There is no doubt that we all want a substantial improvement in the health systems for what they represent in the quality of life of each and every one of us. The proposed goals are very ambitious. There is talk of evolving towards a more proactive, preventive, integrated and community model, leaving the current model, eliminating excess bureaucracy, the deficits of certain professionals, the barriers to care and the centralization of decisions, among other things. Changing the model when the destination is the opposite of the current one is a maneuver that requires not only resources, but something more difficult to change: the mentalities of professionals and managers. Let’s add the organizational models, the tactical and operational priorities, the purposes of the professionals, the training and competencies of the different unions. In essence, it is expanding the concept of health to go far beyond the prevention or repair of diseases.
For example, admitting that the doctor assigned to a patient changes without hardly communicating it to the user, opposes that basic sense of person-oriented health. The usual disconnection between medical specialists gives the user the feeling of going from window to window without anyone taking charge of their overall personal or family situation. Each doctor acts from his or her point of view, ignoring the interrelation of the treatments. Sharing information between professionals – public or private – in search of integrated and effective action is an exception. Needless to say, there are collegial demands on professional competencies among the different agents of the health systems. Personal, union and collegiate objectives are prioritized over those of current or potential patients.
Saying that the system must be more integrated means approaching this type of interactions from a perspective contrary to the current one. From a new perspective where cooperation and the transfer of knowledge towards the user, and between the different disciplines and intermediate scales, should be the behavioral guide of multiple agreements in the design of services. Agreements where quality care (safety, response time, trust, professionalism and empathy) and interprofessional cooperation are prioritized.
The diagnosis of the system is done and surely the identified deficiencies will worsen, because when something deteriorates the greatest enemy is time. The challenges are significant and no different from those of other countries around us. They are a combination of social trends in relation to demographics, pluripathology, co-responsibility in the education of healthy habits, and the social structure and involvement of family units. Also added are the weak border between care and health, the technological emergence in medical techniques and technological communication systems. And finally affecting professionals: their size, location, qualifications and work models, initial and continuing and interdisciplinary training plans, and professional and information interaction between public and private services.
These challenges are structural because we come from a culture of scientific progress through specialization and isolation of knowledge, with departments of equals together, a model that extended to industry and also to the field of services – public and private – such as health. For this reason, the training of more specialists, who do not work in sufficient coordination with other specialists, is set as priority objectives, except in special circumstances of cases of certain importance. The horizontal vision of preventive health requires stable and multidisciplinary teams, better recognized and paid generalists, empathetic people close to the user, resources based in a territory and associated with a group of patients or family units to whom they care in a sustained manner. Closeness and mutual knowledge – professionals and patients – is a huge source of reducing diagnostic costs and the only way to grow in prevention. This is the necessary integration and territorial distribution of social and health services, mental health, in addition to pharmaceutical care units. If we expand it – as we should – we must also have sports centers, youth and citizen education initiatives in nutrition and mental, physical and social well-being. A great interprofessional pact for health with sustained development over time is required – those 10 or 15 years – if we want to achieve objectives as important as those mentioned.
All of this, which is a utopia at this moment, is only approachable through a cultural change in the sector, its leaders and its members, in the great space of health. It is not primarily a question of resources, nor of local decisions, but rather a transition from disease systems, a previous model with the nerve center in hospitals, to health systems with the operational and informational core in the communities of professionals and users. That is why prevention, proactivity, integration and community are cited as basic principles of the new. Recovering the prestige of the health system is overcoming current problems by creating a culture and a system that provoke a new way of understanding and doing things, and above all doing things that have never been done.
Culture is so important in individual and collective behavior in the face of change that it is said: “Culture eats strategy for breakfast, management for lunch, and innovation for dinner and goes to sleep until the next day.” It’s about changing culture, which is not a matter of making decisions every day. The change of culture is for many years and its beginning must be focused – when it is radical, as in this case – through a new organism with powerful internal and external horizontal relationships, which is born with different DNA, and growing absorbs the resources of its predecessor A great opportunity given the avalanche of health professionals close to retirement.
Cultural change occurs through a new grouping of resources and a redefinition of the missions that the different groups of the new institution must undertake. It requires separating and uniting into new groups, assigning different missions, rethinking the design of services to progressively grow the units and leaders that we want to dominate the final cultural scenario. Without forgetting communication as the oxygen of cultural management
. The new internal and external communication offers enormous opportunities for transformation through unstoppable information technologies. Technologies that continue to illuminate solutions with enormous impact on future health services, significantly reducing costs, combining effective knowledge and information management with interactions between professionals and people served.
It is necessary to rethink that the health system will be something else, if we want to lay the foundations for a different instrument, with a future beyond 4 years. Looking outside is not the only solution. Success is more conditioned by how we understand and make cultural change than by the objectives we intend to achieve.
Industrial Engineer. Doctor in Organization