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Public health care system has been suffering for a long time. Here's how it needs to change

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Chris Maxon
Chris Maxon

The ‘paralysis’ of public health care has been topical for some time, including at the Presidential Health Summit held last year in Boksburg, Gauteng.

Today, the euphoria is around renewal, and President Cyril Ramaphosa is poised to lead the country towards a new trajectory of delivery and focus on the people’s needs.

The first thing we must realise is that you cannot renew a factory, you cannot renew a company, without renewing the people.

Technology is important, clearly, together with all those other factors which managers consider important, but, at the end of the day, based on the little I have seen, perhaps the most vital element, and I deliberately use the phrase ‘most vital element’, is people.

Our health system needs to change by revitalising its people in order to achieve “value-based health care”.

Revitalising people is an attitudinal change – people’s attitudes have to change. There is a new term every time these things come up and the new term now is “mind-set change”.

Generally, adults do not change their attitudes.

They do so only in response to profound personal tragedy or grief. Otherwise, things happening in office – trying to get a manufacturing competitive advantage, perhaps – do not change attitudes.

That being the case, we have a problem. I really believe revitalising public health care, the organisation, delivery units, takes, among other things, the revitalisation of people.

If that requires changing people’s mind-sets, yet you cannot teach old dogs new tricks, where does it leave us?

Our health system needs to change by revitalising its people in order to achieve “value-based health care”.

Much more important to revitalising people is changing the context that management creates around people.

The late Professor Sumantra Ghoshal, a business management guru, related an analogy in which he compares the impacts that spending time in Kolkata, India, in summer and a forest in Fontainebleau, France, in spring have on his energy level and motivation.

He goes on to say that most companies create a Kolkata in summer (very tiring) rather than the more serene spring in Fontainebleau (refreshing).

Ghoshal says, “There is something about the smell of the air, about the trees, that will make you want to run, jog, jump up, catch a branch, throw a stone ... to do something. You will find that, even though you entered the forest to have a leisurely walk, you are doing something else – and that is the essence of the issue of revitalising people.”

Having spent over two decades in the public service, I can state without fear of contradiction that there is an over-obsession with numbers (note, I don’t mean data).

In the same way, Jack Welch – the former chief executive officer of General Electric – once pointed out that we create organisations in which “managers rule and staff listen and do what the managers say”.

We shun good ideas and creative solutions to problems.

We forget that organisations need to capture intellect and encourage people to articulate their ideas and solutions.

This is easier said than done, and demands that we create learning organisations in which ideas and intellect rule over compliance and hierarchy.

Having spent over two decades in the public service, I can state without fear of contradiction that there is an over-obsession with numbers (note, I don’t mean data).

Believe me when I say, public managers have some kind of obsession with long presentations.

Read: Public health is the backbone of the medical fraternity

While I believe in the power of data, we must create an environment where data is appreciated by all staff and is meaningful to them too.

Data for decision making requires that it is embedded in the organisation culture and not imposed from above. This requires a culture that balances attention to data and values.

The message that must be sent to all employees must be unequivocal: Don’t harp on numbers; lead by example and let values rule!

The revitalising project demands that leaders stop creating strategies and making all the decisions; rather, they must create a sense of purpose, an ambition that is clearly articulated and exciting to every individual who can understand, have pride in and relate to it.

We need to instil a culture of self-discipline among workers.

Just the ambition or a statement of ambition is not good enough.

It is not good enough to say, “This is what we will achieve.”

It is equally important to describe who we are, what we want to be; articulate a set of values and big ambitions, and bring them down to the level of each individual, who will then be able to relate to those ambitions.

We need to instil a culture of self-discipline among workers. Self-discipline is commitment. Self-discipline implies you do what you promise.

If you promise a 14% reduction in fiscal wastage, you die to deliver that. If there is a meeting at nine, everybody is in the room at nine.

The public health care system has been suffering for a long period.

From my little experience and understanding, what I believe to be the real challenge is that there is too much of a “downtown Kolkata in summer” ambience.

One cannot win the public health care revitalisation game on the strength of decree, scale or government policy.

These are essential, but winning is possible only on the basis of the individual, initiative, work and energy.

That is the real challenge before leaders in health care. True competitive advantage is the tremendous unused potential in our people.

Our organisations are so constructed that most employees are asked to use 5% to 10% of their capacities at work. It is not a matter of hours or effort; it is the capacity.

When the same individuals go home, they run their households, build a summer home and lead their families.

The real challenge is to recognise and employ the untapped ability that each individual brings to work every day.

Reversing the persistent and demoralising logic will help public health care in crushing the hold of the gripper, with a liberating effect for leaders and employees at all levels.

This must be the hard edge of the new moral contract on our leader’s side – the commitment to help people become the best they can be – which counterbalances the new demands on people, which the “new public health paradigm” creates.

Maxon is a public servant

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