Healing Health Care

"Between the idea
And the reality
Between the motion
And the act
Falls the Shadow"

The Hollow Men, T S Eliot

There is no question. Health professionals, patients, and families agree that health care should:

• Center on the patient
• Ensure equal access
• Avoid disparities in outcomes
• Provide care close to home
• Treat the whole person
• Search for solutions that are both efficient and effective
• Invest in prevention

These are worthy goals. They make sense. They would provide benefits for individuals, families, communities, and institutions.

Around the world, small-scale and local efforts successfully create patterns of effective, accessible, and equitable care. The problem is that those efforts do not scale up to the larger community or translate to diverse environments. In general, everyone sees the logic in these innovative principles for health care delivery, but we and our institutions are too stuck to take action to create the reality we imagine. Between the idea and the reality lies the shadow.

Many factors make it easier to talk about change than to implement it. Habits of thought and practice; tight budgets; old assumptions; racial and cultural biases; complicated policies, processes, and practices all work together to keep us stuck in patterns of health care delivery that are neither effective nor cost efficient. Talk will never change these patterns of past practice, but Adaptive Action might. Three foundations of HSD can build a bridge across the shadow between idea and reality.

1)   Adaptive Action moves thought and intention to action. The three simple questions—What? So what? Now what?—allow individuals and groups to turn their beliefs into behaviors. Any person, at any place in the system, can observe a challenge in a moment, consider the possibilities for creative response, and take concrete action to contribute to new patterns of care. In our Adaptive Action Labs with health care professionals, we have seen how cycles of Adaptive Action inquiry make a real difference. They are able to shift patterns for interdisciplinary practice; leadership; process improvement; quality; and employee engagement for individuals, teams, departments, organizations, and communities as a whole.

2)   Pattern Logic uses the power of the present to enable an emerging future. The principles in the bulleted list above define the patterns (similarities, differences, and connections) of a healthier future, and they also inform action. By comparing and contrasting the current patterns to the proposed patterns, individuals and groups can make concrete decisions and focus actions to set conditions for systemic transformation. Relationships among physicians, across professional teams, and with patients shift when conditions change and generate new similarities, differences, and connections for health and health care.

3)   When the patterned principles are stated in active verbs, as they are in the bulleted list above, they become the Short List of Simple Rules to guide individual and collective action. These particular actions over time create generalized patterns that influence how policies, processes, practices, and people interact with each other across the entire system. Imagine how a health care setting will be transformed when every person consciously uses these rules to shape day-to-day actions and interactions.

These three foundations are simple, but they are not easy. They require thoughtful action and clear commitment. They ask that we stop talking about the change in abstract and general terms and that we begin to live it in concrete specifics. Each person in the system can contribute to a new reality; in fact, the change will not happen until they do. These defining principles and foundations can influence new behaviors across the system. Those behaviors will generate patterns of health for the medical establishment and for the people it wishes to heal. 

Join us for the live virtual workshop on 14 April at 11 CDT US as we explore theory and practice of HSD to Heal Healthcare.