The Braver journal
Redefining the boundaries of the healthcare network
I do not know why, but in life I tend to see things systemically. Some people like observing the infinitely small through a microscope, while I like taking a bird's-eye view of the relationships between the different components of a system. This way of thinking sometimes makes me see life as a little too complicated, but in the context of innovation, it helps me make new connections.
Marie-Lou Gagnon
With this troublesome tendency to see everything as a system, you can understand why silos and tunnel vision irritate me a little. And, mea culpa, I have a cognitive bias, and if our society consisted only of people like me, life would probably be far too complex. But that is how I am, and it has left me somewhat perplexed by the way we solve problems in our healthcare system.
I know, I know, the problems in question are not easy to solve. But it worries me that we are solving complex problems with incomplete, partial solutions. It worries me because we are building tomorrow's healthcare system, and you know as well as I do that a transformation of the healthcare system does not happen every 10 years, and that all too often, it fails.
A question of semantics or perspective?
We often talk about the healthcare system as a “network”. A network is a “set of interconnected or intersecting lines or elements”. That makes sense, but I wonder whether a different perspective on this “network” could help us solve the healthcare system's problems differently.
From my perspective, I like to see it as an “ecosystem”, meaning “an organized environment”. By seeing the healthcare system more as an ecosystem than a network, we move a little closer to its inherent nature: an “ecological” whole.
In concrete terms, this means that the patient (a human being) moves between different healthcare professionals (other human beings) in different settings. Period.
Perhaps that statement seems obvious to you, but I sometimes feel that this perspective is not taken into account when solutions are developed within the healthcare network.
For example, there is currently talk of easing family physicians' workloads and breaking down barriers between practices. One solution being implemented is to involve pharmacists and nurses. This is undoubtedly a very big step, and I find the initiative promising and wonderful.
BUT we never mention how other healthcare professionals could be involved. Actually, let me correct myself: the professional associations and the people directly concerned do talk about it. Since half of their work takes place in the private sector, the “network” perspective leads us to see them as though they were not part of that “network”. Yet if we change our perspective and see the healthcare system as an “ecosystem”, we quickly realize they are clearly part of it.
This “network” perspective on healthcare is dangerous, because it currently dictates how our healthcare network solves problems. And solving them while considering only part of the ecosystem will lead only to partial solutions with limited impact. And possibly harmful ones!
The healthcare ecosystem is overloaded, and we all know it. The population is aging, and we all know it. So why do we not join forces and work together?
The people holding up our society's health are our healthcare professionals. They include not only physicians, nurses and pharmacists, but also social workers, physiotherapists, nutritionists, occupational therapists, psychologists, speech-language pathologists, dentists, and many others. They work not only in hospitals, family medicine groups and pharmacies, but also in community organizations and private clinics.
We need to address the problems of the healthcare ecosystem by considering every person and every setting within it. We do not have time to divide sectors. We are one single healthcare ecosystem.
Because a psychologist can save a life too.
Because a physiotherapist can change someone's life too.
Because a nutritionist can transform people's daily lives too.
We need to be resourceful. Break down silos. Do things differently.
We need to imagine the best solutions: solutions that are thoughtful, coherent and lasting.
Transformative solutions.
Solutions that promote and actively involve every part of the ecosystem.
We need to think through our solutions from a perspective of cross-sector collaboration.
I know it is not an easy task. I know how complex all of this is.
But we have had enough of a fragmented, reactive healthcare network. We need a collaborative ecosystem that promotes “working together”, because otherwise, our professionals will be the ones we have to hold up.