A couple of weeks ago I was fortunate enough to attend the Salzburg Global Seminar with healthcare leaders drawn from 26 countries to learn about radical innovations in healthcare delivery.
I made some astonishing discoveries. Let me share just one.
Aravind Eye Care in India is an organisation that treats the same volumes as all eye care providers combined in England. They do this at 1% of the cost and with better clinical outcomes.
Their mission, indeed their passion, is to drive down costs so that their services are affordable to as many people as possible. They brag about being able to do a cataract operation for $15. They are working to get that down to $14.
How many NHS or private sector hospital leaders know the cost of a cataract operation or care, so long as they get paid at tariff? How many see driving down costs as a social goal in its own right? Imagine what would happen if they did?
But then think of the enormity of the leadership challenge of doing this.
I want to set that against another discovery I made at the same event, a malaise amongst the medical profession world-wide: the richer the country, the richer the doctors, the deeper the malaise.
I describe this as a state of grief.
The loss of vocation. The loss of a sense of professionalism as previously understood. The loss of clarity as to role and responsibility compared with other professions. The loss of professional role models. The loss of well-understood career expectations. The loss of feeling that the way they are trained today will prepare them for tomorrow.
But, most worryingly, the loss of that sense of authority and legitimacy necessary to make and act on decisions in the clinical team. We saw that in Mid Staffs – where good people stood by and let bad things happen.
Yet if we want to get anywhere near levels of Aravind Eye Care’s productivity we need to embed a ‘new professionalism’, where doctors:
That’s the destination. But before the train leaves the station let’s jettison any notion that it is the doctors who are to blame here. They are not.
To be honest, we have yet to come to terms with just how profound these changes in healthcare are for the working lives of doctors. They go right to the heart of their ideals and their sense of self. This is deep, profound change.
It’s the job of the leaders to enable them to put mission in front of self. To be clear about acceptable behaviours. To appoint on values. To set clear rules but tolerate difference. To take responsibility for the next generation.
In that context, we at the Health Foundation we are going to attempt to bridge the gulf between believers in new professionalism and the reality on the ground.
We will be spending next year leading a major engagement programme to create this space to understand the issues and to define a clear agenda for supporting medical professionals to develop their roles. We believe this will shift us all from endorsing a broad rhetoric about new professionalism to a clearer idea of what making it a reality across the profession means.Importantly we are committed to following through for the long term on the agenda it defines working alongside the other partners. Watch this space.
Stephen is Chief Executive at the Health Foundation.