Should the NHS prioritize patient outcomes above financial performance, access and addressing health inequalities? For this article I have replaced inequalities with inequities. While inequality is a significant, the real issue for many health systems is inequity.
Increasingly, those responsible for managing today’s health systems are retreating from the idea that achieving all three objectives is not possible and trade-offs between them are becoming the norm.
The graph below provides a useful insight into how we got to this point.
In simple terms, it is the story of changes in demand and supply moving at a different pace. Changes in demand are moving along on the exponential curve while health system supply responses continue to change on the linear line.
The narrative of this graph has two parts:
Demand-side changes, moving on an exponential curve trajectory driven by the speed, volume, frequency, and convergence include:
The complexity, uncertainty, and ambiguity of these changes make it challenging to respond traditionally. The consequence and impact on individuals, families, communities, and population have become difficult to predict. The recent forest fires in California with its devastating impact is a case in point.
Many of these changes in its early stages to the casual observer look very benign and inconsequential. However, its exponential trajectory will accelerate to a “J” or “hockey stick” point. When that happens demand changes will quickly catch up with any slag in the supply line, cross the “tipping point” before racing ahead and opening the gap between the two.
Stephen Kotler’s concept of 6Ds (digitalization, democratization, demonetization, deception, and disruption) provides one of the better explanations on why the exponential curve behaves this way. The book BOLD by Stephen and Peter Diamantis provides a good explanation of the impact of the 6Ds.
Supply responses contributing to this gap include:
Leading, managing and changing responses in an environment of exponential change requires more than better strategy, tools, and resources. It needs leaders that can create a team-based culture and environment that is comfortable with constant change, prepared to take a safe to fail (early, fast and inexpensive) portfolio approach to innovation and courageous to make swift decisions (stop, accelerate or change) on current core activities.
Crossing the chasm to deliver on all three objectives requires the following 7 pieces of the jigsaw:
The three objectives of “better outcomes, reducing inequities and balancing the books” is the high–water mark for any health system. Today’s ever-growing and deepening chasm between the exponential forces that drive demand and the linear pace of responses has given rise to a mindset that all three cannot be achieved. Trade-offs between them must be made. This is flawed thinking and is an admission that the pressure has got the better of us. This flawed position is also contributing, reinforcing and deepening the chasm.
The alternative and only viable view is to not just cross the chasm but always to be ahead of the demand curve so that ALL three objectives are a reality. The transition phase may see uneven progress, but the trend of improvements for all three objectives remains positive. Keeping the balance and ensuring that no one objective is lagging too far behind is first and foremost a leadership challenge.
Many government committees, boardroom, and senior executive‘s agenda give an insight of where they are on this leadership challenge. There are glimpses of progress but there remains a lot of ground to be covered. When you read this article, where are you and your organization in this leadership challenge? Reflect on where you and your organisation are currently position on the exponential/linear graph and against the 7 pieces of the jigsaw puzzle. History are made and futures shaped by those who embrace and execute all 7 pieces of the jigsaw!
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