Any system is just a set of arrangements perfectly organised to deliver the outcomes it delivers. As such, you can’t ‘fix’ a problematic health system, but you can change the conditions in which a system functions to deliver a new and more desirable set of patient outcomes. This is where governments can make a difference. They can ‘shape’ health systems over time.
So, the crux of the problem is less about the system per se but more about understanding the interests that it serves. When people say that a health system is failing what they are really saying is that it is not meeting the interests of the people it is meant to serve, but make no mistake, the current system is serving the interests of someone, and this is why it is so resistant to change.
Health system reform is not for the faint-hearted!
No-one controls all aspects of a healthcare system. Governments can control legislation, policy, most of the funding and organisation structures, but they also need the cooperation of those delivering the healthcare services. The interests of those delivering healthcare services do not align perfectly with their patients. Unfortunately, it is the inefficiencies of our health system that delivers the greatest financial profit to commercially interested ‘vested’ groups. We need to acknowledge this and understand the different motivations at work.
In my experience, while service providers almost universally agree that the Australian health system is unsustainable and on the verge of collapse, getting agreement on the changes needed is another thing altogether. All proposed changes are naturally ‘filtered’ through the lens of self interest and so the conversation stops. We can’t expect people to voluntarily do things that go against their self-interest.
It is therefore left to our politicians to take the heroic steps needed to change the conditions in which service providers operate to incentivise and reward those things that deliver the outcomes that patients and the community value. Politicians know that being heroic is usually not vote-winning … so the conversation stops!
Therefore, for real change to happen we also need to see a ‘grass roots’ movement at the community level which demands and mandates the health system reforms needed. Community leadership is vital.
True and meaningful reform involves a suite of co-ordinated and mutually reinforcing changes at the legislative, policy, funding, organisational, service delivery and community levels. This is why it so tricky … but not impossible.
Click here to learn about how complex systems actually work.
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