What really needs to change in healthcare…and what you can do about it

It’s so good to see the medical profession organising itself and doctors and students actively working to promote their own wellbeing.

I for one, can’t read anymore articles about physician suicide and distress – it truly is time to start to put things right. We, as health care professionals, should not be destroyed by our jobs – by trying to heal and help others.

Many of us feel like victims of the system – and are now reaching our for autonomy, empowerment and self-determination to put things right which sees us campaigning for system change.

And so we should.

But here’s the thing about systems – changing them is extraordinarily difficult.

Systems like the health system are large, complex and weighted towards homeostasis.

We see this all the time in clinical practice. Consider just how hard it is to make sustained weight loss changes over the longer term.

A person who reduces their caloric intake, will very have short-term weight loss. Some people are able to keep the weight off, but it seems for many in the longer term, this reduction in energy intake triggers other metabolic and hormonal changes and the whole physiological system acts to shift body weight back to where it was.

We also see it in games like whack-a-mole – squash down one and another raises it’s head in an unpredictable place.

You see it in well meaning efforts to reduce traffic congestion only to find it made the whole thing worse.  

Health system moving parts

So too in the health system. There are so just many moving parts and competing motivations and interests in all the health system players. There are economic influences, resourcing influences, regulatory influences, safety issues and more. In such a complex system, making a change in one part will inevitably have impacts on other parts of the system. 

Sometimes, intended and sometimes unintended. But often idiosyncratic and unpredictable. 

Here is a list of just some of the people and organisations that have an interest or stake in the health system:  

This just how many stakeholders there are – whose attitudes and behaviours would need to change for successful system redesign:

Health care professionals e.g.

• Doctors and students of all levels of training and seniority working in a variety of health care contexts
• All other health care professionals
• Supervisors, teachers and trainers
• Support clerical and admin staff

The community e.g.

• Consumers and carers
• Employers
• Families

 Funding bodies e.g.

• Federal and State Departments of Health – and all their employees
• Health insurers
• Workcover
• Banks and other financial institutions e.g. who provide finance for private practice

Regulators and standards setters e.g.

• AHPRA
• Accreditation bodies
• ACSQHC
• Colleges
• Departments of health – Federal, State and Territory
• OH&S

Training institutions e.g.

• Colleges
• RTOs
• Hospitals
• GP training practices

Health care institutions e.g.

• Hospitals – public and private
• GP clinics
• Community health centres
• Primary Health Networks
• Aged care providers

Legal and regulatory support e.g.

• Medical indemnity organisations and other insurers eg public liability
• AMA
• ASMOF
• Other advocacy groups
• The legal profession

Other stakeholders e.g.

• NGOs and special interest groups
• Research organisations
• Other Government departments

I’ve no doubt missed some stakeholders here. But even if we considered this complete – the attitudes, behaviours and expectations of a broad range of people (well really the whole community) needs to change in a desired direction to care for health professional wellbeing. 

No single stakeholder really has the power to implement any of the desired changes – from better rostering to more family friendly training.

This is going to require sophisticated and imaginative interventions that cuts across hierarchies, silos and helps unite competing interests.  

This can’t in any way be considered the responsibility of any individual.

Micro changes also count

All of the above is true if we are talking macro changes.

What it, though, we started to think more in terms of micro changes. Changing people, attitudes and behaviours one by one. After all, theoretically at least, inasmuch as all the components of a system are interlinked, then even a small change in one component, at some level changes the whole system.

So the attitude I’ve been taking is helping individuals make the changes they can within themselves and impact the people they can influence.

It’s a bit like the starfish story (If you don’t know what this is check out the following)

The reason working on the edges like this is so important is, in truth, the only person we have any control over in terms of making changes is ourselves.

No matter how hard our external situation is, and sometimes situations border on the horrific, we have in our control the ability to choose our attitude and find meaning. As Viktor Frankl said:

“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” 
― Viktor E. Frankl, Man’s Search for Meaning

Only we can be the change we wish to see.

Only we can see ourselves as human beings with real needs and not as cogs in the healthcare machine.

Only we can provide the self-compassion for the very real challenges and traumas that occur on a daily basis.

Only we can make a pledge to treat our colleagues with respect and trust.

Only we can choose to turn towards empathy and compassion towards our patients.

Only we can bring the meaning back to our vocation

Only we can begin to make the changes we want.

I highly recommend taking half an hour to listen to Viktor Frankl himself

The things in your control

Yes, for sure there’s lots that not in our control – maybe the only thing in our control is the attitude and intention to change.

But if each of us recognises and exercises the personal power we do have – even incrementally – then ultimately the bigger changes we hope for will become more achievable.

So change begins with you – and you are free to make changes immediately. One small step for you may turn out to be the beginning of a giant leap forward for the healthcare system.

You have no idea how just one simple smile or word of kindness can change everything for a person – or even for yourself.

There’s no time to waste – lives depend on it. 

So think about what it is in your power to change – no matter how small and make plans to do something towards getting that change started.

Remember: Change starts now.

What will you do differently?