Wednesday, October 17, 2012

How Different Is The Health Sector From Other Parts Of Our Economy? Part Of A Course I Am Developing.

I am working quietly to develop a unit of a Masters Course for Health Managers.
One of the topics I am trying to cover, briefly, is why the Health Sector is a bit different. Would love comments on what I have wrong or have missed.
----- Begin Extract

Health Sector Culture.

While hard to explicitly pin down there is a sense that the nature and responsibilities associated with the delivery of health care drives a workplace culture in the sector (at the coal-face of care delivery) which is different from other workplaces.
Some aspects of this culture are important when considering the operations of the sector, especially as this is related to the use of and interaction with technology.
Aspects of the culture that may be relevant include:
1. Conservatism - because much of what is done in the delivery of care has not changed over a long period sticking with the ‘tried and true’ seems both safe and sensible.
2. An understanding of hierarchy and the associated responsibilities. While there is a culture of ‘team work’ clearly needed and indeed in evidence in most settings there is also a need to decisions to be taken when required.
3. Separate and somewhat distinct cultures for each professional group also exist (nursing, medical and so on) and it is noticeable that the further away an individual’s role is from direct patient care the less traditional caring values are in evidence (e.g. clinical and nursing working hours are often very flexible and have a ‘till the job is done’ attitude which does not exist in say the accounting staff).
4. Clinical workplaces are typically environments where patient privacy is carefully protected and where preservation of patient dignity and autonomy is seems as important.
5. A sense of individual accountability for patient outcomes and especially for errors that may have harmed a patient.
6. A lack of sensitivity to cost. What a patient is seen by the carer to need will be provided if at all possible - even though, on occasion, the evidence backing a choice may be lacking.
7. An appreciation of the tenets of the Hippocratic Oath and observance of the general spirit embodied therein.
See here for a range of texts of said oath:
These attitudes can feed into how change management and technology implementation are approached.

Change Management in the Health Sector.

As outlined in an earlier section the Australian Health Sector faces a number of what may be termed ‘challenges’.
A short list of the key ones include:
1. The Ageing Population.
2. Workforce shortages and ageing.
3. Remorseless rises in Healthcare costs above inflation leading to financial sustainability issues.
4. A continuing inability to allocate clear lines of funding responsibility with inevitable political bickering, blame-shifting and waste.
5. Rising cynicism and alienation within the workforce with a loss of some value-driven behaviours (as cited above)
6.  Work-practices which remain arguably much too provider centric rather than consumer / patient centric.
7. Continuing very slow diffusion of evidence based practice approaches into the clinical community.
8. Continuing inability to measure much in the way of clinical outcome and patient satisfaction information.
9. Many professional staff feeling the effects of what are felt to be excessive work pressures and bureaucracy.
Taking the mixture of the culture described above and the issues identified in this section it is clear that any significant change - technology based or not - is going to face considerable resistance and if change is to be successfully implemented then considerable careful planning is needed.
Specific considerations in health sector change management that also need to be considered are:
1. Often the thought leaders are both highly opinionated, highly competent (at least in a narrow field) and typically influential on those they work with on teams.
2. Impact and quality and safety of patient care is much more highly valued that efficiency and cost saving.
3. Many of the hospital workforce and virtually all the non-hospital workforce are independent practitioners who are not responsive to command and control - need incentives, carrots, explanation and intelligent justification of change.
4. At least some any change will need to convince have highly developed ‘bull**** detectors’ and are pretty smart and cynical to boot - so are often a very, very hard sell.
5. The risk / reward ratio of making any change needs to be apparent and easily understood and possible and or potential issues identified up front rather than hoping no-one will notice.
In summary change management in the sector can be very difficult and needs a high level of cultural awareness as well as a sound considered approach.
The Wikipedia article on Change Management provides some useful general background.
----- End Extract.
Additionally anyone who has any useful references in the areas of Health Culture and Health Sector Change Management I would be very grateful!
David.

2 comments:

Grahame Grieve said...

hi David

Risk works differently in healthcare - we do things that are risky because not acting is riskier. Associated with this is something really odd: the moral imperative that comes with being a doctor. It does have a real impact.

I blogged about this general subject too: http://www.healthintersections.com.au/?p=279

see also http://www.healthintersections.com.au/?p=333 and http://www.healthintersections.com.au/?p=465


Bernard Robertson-Dunn said...

The Health sector is one of, if not the, most regulated part of society (it's more than the economy)

There are also many highly significant stakeholder groups with divers and competing priorities:

1) Citizens - some of whom may be patients. Their highest priorities are their well being, health, privacy and the cost of health care.

2) Health professionals who need access to as much health information and technology as possible. They also get other people to pay for much of the costs.

3) Health insurance, who is concerned with macro risk and uncertainty

4) Various governments, who are mainly concerned with total cost.

If you look at health through each of these lenses, you realise that these groups have incompatible and competing perspectives on health.

AFAIK, there is no other area of society that has such a wide range of incompatible priorities, overlaid with vested interests and entrenched power bases.

IMHO, the only way to bring about significant change is slowly and subtly - not one of government's key strengths.