I spend a lot of time on the road talking with individuals across the United States about the future of healthcare. With healthcare reform a prominent topic for discussion, everyone has an opinion about the direction of our nationâs healthcare system, and it has been enriching to hear such different perspectives and ideas.
A few weeks ago, I interviewed stakeholders on their thoughts about the current challenges in healthcare and their desires for the future of their communityâs health. One of the last interviews was with a community physician who echoed concerns that health improvement is too broad a mission. He elaborated that health is so deeply entwined with jobs, education, income, food resources, family dynamics and transportation. He continued adding other contributing factors while we recognized that the list he was creating is dynamic, not linear. These elements influenced one another, and healthcare is in the middle of a messy matrix of other sub-performing systems.
The physician questioned the initiativeâs ability to improve the communityâs health; a skepticism that preceded the projectâs initiation. We discussed the expansiveness of our countryâs health problem, making this effortâlike so many othersâvulnerable to a scope creep that can ultimately paralyze the project. Having barely made it to the starting line, I was startled by the timing of this cynicism. But his apprehension was real and familiar. I understood his concern, and believe itâs one that resonates with many in the healthcare field. Our interview ended on that somber note and I left thinking, âHow can we fix what seems like a doomed cycle?â
Traveling as much as I do has its pitfalls. For one, I am perpetually behind on my television shows. That night, I watched a marathon of Walking Dead episodes to catch-up to the mid-season hiatus. A cohort of the prison residents had fallen ill and was placed in quarantine to protect the healthy. Several began dying and consequently turned into zombies creating more chaos. Some of the communityâs most agile zombie slayers were urgently deployed to apprehend medicines from a nearby veterinary school. Hershel Greene, a farmer and veterinarian, sacrificed his safety by entering the quarantine to care for the ill as they awaited medicine, buying them time. Hershelâs compromise was not surprising. After all, his mantra was âwe all have jobs to do.â He recognized that his caretaking skills could help others survive, and so it was his duty to do just that for the greater good of the collective.
Watching the community on the Walking Dead come together, each person playing a role in keeping the group alive and safe from zombies inspired me. âWe all have jobs to doâ may be the solution to addressing the big challenge of improving the health of our country, recognizing that itâs a collective effort and not any sole entityâs responsibility. Ultimately, the idea that itâs one person, one organization, one professionâs duty to solve the healthcare problem is what creates skepticism and stops us from trying without even starting. In fact, that physicianâs fear will become reality if we place the burden of responsibility in any one area. That just isnât a feasible or sustainable approach.
Itâs time we recognize and hold accountable all that contributes to our health. Our healthcare system is responsive to illness, but not necessarily preventive of it. Weâve lightened our attention on all the factors upstream, driving people into our healthcare system. Real, tangible change, however, occurs when we all do the jobs we need to do. That means responsibilities and roles for schools, city planners, restaurants and places to buy foods, social services and individuals. I wrote earlier this year that the players in the healthcare field need to work together to productively pivot the direction of our system. Well, itâs more than those players. Health is rooted in more than just the scope of the healthcare delivery system.
The involvement of so many stakeholders can feel overwhelming. Â The difficulty is in the coordination. It is simple to rally everyone around the shared mission of improving health. Recognizing each stakeholderâs role in and impact on individual health is also clear. Coordinating these efforts to remove duplication and ensure alignment with the mission, however, is the challenge. Without coordination and engagement of every stakeholder, the effort will be bottlenecked. One President or policy can only take the mission so far. The job of the Affordable Care Act, for example, is to set parameters for improvement among those healthcare entities within the governmentâs jurisdiction. Thereâs so much more though. Hospitals, insurance companies, schools, supermarkets, community and religious organizations, individuals and their social networks also have jobs to do.
We need to rally everyone around a real conversation about improving the health of our nation, and everyoneâs job around that mission. And more than that, we need to accept that responsibility and hold ourselves accountable to those jobs. It is the only way to improving our countryâs health. If itâs a strategy that has kept Rick Rhine, Hershel Greene and (most of) our Walking Dead cast alive for four seasons of a zombie apocalypse, Iâd be hard pressed to believe it wonât work for our healthcare system.
Cecilia S. Lum, MHSA, is a Healthcare Consultant at Blue Cottage Consulting.