I don’t have answers. I have ideas. I have questions.
Saving our healthcare system means we all must come together to share ideas, needs, understanding, and ongoing learning. We need to understand our own needs and the needs of others. We need to be proactive and learn to be healthy. We need to promote wellness. We need to be curious.
Though many of our needs remain the same, many have changed.
What Has Changed?
How has healthcare changed over the years?
Growing up and in the years before I went into nursing, doctors still made house calls. I didn’t enter nursing until my late-20s, I am now in my mid-70s and the changes have been enormous in some ways, but very much the same in others.
Nurses are no longer expected to stand and give up their seat to a doctor when they arrive in the unit. Nurses are no longer handmaidens, though they are often not treated with respect deserved by anyone, let alone someone with their knowledge and skills. The innumerable roles of nurses, knowledge, and skills are often unknown. Healthcare and nursing are complex systems.
According to Rose (2015) “Nursing is an increasingly complex profession within complex healthcare organizations. Complex adaptive systems form the roots of healthcare delivery (Crowell, 2011).”
This complexity has come about for several reasons. One substantial change is the patients. Patients that at one time would have been in an intensive care unit (ICU) are now cared for on a general ward. “For nurses, doctors, and other health professionals, taking care of a patient today is, on average, more complicated than taking care of a patient was 10 or 15 years ago,” study author Hiten Naik, MD, a research fellow at the University of British Columbia, Vancouver, Canada, told Medscape Medical News.”
Overtime has become the norm and has been for many years. According to the Canadian Institute for Health Information (CIHI), “In 2021–2022, hospital staff (excluding physicians) worked more than 26 million overtime hours — the equivalent of 13,000 full-time positions”. Would our system save money by hiring more people? Are there enough qualified people to hire? Would improving working conditions help in recruiting qualified healthcare professionals? Though many provinces show they have increased the number of nurses entering the workforce, Alberta lost nurses. Why?
What Hasn’t Changed?
Leadership
From my perspective, healthcare leadership remains hierarchical. This outmoded form of leadership continues, not just in healthcare, but in many businesses and organizations. Other forms of leadership need to be considered. One form of leadership that allows the incorporation of numerous leadership styles is Complexity Leadership. Could this be considered and help to improve healthcare?
“Complexity leadership is a framework for understanding how to enable people and organizations for adaptability. It draws from complex adaptive systems (CAS) theory in complexity science to show how systems can be more adaptive in the face of complexity. Examples of CAS are neural networks in the brain, the immune system, and the developing embryo. All of these function by enabling information from across networked interactions to flow into an “operating system” that can capture the information, make sense of it, and apply it into the system for adaptability.” (Uhl-Bien, Mary, Meyer, Danika & Smith, Justin. (2020). Complexity Leadership in the Nursing Context.
The descriptions of Complexity Leadership and Complex Adaptive Systems accurately describe healthcare and nursing.
Where to Start
We can’t wait for someone else to start making changes. We are each responsible for stepping up and doing something, anything, however small. Speak up, write letters, sign petitions. Ask questions and learn what is happening, though finding that out is not easy, we can still push and try.
Be curious!!
Encourage healthcare bodies (despite frequent changes to boards and political appointments) to include doctors, nurses, other healthcare workers, the public, and patients to share their needs, views, and opinions. My healthcare needs might not be the same as yours.
Health is more than the absence of disease. Health is more than a strong body. Our health is influenced by many things: our education, our job (or lack of), where we live (country, rural or urban), family, friends, support systems, access to healthy nutrition, and a place to live. Many of these are outlined in the Social Determinants of Health.
Many years ago, the PDSA (Plan, Do, Study, Act) cycle was used in the Calgary Health Region (not sure if that was the name at the time as there was much change occurring) for quality improvement projects. This is a method that might be considered again as improvements are needed. “PDSA cycles form part of the Associates in Process Improvement’s Model for Improvement, which provides a framework for developing, testing and implementing changes leading to improvement. The model is based in scientific method and moderates the impulse to take immediate action with the wisdom of careful study.”
What else could we try? Healthcare and education within schools, seniors’ residences, community centres. Different payment options for physicians. Health and life support for shift workers – initially in hospitals, but for all shift workers. Consider how our education system can work in tandem with our health system. Stop separating mental and physical health – one influences the other. Let’s brainstorm and come up with ways to make neighbourhoods safe and healthy.
There is no single answer, no single question, but there are numerous possibilities if we explore and are open to doing something different.
