I thought about sharing this post on our Traversity blog, but I'm not quite sure it's appropropriate. I'm still learning how to navigate this whole business communications thing, and I have a feeling I need to err on the side of conservative a bit more than I would like. So I shall share it here instead.
I've been taking my start up obsession deeper lately and have been re-watching Silicon Valley. The final episode of season one is particularly hilarious (albeit crude) scene, even when watching the second time around.
I will try and remain professional so won't go into the details of what they're talking about (you can watch it here if you don't get offended easily), but the crux of it is that they're a small team looking at a tech problem that heaps of smart people have tried to address before, all of whom have reached a similar outcome. Their team made what appeared to be a major breakthrough recently which they thought would put them at an advantage, only to be matched by a much larger competitor. They find themselves in the position where they need to do something better, or fold.
In their moment of despair and feeling downtrodden, they turn to rude insults and banter to lighten the mood. And they go deep with the insults...using a whiteboard to map out a whole schematic with equations and everything (which are apparently mathematically sound).
As Richard, the Founder and lead developer sits absorbing the conversation around him he has a mental breakthrough. A breakthrough enabled through the structural analogy. Everyone's been approaching the issue from the same angle - unidirectionally. What if they approached it from the middle-out - bidirectionally - instead?
This results in a mega breakthrough which catapults their technology ahead of their dominant competitor and everyone else, and they're back in the game, at least for a few more episodes.
As inappropriate as this analogy may be, I use it because it relates to my own experience recently with my understanding of integrated care.
Integrated care is one of the major concepts that underpins health policy initiatives of many nations trying to deal with the growing demand for health services relating to an ageing population and increased prevalence of chronic conditions. When my PhD supervisor suggested that I look into the concept of integrated care I did so more out of compliance than desire. I begrudgingly worked my way through the literature, a lot of which was very wordy and confusing. It felt to me like the kind of concept that was built for policy, not practice. The interventions reported in the literature looked great on paper, but how could you possibly deliver them at scale across an entire country? It'd be like running tests based on a Rolls Royce but using Toyota Corollas for the roll out...it wouldn't exactly provide the same user experience.
If you approach integrated care only from the top down (i.e. through policy and infrastructure etc), it doesn't go very far. There'll be the practices that get paid for the pilot, then a few other early adopter/innovators, but there'll probably come a point where a local maximum is reached and it's hard to get broad scale adoption. This is great for the pockets where the innovation happens, sure. But there's a risk it will end up broadening the divide between the exemplary care providers (who were probably pretty good at quality improvement anyway) and those who are satisfied with sticking to the status quo. Not exactly equitable healthcare.
If you approach integrated care only from the bottom up (i.e. through practice based initiatives), it doesn't go very far either. Say there's a group of motivated care providers who can see a way of delivering care differently and they get themselves a grant to run a practice improvement project. This sort of practice based research is really valuable, and chances are it will produce a positive outcome for the patients that they serve. But how do you get that innovation to spread beyond that particular practice? How do they continue to deliver that standard of service once the funding runs out, as it so often does? Implementing innovation without the support needed to deliver it (remunerations, infrastructure, policy etc) runs the risk of ending up with a bunch of highly skilled but burnt out care providers, who may one day grow tired of martyring themselves and disengage completely.
For integrated care to work, it has to come from both directions. This message is throughout the integrated care literature, it's nothing new. It just took Silicon Valley scene for me to see the practical implications of it.
Australian governments and decision makers are doing a lot of work to develop the policy framework and remuneration models to support the development of new ways of working required to deliver more integrated care. That's great, we need this. But we also need more. We need a way of moving the concept of integrated care beyond policy speak, and into something that is meaningful to those who will have to do the work to make it happen.
I'm not talking about accreditation standards and other mechanisms of fear and control. You can't just create a policy with accompanying standard, it won't work. You can't just 'do' integrated care.
Integrated care not only requires individuals to engage in new ways of working, it requires people to work together in new ways. This isn't just hard work, it's bloody hard work. I'm not just talking about clinicians here by the way. Administrative staff, practice managers, technologists...there are many types of people who are integral to delivering these types of complex interventions.
We need to create an environment that fosters connection between the policy and decision-makers and those who are doing the work to make change a reality. An environment built upon mutual respect. One that motivates individuals to participate in integrated care initiatives by providing them with greater fulfilment in their work. Supports them by providing what they need to get the work done. Encourages them to develop their professional autonomy, mastery and purpose.
That's what Traversity is here for, to provide a venue for this to happen. It's up to all of us to take action and make good things happen, so we might as well get started. Please join us.