Money. It is a distraction from focusing on what matters. What happens when a business makes making a profit, it’s only reason for being? What happens when a government makes exceptionally low tax rates it’s only reason for being? In both cases, the organizations quickly forget why they exist in the first place and begin to make decisions that jeopardize and limit the potential of their organizations to do good (even great) work, that matters.
I’ll be blunt, saving the taxpayer an extra $100 or even $1,000 a year, is not going to motivate the kinds of public servants the province needs to innovate, to effectively run its programs and to deliver exceptional taxpayer value (services bought for the money spent). Similarly, making money for the shareholders of a business, likely will not be able to inspire employees to bring their “A” game to the office, day in and day out. A nameless, faceless shareholder or taxpayer simply fails to inspire and meet a deeper need for meaningful work. Even if those working are objectively paid well for the work that is done.
Meeting a deeper need for meaningful work is what enables people to go above and beyond, is what makes a difference between a job done well, and a job done exceptionally well. Finding passion and purpose in the work that is done, unleashes the potential to do not only good things, but, amazing things. People who have passion and purpose in the work they do, do not work 9 to 5, they work 24/7/365 because their work fills an intrinsic need beyond just paying the bills. A need to know that what a person has done matters, that it makes a meaningful difference to lives of others.
That’s not to say that the work that is done should be done without thinking about the financial impact of undertaking the work (resources are not unlimited), or that employees should be wasteful in their use of resources. Rather, it is to say, that in the long run focusing on what really matters is likely to yield much better outcomes.
Applying this thinking to the health system, think about the kind of system that results from focusing on the cost of care (taxpayer centered) versus the kind of system that results on focusing on the quality of care (patient centered).
If the costs of care become the focus, then what is in the best financial interest of the system becomes the priority when making a decision. In a system focused on cost, there is rationing of care. In a system focused on cost, there is a need to control information and decision-making, there is a need for “gatekeepers” and collateral damage becomes an acceptable cost of doing business. In a system where cost of care is what matters, even the needs of providers might be neglected. In a system focused on cost, it is not about what is possible, it is about what is affordable. A system focused on costs sacrifices the needs of both patients and those who provide services in order to appease the taxpayer – it sacrifices the great in favor of the mediocre.
If the costs of care are taken as a given (as much resources are used as are needed to meet needs), then the focus shifts to what is in the best interests of the patients and what is in the best interests of those delivering the services to patients. Information is no longer feared and hoarded. Innovation is embraced. There is no need for care rationing and there is a great incentive for shared decision-making. Further, the work becomes intrinsically meaningful as it becomes about making life better for others, and in particular about making life better for patients. The pursuit of better care and better outcomes becomes the goal. The possible is unleashed.
To highlight the difference between these two approaches, consider the work of Elizabeth Holmes and her company Theranos. In a system focused on costs of care, her work could be seen as a threat, as it opens the door to demands for health services that would otherwise be deferred or go unneeded. In a system focused on quality of care, her work becomes a tremendous opportunity to avoid bad outcomes from ever materializing in the first place. A system that might cost more, but might also deliver far more for the dollars spent.
So what matters, really?