#systemsstudy

Palomar Medical Center. June 2018. Escondido, CA 

• Institute for Healthcare Improvement: Across The Chasm: Six Aims For Changing The Health Care System

From the Article:

“Not only is the current health care system lagging behind the ideal in large and numerous ways, but the system is fundamentally and incurably unable to reach the ideal. In order to begin achieving real improvement in healthcare, the whole system has to change.... Safety must be a property of the system...” 

I appreciate this article being posted in the hall of Palomar Hospital’s Interventional Radiology Department @palomarhealth; Publicly acknowledgment of a gap, or chasm, and a clearly stated vision, are great first steps toward system improvements. 

“Ombudsman”

So cool! I had no idea this role existed! Until I began spending time in hospitals & skilled nursing facilities, and googled this with a doctor; No it’s not named after the winning plaintiff in a court case (which is what I initially thought) - it’s actually the name of an official role in a system.

From Wikipedia:

“An ombudsman, ombuds, or public advocate is an official, usually appointed by the government or by parliament, but with a significant degree of independence, who is charged with representing the interests of the public by investigating and addressing complaints of maladministration or a violation of rights. In some countries an Inspector General, Citizen Advocate or other official may have duties similar to those of a national ombudsman, and may also be appointed by a legislature. Below the national level an ombudsman may be appointed by a state, local or municipal government. Unofficial ombudsmen may be appointed by, or even work for, a corporation such as a utility supplier, newspaper, NGO, or professional regulatory body.

When perspectives converge, it's helpful to be able cite at least 2-3 articles / studies that support your position. Similarly, one can ask to be pointed in the direction of research that supports another practitioners' philosophy of practice (and not in an ‘I gotcha' way, as that’s relationship damaging in the long run…(I know, because I just made that mistake :-/)…. But rather in a sincere, attempting-to-understand, information-seeking way).

A sincere ask on this front not only demonstrates curiosity about anothers’ point of view, but also invites them to examine the foundations of their beliefs. 

Keeping the bar high for everyone. 

Moral Conundrum Questions (not rhetorical, but genuine & information seeking):

1) If I participate in a system that I don’t fully believe in, am I being integral?

2) If I participate in a system that I don’t fully believe in, and do nothing to try to change it, am I complicit?

3) (Whatever the answer).. How far does this extend? — Classroom? School? City? County? State? Nation?

After a certain amount of time in a system, one starts to become the system; Values are internalized, behaviors & dispositions, normalized; Experimenting with new approaches, or maintaining practices that fall outside the norm becomes increasingly difficult, as it requires supplemental & sustained energy to ‘swim upstream’ - which seems to steadily diminish the longer one remains in the system.

Possible solution?