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Growing pains


Change implicates loss and all the elements of mourning are applicable ... Part of the difficulty of changing PHC is caused by mourning GP's ... – PowerPoint PPT presentation

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Title: Growing pains

Growing pains
  • Thoughts about change, mourning professionals,
    groupthink and leadership in primary healthcare

Based on experiences in the field, common
sense, soap series and good books
Growing pains
  • Ron van t Land
  • Former GP
  • Quality management for outpatient anticoagulant
  • Consultant PHC for Kenniscentrum Eerstelijn (KC1
    / Knowledge Centre PHC)
  • Director regional Medical Coordinative and
    Diagnostic Centre

Growing pains
  • Thoughts about change

Need for change
  • Dutch working force will not be able to provide
    for future healthcare needs if we go on like this
  • Quality is to be controlled, proven and improved,
    more than it is now
  • Possibilities grow faster than budgets and
    knowledge grows faster than brains

The government approach
  • Introducing a market system within an unchanged
    overall budget, thereby accepting
  • Increasing cost of transaction
  • Pursuit of profit
  • Bankruptcies
  • Introduction of fortune-seekers
  • Steering the interactions between the insured,
    the healthcare insurers and the healthcare
    providers with money, laws and surveillance
  • Forcing complex change using the
    unfreeze-move-freeze method by introducing a lot
    of pressure and a certain level of chaos

What GPs are forced to do
  • Profiling, negotiation, contracting
  • Efficiency
  • cost-sharing, centralizing purchase, combining
    competence and redesign processes
  • Accounting for quality
  • System, process and outcome
  • Increasing chain participation with other
    healthcare providers
  • Professional, financial, strategical

What makes it so difficult ?
What makes it so difficult ?
  • Doctors in general have been trained to be alone
    and lonely in a tricky profession. They tend to
    rely only on their own judgement, even in matters
    that dont match with their own competence. They
    forget to ask for help and support

What makes it so difficult ?
  • When you Google for managing complex change,
    this is what you get

Dr. Mary Lippitt / 1987
What makes it so difficult ?
  • Struggling With the Demon Perspectives on
    Individual and Organizational Irrationality

What makes it so difficult ?
  • As explained by Manfred Kets de Vries
  • Ongoing change needs
  • Social support
  • A strong (internal) locus of control
  • Change implicates loss and all the elements of
    mourning are applicable
  • Denial, anger, depression
  • Acceptance

What is the GPs loss ?
  • Romantic picture
  • Based on very ancient rol models but containing
    very important values
  • But also
  • Freedom
  • Getting limited because of quality transparency
  • Monopoly
  • Very much affected by the introduction of an more
    or less open market

What happens to GPs ?
  • Some of them get inspired and creative, but
  • Many of them get confused, scared, angry and
    depressed, resulting in
  • Territorial behaviour
  • Victim behaviour
  • Weariness, demotivation and inactivity

The GPs challenge
  • Try to understand what is happening and the
    impact it has on you. Ask for help if you dont
  • Dont victimize yourself. Accept, adapt and make
    what is important for your profession survive in
    a new kind of world

Keep it safe and motivate
  • Be more careful about introducing market
    mechanisms at regional level where health care
    providers need time to learn how to compete and
    cooperate at the same time
  • Ask GPs and other providers for help instead of
    trying to manipulate them. Helping is what is in
    their genes, what they are trained to do and what
    they like to do most

Create proper incentives
  • Dont simplify by focussing on outcome, but
    reward process improvement
  • Pay for ambition, quality focus and patient
    orientation. This is more effective, more fun and
    less threatening
  • Leave them part of the profits for further

About social support
  • Good social support is about learning, sharing
    difficulties and celebrating success. But beware
    of groupthink !

What leadership must do
  • Create safety and trust in the process of change,
    rather than mobilizing fear and anger
  • Coach on developing a solid locus of control and
    new points of view

Independent leadership
  • The GPs own leaders
  • The groupthink obstacle
  • The question of mandate and trust
  • Selling the message to the work floor
  • Or outsourcing to a trusted extra party
  • Independent towards government, insurers and GPs
  • Knowledge of the work field
  • Understanding change at all levels

Take home thoughts
  • Part of the difficulty of changing PHC is caused
    by mourning GPs
  • Groupthink and territorial behaviour are easily
    induced and very much obstruct the change we all
  • To much pressure leads to some improvement and a
    lot of resistance
  • Results might be better using independent
    leadership that is coaching on the process of
  • Even a GP is just another human being

Growing pains
  • Dont forget to read The alchemist by Coelho