If strategy alone were adequate, there would be no waits for healthcare, there would be no unmet health needs, there would be no waste. If strategy alone could solve the problems that are being faced, it would have already done so. There has been no shortage of strategy - indeed there are entire government branches and divisions dedicated to "planning" in the healthcare sector. As such, you will have to forgive my cynicism and skepticism with respect to the idea that a Seniors' Strategy alone will be enough to navigate through the coming decades of healthcare challenges. Further, there is part of me that thinks that yet again, the generation before me (boomers) is lobbying loud and hard to reallocate resources to its own interests and perhaps away from the interests of the generations that follow.
After much thought, I have come to the conclusion, that the biggest problem in healthcare is not strategic - but rather cultural in nature. The culture of the healthcare system is anachronistic. It is bureaucratic and resistant to change and innovation. The culture of the healthcare system is hierarchical with a clear "chain of command" - it has evolved into difficult to break silos. The culture of healthcare is to view the current organization of healthcare (a public monopoly on the funding and administration of medically necessary services) in Canada as being sacrosanct. The culture of healthcare disempowers patients, seeing patients as a demand on the system, rather than a potential resource. In large part the culture of healthcare also disempowers those who work within the system. The current culture, is very much so focussed on delivering a system that minimizes the expense to taxpayers.
The trouble is, that the culture of healthcare, itself, is not sustainable.
Further, this cultural sustainability problem is likely a far bigger problem than (and maybe the cause of) the financial sustainability problem.
If an organization cannot engage and innovate – how can it reach the limits of its potential? If an organization drives away, or causes its best and brightest to burn out – how can it reach the limits of its potential? If an organization cannot tolerate a diversity of viewpoints and perspectives – how can it reach the limits of its potential? If an organization cannot adequately identify the needs of those it serves – if it cannot listen (and hear) what they (patients) need – how can it reach the limits of its potential? If an organization is unwilling to identify its weaknesses, and to be accountable for them – how can it reach the limits of its potential? If an organization, allows resources, to go untapped – how can it reach the limits of its potential? If an organization is focussed on process, rather than meaningful outcomes – how can it reach its potential?
It is a near certainty, that if a “Seniors’ Strategy” is developed - the dollars to fund the strategy will follow, but it is less clear whether or not the strategy will actually solve the problems that it is intended to tackle. It very well may be just another strategy on the mountain of strategies – that fails to meet its potential because it will be strangled by the culture of healthcare.
Indeed, culture eats strategy for breakfast, even in healthcare.
Note: Musings here have been inspired by Dan Pontefract's Flat Army: Creating a Connected and Engaged Organization, particularly as they apply to healthcare organizations and more broadly the healthcare system.