Canadian Healthcare Is A Social Mess

By Gerrit Van Wyk.

Ottawa ‘Not Looking for Placebo Policy’ To Fix Healthcare.

Global News published an article by Laura Osman recently, about the healthcare mess in Canada. She wrote provincial leaders are frantic about the ailing state of healthcare, to which the Federal Government responded by offering money, but with strings attached. As part of the deal, some provinces, and the federal government brokered a collective long-term vision for healthcare improvement, which doctors, nurses, and health advocates say is not working.

According to the Federal Health Minister, leadership is taking on different elements of the health system with a spirit of learning and evaluation, but the President of the Canadian Federation of Nurses Unions points out most of those are closed discussions amongst bureaucrats. For nurses, so far, that changed nothing.

It seems the emphasis is on community-based care, and making healthcare records compatible countrywide. Health advocates don’t agree on whether this will fix the problem.

The Health Minister pointed out Canadians lost confidence in their healthcare system, and healthcare providers in leadership, because they don’t see a workable plan. Until now, healthcare workers propped up crumbling systems, but many are by now too burned out to continue doing so, and leave healthcare for other options in droves, aggravating the problem.

I quote this article at length, because in the background, it describes what is the root cause of what is wrong, and why this initiative, like all initiatives before it, will inevitably fail.

The mechanics of what’s happening is roughly as follows. Politicians are responding to a voter concern; healthcare is failing, which is likely to be a major issue during the next election. Hence, for political reasons, they must respond. They don’t know how, so they turn to health “experts”, and the bureaucrats they appointed for answers.

Bureaucrats take the long view and move at glacial speed, if at all, and both bureaucracy and “expertise” are based on the perspective healthcare is like a machine that can be fixed. Additionally, bureaucracy isn’t known for creativity and innovation, which means more of the same in different guises.

In other words, experts and bureaucrats believe they can sit down and plan changes with measurable outcomes, and based on that, can say with certainty their plans will make things better. Notice the patriarchal nature of the approach, in which healthcare professionals, healthcare workers, and patients are like children, with parents making decisions for them without their input.

Peter Drucker pointed out many years ago healthcare is not like s simple machine that can be fixed, it is immensely complex, hence what we are faced with, as stated in the article, is a mess.

Messes are the outcome of the decisions the political and healthcare patriarchy made before, and the more they interfere with a complexity they neither acknowledge nor understand, the bigger the mess becomes. What we are faced with is a problem too big to describe clearly, with solutions that are not clear, the problem context is constantly changing, there are multiple perspectives about what the problem is, and what may be done about it, and disagreement between them, there probably is no single plan or answer, and whatever the solution is constantly changes.

One of the major reasons for the mess is the political nature of the problem, which means in the background it is driven by power interests and games, and collective and personal interests and gain. In other words, there are too many people more interested in how they gain from solving the problem than in solving the problem, and that interest lurks in the shadows. Most of the time we remain ignorant of it, or, for social reasons, can’t openly talk about it.

Social messes are in principle solvable, depending on two conditions; a paradigmatic shift towards seeing and understanding the problem space as complex, and secondly suspending power games. The first is attainable, the second more problematic.

Complex phenomena, like this one, operate differently from machines, based on different principles and laws. You must admit and understand that. Socially, it means everyone are players in the mess, bureaucrats and “experts” can’t know the answers to the problem, and the only way out is learning our way out. It means you have no chance of succeeding without the consent and cooperation of those affected by the outcomes of our decisions, possible solutions emerge from conversation, dialogue, and interaction, not academic exercises and meetings, and the role of bureaucrats is to enable and facilitate those conversations and dialogue, not making decisions. The only way to restore faith in our healthcare system is to invite health workers and patients to participate in planning the solutions to their problem, and own the implementation.

There are ways, based on complexity principles, to do so, but our bureaucrats and “experts” seem ignorant of it, or, if they know about them, won’t give it a fair chance. Instead, we keep recycling the same failures expecting a different outcome, which, by Narcotics Anonymous’ definition, is insane. Or, perhaps, they simply prefer to keep playing the same tired games for psycho-social reasons, that have nothing to do with finding a way out of the quagmire.

The French Revolution was a seminal event in the Western world, and outwardly destroyed the feudal system. The irony is it didn’t do so in our unconscious minds. Politically it gave us democracy, but deep down, socially, we still have the same hierarchies, sources of privilege, dominance, and oppression, etc., governing our social world, only the players changed. Our royalty we must obey are now in politics, bureaucracies, and the business world, and the rest of us are as irrelevant to them as to the lords and ladies before. Like in pre-revolutionary Europe, they still make the major decisions about our lives without our consent, and we tolerate it because we don’t see the invisible strings attaching us to that world.

If we really want to restore healthcare to some sort of workable proposition, we must remove what shackles our minds about our physical, and social worlds. No solution based on an outdated perspective of reality, built on a foundation of the dynamics of a feudal society can, or ever will solve anything.