So I’ve just downed a pre-workout and am about to “Write in Overdrive“. Look, I haven’t read the book (I will), but I’m doing it.
Today, I thought I would write a little about my journey into health care leadership. I’m what you might term an accidental leader. I’m fiery and passionate, and am a man of extremes. I love those that are kind, and am enraged by injustice. You might say I’m a social warrior.
There are things I stand up against with passion. Simple things. It might be a rude conversation. Someone might be belittling someone else. I remember once being enraged by a health care professional not introducing themselves to me by their name. Reflecting on it, it doesn’t seem like much. But it angered me because I felt it is something that we just can’t afford to get wrong in health care. It’s the first step to compassionate care. How on earth can you build a relationship with someone if you don’t even know their name?
There was an entire campaign around it #hellomynameis. And you know what, it makes sense. When Dr Kate Granger, a doctor with terminal cancer, interacted intimately with the health care system, she realised fast what it was like to be a patient. One of her starkest observations on the quality of her care was that not all staff who approached her, introduced themselves to her.
So what’s all of this got to do with becoming an accidental leader? A lot, I think. I’ve agitated from the bottom up and have aligned myself quite naturally with people who have done the same. I’ve been very fortunate in that the opportunities that I’ve received have been because others have seen me for who I am and what I represent – truth (9 times out of 10, maybe more, I’m honest to a fault), integrity, and a commitment to doing the right things, not just doing things right.
So what has that meant practically? I’ve found myself in roles that have required me to step up to the plate and get the right things done. As a clinician, this is relatively easy for me to do in the consult room. I’m used to talking to people, square in the eyes, one on one, and paying attention to every word, every bodily gesture; empathising with them, because that’s what I do best. I’ve gone through my own share of personal challenges in life and so I have a knack for “getting people”.
I’ve been called a stabiliser – I bring peace, tranquillity and an open mind to any environment I enter. But I’m also a bit of a hot head. Very few people know that about me – but when they see it, they never forget it. Give me a bit of social injustice and it’ll set me right off.
The challenge I face now is, with what I know, finding a path forward, acquiring the right knowledge to get things done, and figuring out, out of all the things that enrage me, which one I would like to focus on solving.
So I read books, listen to people, listen to more people, and am starting to learn how to listen to myself.
I came across these eight symptoms of bureaucratic breakdown whilst listening to The Personal MBA: Master the Art of Business by Josh Kaufman.These eight symptoms resonated with me and align almost poetically with my experiences in health care. I hope that you will find them to be of value. Does this ring true for you? Let me know what you think.Josh Kaufman attributes this to Dr Michael Sutcliffe from the University of Cambridge.
- The Invisible Decision – No-one knows how or where decisions are made (there is no transparency).
- Unfinished Business – Too many tasks are started but very few carried through to the end.
- Co-ordination Paralysis – Nothing can be done without checking with a host of interconnected units.
- Nothing New – There are no radical ideas, inventions or lateral thinking—a general lack of initiative.
- Pseudo-problems – Minor issues become magnified out of all proportion.
- Embattled Centre – The centre battles for consistency and control against local/regional units.
- Negative deadlines – The deadlines for work become more important than the quality of the work being done.
- In-tray Domination – Individuals react to inputs, that is, whatever gets put in their in-tray, as opposed to using their own initiative.
Josh states that “If any of these qualities describe your daily work experience, your team is probably suffering from a case of Communication Overhead.
The solution to communication overhead is simple – make your team as small as possible. Read more on PersonalMBA.
One of the take home messages is that beyond 8 people, each new team member requires more investment in communication than they add in productive capacity. Including them is causing more work than it is adding in benefits.
Make teams as small and autonomous as possible – “Keep teams elite and surgical” – ‘Peopleware’ by Tom DeMarco and Timothy Lister
Equally, a team of one is also not productive, as can be the case in general practice. This guides some of the philosophy behind creating pods and teamlets such as in the Patient-Centred Medical Home model.
Would love your thoughts!!
I am not available to see patients on Mondays. In health care, access to care is everything. So, I better have a really good reason to not be in clinic. This post is dedicated to my patients, to whom I owe so much, and who are ever so generous with their understanding.
On Mondays, I work as the Director for Clinical Governance at WentWest Western Sydney Primary Health Network. Now bear with me, because even my hospital specialist buddies have a hard time understanding what this means.
It’s called integrated care.
Primary care is a grand mix of lots and lots of GPs, and lots and lots of what we call Allied Health Professionals (you know, physiotherapist, dietitians, podiatrists and the like). They’re all independent small businesses, which makes the whole affair a big jigsaw puzzle. My patients know that it’s sometimes hard to explain something all over again to a GP working in the same clinic as me, so moving from one place to the next in primary care is inefficient – it’s better just to stick to the one person that knows a little bit about you.
But there are times when you have to move around – from one practice to another, from your GP to your exercise physiologist, or between primary care and the hospital docs.
Your government knows that there is nothing quite so frustrating as working in silos. So they set up ways to bridge the gaps, and to make sure people don’t fall through the cracks. Organisations like PHNs enable this, and good IT through things such as the MyHealthRecord helps. Amongst other things, PHNs are a mechanism to reduce fragmentation in health care, and increase collaboration between the primary and tertiary care sectors. But they are often misunderstood.
Should we just invest more in primary care and let the GPS figure it out?
To answer this, we need to answer three questions:
- Is health care in Australia currently operating in an organised enough manner to drive high quality outcomes regardless of where a patient is in their health care journey?
- Are you confident that your loved ones will receive high quality primary health care regardless of which of their local general practices they visit?
- If we are not quite there yet, and we believe our system is fragmented and disconnected, how do we ensure that as taxpayers, we do not just pay for more of the same?
Let’s also consider:
- Are practices set up in a way that they would be able to demonstrate improvements in health outcomes over a period of time?
- How many practices in Australia routinely collect and scrutinise their data?
- How many practices have a comprehensive understanding of their patient population?
- How invested are our professional bodies in considering alternative models of funding to fee for service?
- In the USA, a certain practice has been able to demonstrate a reduction in the 28 day readmission of their patients due to medication errors from 20% to 2%. How close is our current system from being able to achieve this? Where is the data?
These are all the questions that organised care could answer. PHNs could play a key role in this area, but nationally, they are not perfect.
What are some of the key areas in which PHNs can play a role?
The table below highlights some of the ways in which my PHN, WentWest Western Sydney Primary Health Network provides support to general practices in western Sydney. This is just a brief snapshot from the WentWest brochure, Transforming Primary Care Part II, and you can find out more by visiting the WentWest website.
Source: WentWest Transforming Primary Care Part II, Brochure
WentWest sums it up in this way:
“Accelerated quality improvement calls upon a coordinated and sustained approach to change management across all levels of the healthcare sector. William Edwards Deming states that “It is not necessary to change. Survival is not mandatory”. He uses irony to demonstrate the critical importance of change for general practice to survive. WentWest has positioned itself well as a change leader, with critical success at the forefront of primary care.”
What are others saying?
Dr Charlotte Hespe provides an excellent summary of what primary health networks are, and why they might help us to achieve a better and more connected future.
“[PHNs] are tasked with facilitating and assisting general practice to deliver improved high-quality, patient-centred healthcare and outcomes and can provide assistance by the provision of new services to bridge the current gaps in care that are vitally needed and should be supported to do so.”
Read more of what Dr Hespe has to say here. She’s done a really good job at explaining things from a patient perspective so I do hope you’ll stop by and have a read.
Want to find out more? Why not connect with me and have a conversation, I’d love to talk to you about it. After all, I don’t give you my Monday so it’s the least I could do!
The biggest impediment to improvement is our resistance to change.
We do not necessarily fear change, but we do fear the stress that comes with it. At best, we find change inconvenient and at worst, we find it frustrating and painful. Even seemingly positive change can be stressful.
For example, most people would consider getting married a positive and significant life event. Many, however, struggle to cope with the numerous initial changes that are required for two people to effectively live together.
We find change easiest when we are personally invested in the outcomes of change. According to Dr Rodger Dean Duncan, author of ‘Change-Friendly Leadership: How to Transform Good Intentions into Great Performance‘, “people perform in a certain way when they feel the heat, but the change becomes permanent only when they see the light. In other words, we are more likely to engage in meaningful and sustainable change if we feel connected to vision and purpose. For leaders, it is important to note that “you can rent people’s hands and backs, but you must earn their hearts and minds.”
Being change-friendly is creating an environment where change is welcomed, and in which change leaders appeal to hearts, minds and souls.
Fortunately, a lot has been written about the principles of change management, and my favourite take is John Kotter’s eight steps, which can be found in his book, ‘Leading Change‘.
I share my thoughts on the need for change, and to find better ways, on this article initially posted on BridgeBuilders.
BridgeBuilders is an exciting new project aimed at “building links for the future; connecting people, building trust and facilitating relationships – key components of successful collaboration – so that our future leaders will be able to lead together.”
According to its founder, Dr Edwin Kruys, BridgeBuilders encourages everyone, especially those in leadership positions, to reach out and cross organisational boundaries.
I encourage you to have a look at the BridgeBuilders website and consider how you might contribute to a better and more connected future.
You might also like to read more about my thoughts regarding the difference between Compliance and Commitment, and how organisations can go about institutionalising change.