Sunday, January 1, 2017

Compromising costs

The concept of compromising fascinates me. Totally. Especially in the realm of leadership roles. Many a leadership course/document will ask to you about consensus, the need to find the middle ground…the broader question always has been what ends up getting compromised in the end? Especially if one takes the example of health- who actually gets compromised? The management? The clinicians? Or is it the third party- about whom the debate rages- the patients? The ability to find the middle ground is always an art- but its always a fascinating thing to wonder-who actually gets compromised?

Lets take an example- lets say general medicine and the perennial debate as to "who does it?" I have and will always maintain that the wedge of fraction was sowed in medicine when someone somewhere decided to give one specialty the privilege of being that extra bit special- whether it be cardiology or anyone else. So we have now come a predictable full circle where the bulk of general medicine is the hot potato…who does it? Can we get all back- so the debate rages on…net outcome when we enter the arena of compromise is that we end up getting something half-baked where everyone gets something but somebody somewhere suffers. Some clever Cardiologist once told me "We have too many cardiac issues to resolve"- the compromise being that the others would have to absorb the extra work..the cost? The diabetes or respiratory patients whose outpatient attendances dwindle, community work suffers…we compromised, we went for a middle ground- somebody, somewhere in the health system suffered as a consequence of that.

How does leadership in health square with compromise? Is a rigid style one to follow? Is ones steadfast belief the way ahead? Well, look how that panned out regards 7 day services. A starting point where perhaps compromise could have opened up the gates to a wider debate- has now descended into utter farce. An uncompromising bullish style has resulted in even trained healthcare professionals wondering whether actually anything needs to change on a weekday. On this occasion, the suffering of the professionals and the resultant angst made no patient safer- so who actually lost or won with that style either?

For what its worth, perhaps it boils down to winning the hearts and minds- because beyond all the aggro, all the posturing, I still believe, in the most, doctors will respond to needs of patient care. There is perhaps a reason why mortality doesn't vary on weekends…to me, its perhaps down to the near super-human extra effort put in by the many clinicians battling with different staff ratios-compared to a weekday. That's good will- and no science or research can factor that in their calculations. If we want to improve anything or change a system- whether that be in hospital or specialists working in community, its about the message- and the NHS seems to have lost it in a swirl of money and politics. 

3 things are pretty important in any discussion about change- the ability to convince that it will genuinely help patients, the ability to assure remuneration of pay and the relevance of work-life balance. The junior doctor issue failed us on all 3 issues- and we are where we are. If you want to learn anything from that in an era when "woking differently" is the buzz-word- have a think how you hit the 3 points made…it may help to avoid a compromise. Compromises tend to work well for the players involved- except for the ones whose care is being debated- and that, ladies and gentlemen, isn't why we do what we do.

Just some food for thought (and some personal mulling!) for when we get back to work in the new Year. 
Want to change care? Compromise isn't necessarily the way…because compromise costs. At the end, it always does for someone, somewhere...


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