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How to change an unhealthy industry culture

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We’ve spent much of the last few years framing challenges in healthcare as, “We need people that ______.”

We need people that can help deconstruct data and work silos; we need people that can improve the user experience on EHRs; we need people that have clinical experience taking in administrative roles; etc.

The truth of the situation is much more simple – in fact, it turns up in the first three words of that slogan for fixing, adapting, and evolving healthcare: We need people.

We talk about tools, systems, and solutions, and while they all entail a lot of new, or newly configured elements, they all rely on human players to make them work, to put them into context, and to link them in ways that matter. It is important to retain that focus.

Using meaningful connections

To talk about people is to talk about relationships.

Healthcare is really an industry defined by relationships: doctor-patient, payer-provider, specialist-specialist – everywhere we look, we that find deficiencies are defined by breakdowns in relationships. To heal the system, or any member therein, is to build or repair the relationships they rely upon.

The impact of new technologies – or, given the climate of 2017, the impact of new leadership –  is often framed impersonally:

  • How will changes affect workflow?
  • How will repealing Obamacare affect insurance coverage?
  • What is the capacity for two given EHR platforms to communicate with one another?
  • How can we get more providers on board with MIPS?

We are missing the essence of what really matters, which is how people will make due in any situation, and how they will connect with one another. Ethical failings in healthcare occur when decisions are made either selfishly, or in a way that values institutions above individuals; this can leave caregivers and patients alike in the cold. It isn’t just the new standards, new payment systems, or even the new technology that drives this tension and occasional neglect. It is losing sight of the relationships that drive all performance.

Escaping normal

So people are their relationships; relationships are what makes a culture. Like My Fair Lady’s Professor Henry Higgens, we grow accustomed to the people and relationships we encounter every day, and the every day is what constitutes our “normal.” It isn’t just one choice or one interaction – it is all of them. So if culture is just the local norms we come to expect and even rely upon, then changing culture means redefining “normal.”

When something is normal, it is tolerated. Normal is not synonymous with good, desirable, or superior; it is purely a reflection of frequency, general acceptance, and visibility. What we need, desperately, in healthcare today is a major culture change – a new, relationship- and human-centric normal.

It is normal to sit; in our contemporary culture, though, sitting has become such a marathon activity that experts compare its health impacts to smoking. At this extreme, constant sitting is no longer an acceptable feature of normal. Likewise, heart disease has reached an epidemic scale, afflicting people with less and less correlation to age or genetics. This scale and distribution of heart disease is not an acceptable normal. Our opioid-dense approach to pain management cannot be seen as normal; the incidence of depression and stress disorders has become so common that we can’t see how wrong it is – everywhere we look, the sense of normal settled in before alarm.

To change how our culture cares for its members, we must challenge the unhealthiness of our normal.

Only human after all

This, ultimately, is the ambition of the very technology so many decry for sapping humanity from the system. The difference between technology saving us from ourselves, and our skewed view of “normal,” and technology compounding our burdens, may come down to choice. Too much of the progression into digital health systems has been virtually choice-agnostic. Incentives have been based on compliance rather than on engagement.

Consider the recent study of how patients, with just some basic incentives and an easy-to-use interface, became proactive and largely took ownership of self-monitoring their health and activities. The punishment for non-participation was missing out; the rewards for opting in were social, personal, as well as financial. The underlying technology of wearable health devices and apps were secondary to the relationships, encounters, and self-awareness of participants, including providers as well as patients.

It is reassuring to see evidence that technology can be both important, yet anything other than front and center in changing relationships and behaviors. The most impressive implication here is that by aligning incentives, providers, payers, and technology, we can force everyone to look carefully at what their personal “normal” actually is, and then start a conversation – or even an intervention – to set the new normal deliberately, as opposed to passively; individually, as opposed to collectively.

At the heart of this exercise are all of the elements we know need attention in healthcare, but organized first around the individuals, the relationships, and the culture in which healthcare exists. Technology has a role to play, but always as an enabler of the interpersonal, the human, and the cultural. We have an opportunity to change what is normal in healthcare, and in the culture that determines health. It starts with communication.

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Edgar Wilson

Edgar Wilson is an independent consultant who writes and follows health, education, and environmental policy.

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