- It is untenable to say we cannot have an appointments system that will decongest waiting areas. It is unacceptable to argue that this is the design we inherited from a generation that had at best the manual typewriter ...
“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” Lao Tzu
The history of healthcare in Ghana cannot be written without referring to Korle Bu and the pioneering works of the likes of A. A. Kwapong, C. O. Easmon, E. A. Badoe and the determination of our independence struggle. In those early years, the ambition was to ensure that healthcare was at the forefront of our national development. In this light, the first medical school was set up with nursing and pharmacy following soon after. I have in recent days been wondering whether should our generation be presented with the near-blank slate these illustrious Ghanaians were presented with, we will design the health delivery system we have today? In this line of thinking, I have also wondered whether these health pioneers will be proud of what has become of their handy work sixty years down the line?
I have been having these thoughts because I am of the opinion that our approach to healthcare evolution has been strangulated over the years with a tendency to preserve the status quo and to tweak the edges rather than engineer real change. In a previous blog, I explained why the very approach to the selection of health education related undergraduate students has stifled entrepreneurial thoughts in this sector. In that piece I was unequivocal that the surest way to fail in any health training institution in Ghana was to be contrarian, challenging of conventional views and to be forthright with consistent questioning. Today I seek to explain why we cannot continue down this route.
A look at any outpatient department on a weekday would point to one thing, OVERCROWDING. This scene has persisted since my infancy and with increased population is getting worse. Yet, our generation with all the available technology is doing little to correct this anomaly. In fact, to some health administrators, that view is the best indicator that business is booming. Sadly, in my view, it is the best turn off for many a potential patient unless they are very sick. I cannot imagine for a minute that the early trailblazers will be excited should they resurrect to see this as an offspring of their handiwork.
Using congestion as an example, I have sought to find out what if any are the barriers to improving the patient experience. My research and thinking points to a few things. Foremost is our silo mentality and power distant culture which has made us creators of power blocks overreliant on hierarchies with little opportunity to question even the obvious. As a result, those at the top of the hierarchy are expected to know it all and have all the answers. In truth, they often do not and never pause to think their way out of this self-created illusion.
This attitude of abhorring questioning relegated research and development to obscurity with little time or financial investment made by the government or private organisations to deal with the many problems that confront health. Thus, we have preferred to think inside the box and find our leaders analysing and strategizing to deliver based on existing paradigms, expecting us to celebrate minute success as change. How we have come to continually accept this is one of the wonders I cannot explain.
Another drawback is our approach to networking. Often, networks are formed within our professional circles with emphasis on meetings and per diem rather than on idea generation and prototype building. Thus, these meetings are devoid of cross-fertilization from other fields of health, let alone from virtually unrelated fields. The result is the recycling of status quo thinking as new ideas with little appetite for change and delivery; leading to the same excuses being given for why the system cannot change. Ironically, our own training is the best teacher that inbreeding impoverishes the gene pool and stifles intelligence. Thus, why we have become this inbred whilst compounding our problems without reaching out to external ideas is strange.
It is untenable to say we cannot have an appointments system that will decongest waiting areas. It is unacceptable to argue that this is the design we inherited from a generation that had at best the manual typewriter and operated in an analogue space and cannot evolve into the digital sphere. It is pathetic to even argue and shot solutions down with the cliché, “this would not work” even before they have been tried.
We need to begin question storming at the minimal to rip open our current system and challenge why things are the way they are and rapidly go into idea generation accepting all forms of input in order to start building prototypes as a basis for experimentation and learning. We should not flounder at the first hurdle or mistake and throw our hands in the air. We should rather perceive these mistakes as opportunities to perfect these prototypes and soldier on until we have models in place to address most of our simple patient-centred problems. We should not stop there but continue to perfect these.
We must understand that our current predicament provides us with the best environment to engage in a candid anthropological study of our health system. If anything, we can take solace from the story of IKEA and how they came to make flat-pack furniture. History has it that following a photoshoot a sales agent was trying to pack tables into the back of a truck with little success. Along came a carpenter who suggested the legs be taken off to allow for easy maneuvering which worked. The sales agent unsure of how bosses would perceive his actions kept this to himself for a while but eventually told management. Through research and development, this approach was adopted and today is the mainstay of most of the furniture industry worldwide.
This must tell us that ideas irrespective of where they come from can be the seed for change and evolution. They are not a mark of disrespect even if they are from a source with little clue of the health industry and its intricacies. They are just the perspective from a fresh pair of eyes and must not be meet with scorn. This has been our approach for sixty years and cannot continue. In the IKEA story, the carpenter had a choice to walk past the sales agent and keep his perspective private but did not because the society created an ambience for idea sharing. We in the health sector must fashion a way of creating this ambience and show a willingness to learn. It is only when we shed off the cloak of knowing it all and reclothe ourselves with openness and a willingness to learn will we begin solving the many problems that confront the sector.
I will end with this from perhaps the most renowned futurist of the twentieth century Alvin Toffler. “The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn and relearn.” Sad to say many of us trying to solve the health problems of today fit his classical definition of today’s illiterate. We are failing to unlearn so as to create space in our life to relearn. In so doing we have failed to pause to learn the art of thinking and have become the real barriers to memetic evolution in healthcare. We need to emancipate ourselves from this self-inflicted mental slavery and cure our minds of this unfortunate malaise.
Feature Image Courtesy of Tom Wolters
