traditional strong central leader who made most decisions. As a result of their structures, the former made decisions slowly…the latter quickly. The former valued input and dialogue so they believed they had more “humanist” values. The later saw the organization as cumbersome and un-business like. The notions of the culture were translated into the abilities and intent of the leaders.
We brought the leaders of both organizations together for two days. When the players learned to see one another as humans working in different environments, the ability to trust deepened and the organizations were better able to cooperate AND compete with one another. They had learned the value of the other.
Judgment of others stops meaningful conversation.
Learn the language
Physicians cannot understand the challenges of running an organization unless they’ve been there. They will not understand the challenge of meeting the diverse interests of many types of stakeholders, the need to focus both on the long and short term, the challenge of creating an effective strategy and ensuring the capacity of meeting payroll.
Administrators cannot understand the challenges of attending to the health and psychological needs of humans who tend to be complex, often less than rational, etc. They cannot understand the challenge of moving from one patient to the next in 20 minutes or realizing all the challenges of coordinating care in a complex system.
Both sides need to learn some of the language and challenges of the other and accept the fact that they are real. Otherwise, there is no way to communicate the challenges or the information. Yes we have to meet the payroll and ensure future profits while providing the best care to patients as possible.
Create common forum
The issues are far too complex. The days of a small cadre of people at the top wrestling with the decisions amongst themselves are over. Instead, the organization needs to create a unique space where significant issues can be openly addressed by large numbers of people from many organization levels and perspectives. These spaces typically do not exist within healthcare organizations.
Communities are characterized by people with common interests, diverse skills, coming together because they cannot produce or contribute themselves what can be created by working together. In a community each person must give up something of themselves. Yet to be effective, the community cannot take away from people that which they feel is central to their existence.
The solution to a significant portion of the healthcare equation rests on the ability of healthcare organizations create meaningful internal (within the organization boundaries) and external (between healthcare and other organizations) communities care. To do requires people to see truly see the elephant from different perspectives and to blend their capabilities and assets.
June 29, 2012 Uncategorized