Monday, March 2, 2015

The Invisible Hand of Things Done Well

Choosing the right goal is perhaps the most important thing an organization or individual can do. It will guide what is done or not done. It will illuminate the path to incredible success, or will lead down a rabbit hole of misery where the difference between what is, and what is possible grows instead of diminishes.

When it comes to healthcare, it must be wondered, “Do most of our problems stem from a relentless focus on the wrong goal?” In healthcare in Canada there has been a relentless focus on the dollars spent – all the while, the dollars spent grow and the outcomes do not get appreciably better. All the while, longer wait lists. All the while more disability and suffering seems apparent. All the while, the difference between where we want to be and where we are seems an ever increasing chasm. All the while, our rankings in international reports on the healthcare systems continue to drop – going from being a lead system, to being mediocre, to, now almost last place.

Providers in the system do not seem overly pleased, nor for that matter do patients – further, successive governments are repeatedly chastised for failing to perform. Nobody is happy – and yet despite our obsession with the healthcare system and its costs, nothing seems to get better and many things seem to get worse.

It is depressing and frustrating – how is it a country with so much can perform so poorly when it comes to healthcare? How could we have lost so much ground in comparison to other countries?

The thing is that when things are done well – a simply incredible thing happens, almost always what is possible aligns with what is, and the cost of doing it is minimized. If something can be done better, for less – better for less happens. By focussing on doing better, on better meeting the needs – and then focussing on doing so more efficiently, a kind of evolution happens. It happens in cars. It happens in computers. It happens in almost everything – so why does it not happen in healthcare in Canada?

The answer is quite simple, the pursuit of “better” was consumed by the pursuit of “cheaper”. Imagine if a company failed to invest in making its products better. Failed to spend the money now, to reap benefits later – focussed on the short-term, on maximizing profits for shareholders. It would not be long before that company would fail, before competitors would simply outperform. Likewise, in healthcare – for far too many years there has been a relentless focus on doing things cheaper. Steady increases in the budget have seemed extravagant, but the truth is they obscure the demands of keeping pace with a growing and aging population. The focus has not been on doing “better” for quite some time, and looking forward at budget increases of less than 3 percent in the years to come, it is unimaginable that there will be a shift in focus to doing things “better” for quite some time. “Better” costs money – at least initially, and that is not something that the system seems willing to invest at this time – by focussing on being lean it is growing ever fatter.

Imagine for a moment, if “better” became the focus instead of the dollars spent. If the focus shifted to the things that really mattered, things like minimizing suffering, minimizing the impact of disability, minimizing death, and maximizing patient satisfaction. To solving the very real problems faced by patients. Further, what would happen if the way things were done shifted – from top down to bottom up? What if we harnessed the knowledge of those who do things, to do those things better? What if we smashed the healthcare hierarchy and fostered an eco-system instead?

Would the invisible hand of things done well happen in healthcare – could we have healthcare that is both better AND cheaper?

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