It is more Complex than that!

03/06/2013 8:04 am | Complexity and Simple | 1 Comment

Recently I came across a Linked In conversation through my Institute for Healthcare Improvement (IHI) & Quality Innovators titled “Patients Desperately Need to Be Taught “Patient Skills”. I have to admit, my first reaction was…. well a reaction. “Wow! That sounds rather paternalistic!”

I resisted the urge to fire off a quick reactionary comment, shutdown the computer and continued packing for my upcoming business trip. I would like to think it was my hard-earned, age-appropriate wisdom that caused me to be so mature, however, if I am honest with myself, although wisdom a factor, it was probably in equal proportion to my need to get to the airport!

Funny thing happened on the way to the airport however, actually throughout my whole trip. The conversation continued. I mentioned it to several people and thought about it frequently. So here I am on Sunday AM trying to figure out why this Linked In discussion was so “sticky” with me.

One reason I believe caused the stickiness, was my take on the solution (teaching patient skills) as a very simple solution for a very complex issue. My experience (aligned with some theory) indicates that using simple solutions to deal with complicated (detailed) problems is a fit, however using simple solutions to deal with complexity, which is characterized by interdependent and synergistic linkages and connections versus lots of separate detail, is a mismatched strategy. A strategy that at best can be a waste of resources and at worst harmful.

Off the top of my head I listed below a few multiple structure, process, and cultural factors which synergistically contribute to the current state of patient (and provider) skills. I am sure there are more.

  • Power Differential Present in every healthcare encounter is dependency. Those seeking care are reliant upon the healthcare provider for diagnosis and access to treatment.
  • Litigious Society Presenting to a medical visit with too much information or knowledge can be seen as a warning sign versus a sign of an activated patient.
  • Medical Records It has only been over the last two decades that patients received legal support to personally obtain copies of their own medical records.
  • Medical Visit Time of a typical office visit (10 minutes) supports a list of complaints, perhaps a brief discussion. It is not sufficient for dialogue.
  • Professional Language used by medicine and care providers is complicated (not complex) and takes years to master.
  • Professional Behavior deems that providers need to be separate from patients to keep objectivity and rationality.
  • Expert Model lends itself to a one-way “Banking Concept of Education”.

These factors independently inhibit transparency and learning, together they are more than the sum of their power. Hence, an elegantly simple & robust model, one that embraces the complexity versus cover it with a mismatched simplistic solution, is needed. As an example, to increase the robustness of the initial suggested strategy I might suggest – Providers of Care and Persons Receiving Care desperately need to be taught Partnership Skills and Barriers to its Success. Perhaps even together in the same course!


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