Monday, September 21, 2009

Promised Land

My son's current bedtime book is a biography of Gandhi (his choice!) As I've been reading it with him, I've learned some things about Gandhi's struggle to free India from British colonialism. Previously, my understanding of his life came from the 1982 biographical film, Gandhi.

Born and raised in India, Gandhi studied law in England and then traveled to South Africa. There, as depicted near the beginning of the film, he suffered the indignities of racial discrimination. These experiences led him to develop his ideas of nonviolent resistance, the application of which improved the lot of South African Indians. He then returned to India.

And changed the world.

What surprised me, while reading with my son, was the length of time Gandhi spent working toward his dream. The movie version of his life leaves the impression that he arrived in South Africa, spent a few years organizing resistance to government oppression of Indians and native Africans, and then returned home to India. In fact, he spent over 20 years in South Africa, fighting for equal rights. In India, he spent over 30 years working toward the independence that was finally realized in 1947. During that time, he spent almost 6 years in jail.

I mention Gandhi not because I would in any way equate his monumental struggle and sacrifice with the effort that any of us is making toward health care reform. I mention him because I marvel at the incredible dedication he showed toward reaching an elusive goal. Imagine the physical, mental and emotional hardship he suffered. How much easier it would have been to accept the status quo, comfortably conduct a legal practice, and enjoy a relatively privileged life.

But his clear and powerful vision compelled him. How frustrating for him to be able to see his country's potential, yet be thwarted at every step. What amazing patience!

I recently read the story of a Saskatchewan man's experience with hip replacement surgery. From start to finish, his care was seamless, conducted by a multidisciplinary team supported by an effective electronic medical record. Every aspect of his care was centred around his needs and preferences, not those of his health care providers. He was extremely pleased with his experience.

The story was fictional.

It was intended to spark discussion about how our health care system could function to serve its customers. It painted a tantalizing picture of what excellent care could look like, but rarely does.

The story was fictional. But not far-fetched. All the individual parts of the man's experience - patient-centred care, multidisciplinary teams, electronic medical records - are available now. Each of the separate parts is currently practiced in Saskatchewan, but only in isolated pockets. We just need to put the puzzle pieces together. And that's what's maddening about the story. It's fictional, but the reality it portrays is just beyond our reach. Well, at the pace we're going, it's further off than that.

Be patient.

That's the message I've heard from several health care organizations that have already successfully transformed their cultures toward patient-centred excellence. Executives from Southcentral Foundation in Alaska, and Jönköping County in Sweden explain that some of the changes took up to a decade, or longer, to implement. Be patient, they say. Don't be too hard on yourselves. We worked at this for years.

So, should we take the advice of these high-performing organizations? Should we ease up a little, let ourselves off the hook? Surely, if it worked for them, it should work for us…

Executive-types seem to go ga-ga over Jim Collins's 2001 book Good to Great. Collins's study selected several companies that outperformed "comparison companies". He then investigated the possible factors - leadership style, corporate culture - of those successful companies. His message: Follow their example to become Great.

Leaving aside the changes in fortune (Fannie Mae, Circuit City) and dubious ethics (Philip Morris) of some of Collins's so-called "great" companies, there's something missing from his analysis. We need to know about the leadership style and corporate culture not only of high-performing companies, but also of those that fail. How often do bankrupt businesses have similar leadership and culture to the successful ones?

Collins's book describes compelling characteristics: humble leaders, honest and frank corporate communication, embracing technology. They just make good sense. But we don't know (from Good to Great, at any rate) whether possessing these characteristics guarantees success.

So, should we be reassured by the successful health care organizations that were patient and took their time to bring about cultural change? We know that it worked for them, but how many similar organizations are stuck in the status quo because they're being "patient"? Where's the line between patience and complacency?

We need to pick up the pace. I don't have the Mahatma's patience.

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