The Crisis of the Crisis
What if how we are responding to the healthcare crisis is part of the healthcare crisis?
Most parents have experienced a child who has fallen. Most parents have also experienced the deep pain, anxiety, and stress that accompanies that moment.
Now if we imagine that fallen child as healthcare, our conventional response would be to want to fix the problem. We would inquire with parents what their experience is like and then draw some conclusions about what to do next to avert any future injury or to develop tactics to respond to the injury. We may also inquire with children in that process. Inventors would invent solutions. Statistician would keep data. Entrepreneurs would sell inflatable anti-fall products. Health care would band aid children’s boo boos. Psychologists would focus on cultivating resilience. Everyone would carve out their piece of the child falling matrix. We could even imagine an anti-gravity machine as a possible outcome – astronaut school for kids!
This probing a problem is a familiar approach you see in all kinds of “abouting” behaviour – like how we would naturally about children who fall – white papers, surveys, traditional research, lengthy reports, and the strategies that follow would all describe about the state of things. Talk to the people who are on the front lines of the problem or crisis and then march out solutions through planning and strategizing and politicizing. Makes mathematical sense. It’s why we still have fax machines in health care – more ways we abouted problems, even though so few of us ever had access to a fax machine. So much for universal health care.
The Government of Québec is just about to undertake this process with Geneviève Biron at the helm of Santé Quebec. She promised to inquire with a range of health care stakeholders as they shape future strategies. No doubt many people will be vying for their place in that queue wanting a piece of the solution pie. The Canadian Centre for Caregiving Excellence similarly just completed a similar pan Canadian review on the state of caregiving with tactical recommendations that followed. This surveying behaviour is very common as a way of gathering knowledge about the state of things and then positing solutions. This describing gives us a false sense of security that we know how things are, even if we are subtly deciding what we look at and what we overlook or haven’t yet noticed through the lens of our selective looking.
These conventional processes tell us something about the state of health care. They are good at framing the problem into discrete data points and the addressing those data points with tactical solutions. This is a recurring way we have shown up to modern health care. We do this across all systems. Probe the problem like a colonoscopy and then whack-a-mole the mole with the right solution (no moles or colons were injured in the writing of this piece).
The problem with the problem is how we’re holding the frame through which we see the problem. That frame implicitly holds the quality of our seeing and the quality of our acting. If we hold a complex problem with a discrete frame, we invariably create a host of side effects – pesky moles that keep peering out from the complexity box that inevitably allude our oversized and bludgeoning mallets. Health care like all systems is complex; intertwining moles peering out from endless holes – it’s a maze down there.
Consider how technology was supposed to solve administrative burden for physicians. Introducing more technology would free up more time. What happened? Physicians now spend more time with a data obsessed health care system doing reporting tasks which reduces the time they have caring for patients or attending to families. More physicians than ever are leaving practice. Our preoccupation with the singularity of tech as a solution to the problem made tech the problem and negatively impacted the quality of care and physician retention. All of this and more despite our good abouting intentions. First order solutions revealing nth order effects. You can pull all the dandelions but your risk killing all the bees. And we know what happens when the bees disappear – we solve health care because there will be no more humans on Earth. I knew we had a solution to this health care thing!
How do we stop our addiction to solutioning everything while also holding the problem caringly? How do we get out of our own way? This is the crisis holding the crisis. This is our future work – noticing that the problem has a hold of us.