We intrinsically know we achieve more working together than apart. Collaboration and coordination trump competition and contracts in achieving goals. However we revert to the latter during dysfunction in order to ‘force’ action. A complex system will similarly self-organise, which can mean the parts move in opposition, or at least in disharmony, without something else to give it a common direction or melody. Each of us strive to fulfil our goals. To effectively work together, we need a common goal. In this way, the ‘what’ is clear, but the ‘how’ is not.
Every one of us will at some point in our lives, end up in a hospital. The older we are, the more likely that is the case. The more chronic our conditions, the more frequently we’ll be there. This isn’t a bad thing per se. Modern medicine and continued improvements in the health literacy of the populace have reaped rewards of the best quality of life ever seen for personkind. While wealth has increased across the globe, it is good health that is the touchstone of a good society.
Expenditure to outcomes ratio is plateauing
Nevertheless, that doesn’t mean we ought to just continue in the same path, as if this were some linear set of relationships that will continue forever up, up, up. We have a decaying end graph where our expenditure to outcomes ratio is plateauing – meaning we cannot get the same boost in outcomes with the same amount of money. Most people are in good health, most people get good medical care in a reasonable time, but the bang for buck we got at the early mark is not giving the same return at the latter mark. To get those last little percentage points out, we need to radically change our thinking.
There are a range of matters to be considered, including: the cost of healthcare and methods of funding for it (including revenue sources), what we consider within the remit of ‘health’, variability of access and outcomes, how we measure success (which dictates future investment), how and who we engage with, the workforce, and entrenched fragmentation.
Modern medicine on a pedestal
Most of us will face hospitalisation when we don’t particularly want it. An example of this is the ageing population, who consume a greater proportion of health resources yet don’t necessarily want to. Indeed, at the moment, despite that most people overwhelmingly wish to die at home and amongst their loved ones, most of us will die in a hospital. We’ve put modern medicine on some deified pedestal as if it can solve everything for us – except that it can’t and in many cases should not.
This isn’t a discussion about the pros and cons of end of life care (although it is a worthy debate that I am glad we are having more broadly) rather, it is an example of how we have to shift our thinking if we want to provide equitable access to the same enviable outcomes that many of us take for granted. It took being brave enough to make some mistakes to get to where we are. Yet we seem paralysed, pointing to over-utilisation, funding models and vertical fiscal imbalances, geography and anything else we can in order to excuse not making big changes. This is a system, not a single player. There is no one funder, regulator, provider, or patient. We have to work together, not apart. A nice sentiment, you might say, but how to do this? This isn’t just a few pieces of a jigsaw, but a behemoth complex system with more moving parts than any of us can imagine – I dare any one of us to suggest we understand all the pieces.
What is our common motivator?
The starting point, I believe, is embracing a common motivator. Finding our common ground. While we might all hate 3-word-slogans, the idea is (unfortunately) on the right track (although we still need a good message behind them too). Advertisers have known for a long time that slogans work, it is why they use them constantly. Do you honestly think if advertising didn’t work, profit-motivated companies would spend so much on it? This isn’t about trying to simplify everything – indeed we need to embrace complexity, particularly because no single patient is the same as another. Nor is this about an advertising campaign. Rather, this is about simplifying our goals and our message so that we all can move in the same direction. New Zealand has made some impressive headway by focusing their efforts in considering the patient’s time. Sweden’s experience tells us to consider their test patient, ‘Esther’. This is all about making our system friendlier, not just utilitarian.
So what is our common motivator? What is our slogan? Our call to action? There are a few that easily come to mind. Maybe it is the three ‘a’s: access, autonomy, applicable. Three ‘e’s – efficient, effective, empowering. Maybe it is the three ‘p’s: prevention, participation, patient orientated care. Overall, I think there is one rallying point we can all agree on: the patient. Patient experience, patient access, patient outcome, patient safety. The patient is our rallying point that every part of this complex system can get behind. Now we just need a shared slogan…
Kristy Spillman will be speaking on ‘Navigating murky waters for overall health system success’ at the Transitioning to Integrated Primary Care conference this July. Book your place by May 27th to save $300 on ticket prices.