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Healthcare Issues
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by Ken Rawlings, DHSA 13 the future of Healthcare

A contribution to the Summit for the Future on Risk

One asks what the management issues of health are today. Perhaps, the first question leads to a second question. What are the roles of health leaders today? Truly, primeval purpose might look establishing strategy. Strategy is transformational of institutional economics. It mandates in both public and private sectors the distinction of competitive identity and status in the tribes. In the act of grasping strategy, order is attempted, building directional ability or functional disability.

Perhaps it might look like grabbing the bull by the horns, pressing for results and all the while balancing competing commitments and thus affording the title functional. As reflected by telling one what they need to know as opposed to what they want to hear. And then position around "what actions are necessary?" aggressively defining the If, Then statements whilst examining the follow through window. Where are we today and where do we wanna be? As today is different than yesterday, so, is its works, to be done.

In our global economy whereas there is a mushroom shape depicted of rapid growth changing the age of the population generating many children relative to the labor productivity and pressed with the expectation of our health laws-policies and whereas the consequences of economical neglect might look like reduced investment resultant of diminished savings and increased consumption by the non productive young and aged alike. Where are we now?

There is valid argument to pursue the margins of healthcare economics.

Questions around efficiencies and equity rotate around alternative approaches lending order and functionality to the strategy. What competing commitments and whose values, beliefs, attitudes, behavior needs to change in order to affect the best outcome?

So today we have the emergent patterns of engaging the margins, encouraging unity amongst diversification and directed by global concerns. We are engaging communal tribes to share a common vision. The mission being, One global tribe of co-opetitive (a hybrid of co-operation and competition) community health outcomes, re-ccountable(a hybrid of responsibility and accountability) in nature and guided by informed decisions of community health determinants.

These changes force our institutions and governance model to clarify their value and values. Who am I and how much am I worth? These changes force our institutions to collaborate and co-operate, to embrace new strategy, to adapt in new pastures of competitive tribes, to be subject to lessons learning and measure the lessons learned, to define the assurances of organizational capacities and capabilities. The new tribes will be competitively challenged feeling the pinch of economic reality. What is the adaptive challenge? What are the alignment tools, skills, and conditions that are necessary to create this new structurally informed stage as to affect the community and communities of health determinants?

Transition and transformation towards a seamless continuum of accountable clinical and fiscal outcomes of a demographic tribe requires the coming together of primary secondary and tertiary healthcare organizational characteristics reflective of the communal tribe needs and respecting the integrity of both common and uncommon ownerships.

Perhaps these are a few of the building block issues.

One might say. It's all about lessons learning. Some might say it's about lessons learned. However, one cannot reach lessons learned without passing through the realm of lessons learning first.

When one indicates that they are doing healthcare integration renovations, perhaps, it is a bit of both. As one is to the other; lending compromise and collaboration to the knowledge's and skills necessary to affect the vision.

At the end of day it boils down to "What actions are necessary?"

Persuasion might look like, what are the other action plans, Plan B, Plan C.

These questions are very directional and lend one motivation as motivation is an inside job, persuading harmony to a common or shared vision. Knowing very well that the fortitude of a shared vision is accompanied by the cohesion of preferred visions.

One may ask, what a preferred vision is, and, it is a change from the original vision to one of compromise given the various determinants encountered in the decisions along the journey. It's reality. One must make many decisions on this journey, lending parallels with such things as emotional intelligence, cultural intelligence, informed knowledge's , innovations , re-count-ability (a hybrid of accountability and responsibility). Perhaps, there are many others.

The pinnacle evolution lends one the adaptability to and of the change. One must be happy recognizing there are bumps and will always be bumps and history repeats itself. So one should be happy and satisfied at the outcome, perfect or not. Changed or original, why,,,, because,,, one has grown and growing is changing from lessons learning to lessons learned and has done so in their own accepted, reconciled happiness and in trueness of preferred vision. Resistance to change, why? At one moment, the sun might be hot and the next moment in mythos, the wind might be cold. Change is natural; Resistance is another story highlighting competing commitments as plausible deniability and conflict management as the doorstop. In this context one may permeate with change otherwise one might be unhappy. Happiness reduces stress.

Perhaps the elevation from knowledge to wisdom wrapped in the comfort and patience of preferred visions and yet understanding about bumps is the difference between beliefs and reality. Disappointment and acceptance; If we all know about beliefs, why is disappointment such a depressing deterrent?

So in the "renovation" as it moves from vision to the preferred vision one might consider accepting disappointments with happiness, stamping out fear with innovation and glorifying the transfer of knowledge to wisdom or lessons learning to lessons learned and glancing in the rear view mirror focusing on economic fortitude so the dream has value.

One wonders what the focus of the rear view mirror is as we are driving forward. Perhaps, it is perceived value, perceived social value. Perhaps, the focuses are those very shared values of shared vision. They might look like equity seeking equal opportunity to achieve and receive health services. They might look like quality of life proclaimed as that of a human being. It might look like the right to of informed health. Perhaps, it is these values, which emanate across multitudes of tribes. The objective might look, what legislative actions or otherwise are necessary to compel the well being of the disadvantaged citizen. In other words, what rational connection does one make between the objective and the measure necessary for best outcome?

Health care is complex. Financing, designing, maintaining and operating such systems calls for difficult renovation choices all the time. Both short run and long run.

One might contest one tier against the other (private versus public) with respect to human rights proclaiming the right to life and to personal inviolability and security is affected. One might say that a one tier system is prohibitional, creating downstream logjams and deprives them of the very rights mentioned above and there security has been violated by such things as wait times. Perhaps one adaptive challenge is to accept and respect common and uncommon ownerships.

Healthcare systems and their powerbases need examination of impairments. One could look at the patient and determine if "minimal impairment versus maximal impairment" can be proven causation of the present power structures and further define maximal impairment. One questions; what impairment might a privately funded system hold in its undefined powerbase and what impairment does a parallel system hold and what impairment does an integrated publicly funded system hold. The respect of common and uncommon ownerships need not be debated or illustrated as the opponent or proponent when there is much to gain from all informed decisions. Perhaps, building upon open policy questioning and drawing upon answers generated from the bottom up is good for the tribe.

Perhaps in these challenging healthcare renovation times tough decisions must be made ensuring that all health systems account for equity and efficiency and are measured at the patient level targeting, the tribal health determinants.

As evidenced best practices and best outcomes become common territory, so too, will its benefits.

Some might say that in order to affect a best outcome, health imperialism, the social domain determinants; employment, housing, education effecting healthy environments should enter the arena of healthcare perhaps as instrumental social support network values. Such adaptive challenges might be seen. And yet, the willingness of inclusion is perhaps another competing commitment by virtue of equitable, accountable, efficient resource allocation and of citizen participation. What is disease and what is healthcare? What are the cure/care needs of disease and how does one access the remedy? What are the cure/care needs of healthcare and how does one access the remedy? What are the barriers?

How do we support, re-orientate and integrate tribal health determinants such as gender, culture, child development, income and social status, social and physical environments, personal health practices and skills, biologically and genetically circumstance? Which community developments and commitments are necessary to enable and mediate health promotion breakthroughs?

How do we communicate? Is it dialogue or interruption? Are we listening and have we heard it right? How do we know that we are here, the place we wanna be? How and what will the tribe know about the renovations end product correlating the tribal audience as patient and the renovation as healthcare integration?

Is it as simple as changing the name? Will it be, whereas one does not have to repeat their life health history to each provider? Or, will one never ever undergo the same test for more than one provider? Will it be when one is not deadlocked at one particular level of care because of capacity capabilities? Will it be when one has a wide choice of providers all of which can give you what it takes in the time it takes? Will it be when one can make an appointment with one phone call? Friendly system wide and provider specific information systems might focus on the individual, share information, create co-ordination networks, monitor progress, decipher and evaluate ends and all on a microchip keychain. Who knows? They already have the pet dog on a keychain and it does those things. Perhaps, if we have listened we know where we wanna be and they will know they are there too, lending respect of issues of shared vision. What does seamless look like?

Communication amongst the players on the stage of integration being desired as commonality of purpose, need a common framework to action the action plan. Focal questions designed around If we do this, then this will happen" and "What will it look like" if moving "from this to that". This "common language" and its ends reveal barriers and enables a framework.

As one cannot truly know the barriers of each tribe unless they too are sitting in each balcony, it is unfair to comment in ignorance of balcony participant identity; however, common language barriers could be questioned around "transcending culture to community to organization and then back". There is no room for breakdown. There could be "dispute" mechanisms to avoid clashing with other organizations, of common purpose whom hold their hands up too.

Another barrier might be, social powers wearing social policy and constrained of decisional capacity to effect those changes of cross spectrum conflict. Another barrier, presenting itself today is cost via evidence base practice. Not only is unprecedented cost of significance but the function of preparation to constantly changing is another. Integration might call for the abandonment of organization and hence there will barriers as to the preparations required.

Another barrier, which presents itself, is the constant knowledge shift of society and the capacity of organizations to adapt in a short run term. Today's, certainty is tomorrows absurdity. Another barrier might be tying in economic performance and accountability as ordered up with the entitlement of a socially responsible organization. Accountability agreements across the "spectrum of performers of the Health Imperialism Team". Another barrier might be organization re-building from the bottom/up versus top/down. Might doctors and nurses reorganize healthcare? Changing the teams and thinking requires the most difficult learning. It requires imaginable unlearning crossing the lines of our bone deep thinking. Changing the thinking of command and control and thus parting re-ccountability (the ability to account to a response) to the other. It relates today to the process and not the personal as of yesterday. To the sanctity of evidence based ends. Another barrier is simplicity. All of the resultant actions from breaking down barriers must consider criticalities of the vision. These might be considered as the interests of all constituencies, all stakeholders, all employees and then be easily translated into a co-opetitive strategy of tribal vision.

In asking the question "where do we wanna be", we go from this to that or from here to there. This enables the action framework and points out key needs, opportunities and threats.

Such a kaleidoscope might go from process to outcome from implicit to explicit, from fear to innovation, from blame to support, from complacency to continuity, from procrastination to aggressiveness, from short run to long run, from dollars to sense, from silos to arenas , from fog to transparency, From failure to analysis from opportunity to winning. From risk aversion to risk taking. Perhaps, there are many others of which each tribe is different.

The action plan considers what competencies need to be developed. In going from process to outcome for example, innovation, creativity could encourage reframing problems to create new solutions. From implicit to explicit could be a new approach to tribal social responsibility bridging gaps and forming alliances of common purpose. From blame to support becoming ownership re-orientation. It could mean leadership developing a proactive approach to qualify skills of the worker and re-orientate human resources towards adjustment of new opportunity. Information technology continues to make explicit its turbulent environment and those who fall the wayside will not reap the completive benefits of cooperative nature. From complacency to continuity could look balanced scorecarding, or just in time management. There is bridging of skills necessary to transcend new information. From dollars to sense could look like increased role of human resources management, instilling values of entrepreneurship, knowledge creativity and whereas interpersonal skills become equally important. Interpersonal skills are increasingly important in a global world where technology like the web, cell phones allows companies of different cultures to market its product inexpensively and thus align inexpensive global infrastructures. Interpreting cultural intelligence reduces cross cultural friction of norms and values lending stability of transition and lending to common accepted strategy, by focusing on the reduction of culturally competing commitments. From failure to analysis, as where mediocre quality killed the product, could look like profound knowledge encompassing continuity of the charted\recorded, Plan , Do, Act, Check cycle. Broadening competencies as proactive leadership\management, coaching new skills and ownerships, innovation and reframing beliefs , creative thinking , Total Quality Management, and while harnessing the ends of information technology produces productivity through people.

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