The late Samora Machel is famously prayed for his apt assertion: “The rich man’s dog gets more in the way of vaccination, medicine and medicalcare than do the workers upon whom the rich man’s wealth is built.” Machel was bemoaning that state of healthcare in his country and the salaries that black nurses were paid, whilst doing the same job.
At the dawn of a new era in our democratic dispensation we are forced to invoke Machel as we hope for the best that will assure that the majority of our populace’s lives are worthy than a ‘rich man’s dog’. The perils of public health care is a going concern that requires urgent determination and attention.
As the President and Premiers ponder on the capable people to be deployed to lead the portfolio of healthcare in the country and provinces they need to do so understanding sector changes that could disrupt healthcare value.
They need to understand that the primary mission of health care is to facilitate healing. And people often associate healing only with “cure,” but it is much broader. A clinician heals when s/he reassures a patient that a symptom does not signal a feared health condition. A treatment heals when it mitigates pain and slows progression of disease. Healing even occurs when a very sick patient dies at home surrounded by family instead of in a hospital attached to machines.
Each unique instance of healing represents a physical and emotional journey through difficulty, toward contentment and even peace. All patients need healing, and when clinicians and their institutions actively foster it, they renew themselves, too. As we start this term of administration both the appointed national minister and Members of the Executive Council (MECs) at provincial levels must know that our healthcare workers are unhappy employees – I know because I am there: they are disengaged and unappreciated which has resulted in decreased productivity, and ultimately, bad attitudes.
Disconcerted staff are not only a financial strain, but they are also emotionally draining – disrupting team morale and possibly decreasing quality of care. While keeping employees happy may seem like a tall order, there needs to be an effort to make sure morale stays positive and employees are engaged. These leaders will need to reclaim healing as a core aim by recognizing the threats to it and prioritizing four key intersecting principles: proximity, mutuality, and kindness.
Put workers at the centre of delivery
It’s natural to focus on what’s ahead rather than reflect on how much has been achieved. Taking time to reflect, though, helps employees appreciate how much they have done. The trend has been a focus on the political head of health departments and less on workers. The worst cases has been developing a culture that fears the political head to a point where a mention of the name of the political scares workers. For years our workers have been threatened by this scare culture and the time has come to change it and foster environments of enjoyment and delivery.
Develop a new leadership cadre not narcissists
Working in health you would believe you’re in a military organisation. People are very obsessive (to a point of stupor) about their titles. I wish to urge that the coming leaders must remind those with titles that leadership is all about growing others. It’s about your team and its welfare. It’s about your direct reports and their performance. Leadership is a tough act. It’s a daily balancing act. As a leader, you’re expected to use your insight, experience, and rigor to balance the conflicting demands of short- and long-term results.
Good leaders cast the vision of the future and motivate people to buy into it. They constantly talk about their vision and reinforce it with rewards, which may be in the form of a significant recognition of some sort. Even without the rewards, just sharing your vision as a leader can in itself bring about the motivation your team needs to accomplish the most difficult of assignments.
Proximity: Get Personal
Healthcare is about and for the people. So, decision making that occurs far from the bedside (and life) of the patient is less likely to heal that patient. The high-cost oncology drug that isn’t “on formulary” but may offer a mother another year with her child who has cancer seems entirely different in a spreadsheet than in a conversation between that mother and her child’s doctors. Multiple brief clinical encounters with a patient may look good as part of a revenue stream but may sacrifice empathy by design. When a health care institution builds empathy into the fabric of its operations, it allows clinicians to take the time to discuss with a newly diagnosed patient how each treatment option will affect her family, emotions, work, and identity.
Similarly, the health of a community that faces socioeconomic and racial disparities in care does not look the same on a line graph as it does when under- and uninsured people in that community tell their stories directly to leaders who are making choices about health care resources.
Mutuality: Share Power
In matters of health, no one has all the answers or owns all the facts. The success or failure of healing depends greatly on the pooling of knowledge and information. Clinicians and patients must operate in a climate of trust, respect, transparency, and humility, and require organizational support to do so. Mutuality requires that patients be viewed as the rightful owners of their patient stories. Only then will they be empowered to become full participants in their own health care.
Mutuality allows for a partnership with another person, without judging or needing to be in control of his or her journey. True healing can only occur if patients are given choice, and their individualism. Healing does not occur if patients are shamed for lacking health literacy or seeking alternate therapies, or if they’re overwhelmed with data they cannot possibly absorb. To heal, patients must feel safe in being honest, making mistakes, asking questions – and in being guided, gently, by clinicians who care.
When clinicians share power with patients, the challenging work of healing can become more joyful and rewarding. In this way, it can offer one antidote to work-related burnout.
Kindness: Foster a Culture of Trust
Lastly and most importantly, you need to remind clinicians that working to understand the complex emotions that diagnosis and treatment evoke – and then show kindness to patients as they face those challenges – can mitigate some of the suffering that illness confers. Kindness helps to heal not just the recipient, but also the giver.
Kindness can be learned, and that starts by embedding it in organizational culture, just as protocols for the safe administration of medications are embedded. Kindness earns the patient’s trust, essential for the patient-clinician partnership that healing requires. The absence of kindness – and trust – can lead to patients feeling like hostages to their care and the clinicians who deliver it; “hostage bargaining syndrome,” as it has been called, actively thwarts healing.
We can’t be proud to be engaged in a never ending project of health transformation. Public health has a number of men and women with potential and temperament for leadership. The notion that it is only doctors and/or nurse who are born to lead healthcare, is wrong and must be castoff. Similarly, we must bring back merit based appointments and not the one driven by proximity to political office.
The majority of the poor and under-served people of our country can’t feel less than a rich man’s dog. Health care plays a unique and sacred role in society – to provide healing – and it is up to its leaders to reclaim the primacy of this role before it is too late. Healing requires more than medication and technology directed toward physiological improvement. Emotional and spiritual rehabilitation matter, too.
In order for health care to facilitate healing, leaders must lead the way, strengthening an organizational culture that encourages and enables patient-clinician partnership. By being proximate to see what cannot be seen at a distance, embracing mutuality, cultivating resilient teams, and fostering kindness, we can reclaim health care’s true purpose. By modelling these tenets, leaders will make it easier for clinicians and their teams to heal at the point of care.
I hope you’ll understand that health transformation begins with the leader, flows through every individual employee, and ends with an organisational culture that values every employee, their ideas and creativity, and empowers them in the vision of the future.
Chris Maxon is a healthcare worker and social commentator.