It's Time To End Feudalism In Healthcare

“Getting any change made requires getting some moral authority that we have to do things together. The problem with ORNGE is that everyone in this room and everyone out there in the health sector is going to say, ‘That $25 million, that is the money I needed to run my program.’ ”

Moral authority doesn’t come from without – it comes from within.  Communication doesn’t start with the other party – it starts with you.

Ontario’s healthcare sector has an historic opportunity to do the right thing – collaborate on building an integrated healthcare system.  Starting with “but I need to fund my program” is the wrong approach.  There are countless programs out there that overlap, duplicating services for some demographic groups, leaving others in the lurch entirely.  The same applies to business supports, social services, educational services.

It’s time for public service providers to get out of their feudal mentality – Ontario is not a series of publicly funded fiefdoms, we’re a society.  We, as a people, are integrated – we need our services to be integrated as well.

The way of the future is specialized services offered in coordination.  I can think of several groups of healthcare stakeholders I have spoken to that want to develop shared service models; the consolidation of back-office functions, IT, etc was being discussed by multiple players long before the Drummond Report came out.  The biggest challenge they faced wasn’t will or connectivity, but follow-through.  “We aren’t mandated to integrate” isn’t good enough when there are people falling through the cracks. 

If government isn’t giving you its blessing to open a dialogue with partners, you do it anyway.  Boards of Directors can do this on their own time, without eating into existing budgets.  If you are in the business to serve your stakeholders with the best service possible, that means you support whatever model makes that happen, whether you’re the provider or not.  There’s lots of work to be done, everyone will have a chance to specialize – when they work together.

Besides – if the hammer is eventually going to fall, does it not make sense to proactively plan your own future rather than reactively implement someone else’s plan that perhaps doesn’t accurately reflect your ground-level reality? 

A couple of easy starting points:

- Greater accountability for financial resources – how many dollars get spent in funding envelopes because, well, it’s money, in that envelope?  If it doesn’t have to be spent in one area, reallocate within an institution or even cross-sector to where the need is.

- Shared service models for related services serving overlapping demographics

- A digital map of services to lay out what we have, who it serves and how the pieces interact

-       Look outside the box – much of reactive healthcare could be superfluous if we instead invested in proactive health and mental health promotional services.  Same applies to justice and broader social services.  Because we don’t take the time to plan and act proactively, we spend much more at the back-end. 

Some examples of this? 

     *  “mental ergonomics” in the workplace

     *  staff transition strategies

     *  Social Emotional Learning in schools (included in Full Day Kindergarten, by the way)

      * regular staff team-building exercises.

There’s a real appetite for leadership out there – all we need are people willing to lead.

Thinking Ahead

“for there is nothing either good or bad, but thinking makes it so.  To me it is a prison.”

Hamlet

 “Like everyone else, you were born into bondage.  Into a prison that you cannot taste or see or touch.  A prison for your mind.”

Morpheus, The Matrix

Canada is embroiled in the beginnings of an ethics/corruption scandal – some folk organized vote-suppression calls in a manner that was undeniably unethical and anti-democratic.  Shockingly, in this age of social media and information access, these calls are slowly circling back to bite the perpetrators in the ass.  Who could have seen that coming?  A bit prematurely, to be sure, but some other folks are making comparisons between this and Watergate, the mother of political scandals.  When there is so much evidence of how stunts like this can go horribly wrong, why would people continue to perpetrate them?

And why do we insist on sticking by “gate” as a suffix for any new political scandal that comes along?

Also in Canadian politics, we had a federal Minister trying to pass a security law that gives control over who pokes their noses into the e-bedrooms of the nation to unspecified parties, without much in terms of justification required.  The response has been been outrage from a generally complacent public.  The Minister reacted by telling an Opposition MP “he can either stand with us or with the child pornographers,” later denies having made the comment and eventually has to backtrack entirely.  There’s also evidence that this Minister has been aggressively defending a Bill despite not being entirely clear on the content.  What gives?

Related to the Toews Affair, a Liberal staffer took it upon himself to dig in to and expose Toews’ dirty laundry – setting himself up, robo-call like, to reap what he sowed.  Did this guy think his actions through?  If so, did he disregard the consequences and do it anyway?

Many outraged people got behind vikileaks, saying that it was okay to fight fire with fire, essentially reacting in the same way as Toews and the young staffer did; some are now suffering from an outrage hangover.  What caused the hyper-emotional reaction?

Then, there was #tellviceverything, a clever response to the Bill that invited people to overshare with Toews, making a mockery of both the Bill and Toew’s position.  #tellviceverything has been heralded as a brilliant piece of politicking and has also inspired a following.  Why?

Connecting The Dots

The global economy is in the bust part of the boom-and-bust cycle – a cycle we’ve been through before.  The Conservative Party of Canada is slowly imploding, a train wreck unfolding before our eyes, despite having the benefit of seeing the exact same scenario play out for the Opposition Liberals over the past decade.  Broadly, it’s like society is a macrocosm of Charlie Brown; we tell ourselves that this time, we’ll kick the ball and are repeatedly caught by surprise when we don’t.

How can we continuously not see this coming?

I could go on and on about history repeating itself, but that’s boring.  What we really want to know is, why?  What’s the math behind this?

By and large, people are linear thinkers.  We see life, business, even conversations as a trajectory, like a train heading somewhere.  Our carrot-and-stick approach to education, business and politics all serve to keep us on this linear track.  In reality, though, our world is a bit more like an equation – it’s multiple trains leaving multiple stations at a variety of times and speeds.  You can’t do the math if you don’t have all the variables.

If you could map out those variables, what would they look like?  Perhaps something like this:

 This is a map of a neural network.                                                 This a map of a societal network.

                                               This is a map of ideas.

 Here’s another story that’s slowly taking hold of the global subconscious; there’s a rising awareness of a mental illness crisis that’s costing us billions of dollars and impacting productivity, family life and social cohesion.  We’re trying to find new ways to treat the growing numbers of anxiety/depression cases, which is a lot like trying to cure lead poisoning.  At the same time, we’re looking for ways to make “crazy” people with conditions like bipolar disorder or Attention Deficit Disorder more normal. 

Normalizing = train wreck.

Empowering = filling in the dark corners of our cognitive, social and global maps.

By repeating the same behaviours over and over again, we’re building up social repetitive stress injuries.  On the individual level, these injuries manifest themselves as diagnoses of cognitive stresses like anxiety and depression.  On the social scale, we have protests, revolutions and a burgeoning economic meltdown.

The solution?  We need to add a few dimensions to our linear process – think outside the box, if you will.  Every journey needs a destination, but you can’t plan your trip without a map.

The Political Organism

"In the animal kingdom, organisms evolve to become successful in exploiting a niche. I’m sorry to say that in the public sector, government evolves to become successful in exploiting taxpayers."

Solberg misses the point, me thinks, but I like that he's thinking along evolutionary terms.  Government isn't an animal; rather, it's part of a broader organism, society.  It should, at its best, serve the neo-cortex, executive function role, coordinating resource allocation and accomodation across the series of systems that make up our Canadian whole.

When we embrace this reality, consciously, we'll all be better off.

Success, Consequence and Integrity

“By seeing the seed of failure in every success, we remain humble.  By seeing the seed of success in every failure, we remain hopeful.”

Mel Ziegler

 We’ve all heard the phrase “if you don’t use it, you lose it.”  Sometimes it’s used in reference to muscle strength.  In other cases, it applies to memory or more broadly, our thinking skills.

Can it apply to integrity, too?

Another maxim we’re all familiar with – learn from your mistakes.  Everyone makes mistakes – after all, nobody’s perfect.  Our educational system is designed not just to train our youth, but to test them as well; each experience becomes an opportunity to learn and do things a bit better (subjectively) the next time.  This applies, in theory, to social interaction, too – kids date to determine what they like and don’t like in mates, as well as sort out which approaches work and don’t work.  All this training ostensibly prepares them to find and land a good mate.

This process applies equally to politics.  Elections are the proving and continual testing grounds for politicians as well as political techniques and methodology.  Polling provides an even more frequent performance metric political folk, or business folk, can use to judge their relative strengths.

While life as a training ground makes for a lovely notion, it hardly plays out this way in reality.  There are guys and girls who never learn to mesh well with others; they might blame themselves, or they might feel it’s always the other person who’s the problem.  In business and in politics, there are those who never fail themselves; their failures are trickled down to the market, to shareholders, to government.  These are the stereotypical 1%, the kind who say (and believe) things like “we’re smart, they’re dumb” in relation to opponents, stakeholders, even team members or supporters.  The more often they place blame on others, the easier and more instinctive a response shirking accountability becomes.

A stereotypical 1%er once told me you don’t have to know what you’re talking about; what matters is that you sound confident while saying it and employ enough bluster to make the other person feel you’re right or, at least, that someone else is wrong.  This same person told me that nothing makes them happier than seeing staff they’d let go for some reason or another succeed, but when pressed, could barely recall a couple of names.  When I sought out some of those deposed folk, the opinions they gave me were remarkably similar to what you’d expect of a person who’d been thoughtlessly dumped by a boy/girlfriend.

This isn’t to say that the people at the top aren’t smart and capable; they quite often are.  That’s how they managed to get their first taste of victory.  In business, politics and civil life, however, success often works the same way as it does in evolution; I don’t need to be faster than the bear, I just need to be faster than you.  In any large institution, success involves moving up a hierarchy, a change in title and access to different resources and a different “social class.”  Call it a Starbucks-vs-Tim’s social stratification.

The further up the ladder you go, the further removed you become from reality at ground-level.  Ironically, living in “the bubble” is like having an addiction; the first taste is agreeable, then the euphoria becomes the norm.  Eventually, what had been a positive experience has become a dependency.  Instead of needing the drink or to gamble or have sex, you need money, power, finery, access.  Success slowly shifts from being the thing one strives for to the thing one tries to maintain; accountability regresses into entitlement.  What results is corruption.

When it becomes about winning, not achieving, you’ve lost. 

We’ve all seen it a thousand times; the periodic pop-up in the media of some high-profile individual or organization who gets caught with their hand in the cookie jar.  In Canadian politics, longevity (facilitated by a fractured opposition) left the Federal Liberals without many mistakes they needed to learn from; instead of providing the best option for Canadians, the increasingly-bubbled folk at the top spent their time fighting over the best seats at the table.

The same is now happening within the Canadian Conservative Party – where once they fought for electoral dominance to put forward an agenda focused on safety and security, their concentration is increasingly just on power itself.  Sadly, the result is this thing called corruption.

Governments defeat themselves; as the Harper Conservatives’ grasp starts to falter (due to their own negligent arrogance), their actions will become increasingly desperate.  The net effect of complacent elitism is always, always the same – you reap what you sow. 

What happens when your internal focus comes at the detriment of respect for your voters?  You lose elections.  What happens when businesses undermine their clients?  Those clients get picked up by someone else.  More broadly, what happens when the top of a social hierarchy becomes woefully disengaged from the majority?  You get movements like Occupy.  Remember the left-behind staff/jilted lovers from before?  It’s a lot like that.  Put another way; suggesting that “Canadians don’t care” is the political equivalent to saying “I’m just not that in to you.”

If people aren’t willing to make mistakes they’re never going to make any right decisions.  The same holds true for taking ownership of mistakes – which is what integrity is all about.

Success doesn’t have to come at the expense of responsibility. In fact, lasting success never does.  That, essentially, is what the whole post-capitalism movement is all about.  The world is looking for leadership that doesn’t skirt past responsibility or download accountability to the next generation; we want leaders who don’t mind rolling up their sleeves from time to time and doing the hard work.

Of course, the only reason the populace is itching for more from leadership now is because the times are tough for a growing percentage of us.  Remember, we say 99% today, but we didn’t get here straight from zero.  There are always those on our streets, in our schools and in other countries that have continuously been left behind.  The truest integrity challenge we face is demonstrating how committed we are to moving forward together.

UPDATED Tuesday July 23, 2015: A study conducted by Sanford DeVoe and Jeffrey Pfeffer found that individuals who are paid hourly or bill their time are less likely to volunteer.In another experiment they conducted, individuals who billed their time in the experiment were less likely to send letters to the sick children than those who did not bill their time to volunteer. Remember this the next time you bill your clients.

Yup.  It gets better:

Research by Elizabeth Dunn, Lara Aknin and Michael Norton has found that those who spent money on others rather than themselves reported greater happiness. In addition, in an experiment where individuals were given money and told either to spend it on themselves or on someone else, those who engaged in prosocial spending – spending it on someone else – reported the greatest levels of happiness. Moreover, this effect has been replicated in 136 countries.

So there.

Mitt Romney's Faulty Memory

The Golden Jubilee described so vividly by Romney was indeed an epic moment in automotive lore.  The parade included one of the last public appearances by an elderly Henry Ford.

And it took place June 1, 1946 - fully nine months before Romney was born.

I find this fascinating. 

A guy who could potentially be leader of the most powerful nation in the world relates a fabricated memory to a rapt audience – and yet the story barely registers?

This man’s mental faculties could very well decide whether the US (and its allies) go to war, how the US (and global) economy shakes out, social services, etc, yet this mental slip is not seen as worthy of consideration?

Yet another example of why truly understanding all this mental health stuff is important – our lives and livelihoods truly depend on it.

Canada's Conservative Government On Ethics: Why So Serious?

If I understand this correctly:

A Conservative Government Minister bars an Opposition MP from attending Durban, then chides her for not attending Durban. 

Then, a Conservative Government Minister invites an Opposition MP to fly on a military chopper, then accuses said Opposition MP of taking a ride on a military chopper.

The Fed Tories are adamant that only their finger rests on the trigger; it's too bad they insist on shooting themselves in the foot.

I guess Harper said it himself; there's not much leverage on fiscal conservatism, so the libertarian-esque Conservative Party of Canada is focused on curtailing freedom.

Not the government we need, but alas, the government we elected.

Mental Illness Tragedy in Toronto

Today, at around 1:30 pm on the Queen's Park TTC subway platform, I was part of a tragedy.

Sadly, it’s a tragedy that plays itself out every single day.  An older gentleman, gaunt, bald and with a full grey beard was being kicked off the train by its operator.  The why is no surprise - the man was swearing, claiming he was a US Marshall, pointing and being belligerent to the operator.  The operator was not happy; the other passengers were decidedly uncomfortable. 

I'm hardly an expert, but the behaviour this man displayed was indicative of a mental illness.  The operator was in reactive mode; the man was a threat which he wanted to remove.  The other passengers were equally reactive, trying to bundle into themselves as much as possible, not wanting anything to do with what was playing out in front of them.

Me?  I ran through the underlying context in my head – which illness the old man was likely inflicted with (schizophrenia was my guess), the limbic reactions of the passengers and operator, the broader public services that apply to mental health and justice, plus the sad regularity of the scene.  Yet still, I did nothing but watch. 

Since then, I've asked myself why I sat by, passively, when I knew what was going on and could probably have done something to help.  The answer troubles me; despite what I know about behaviour, about TTC operations and about available mental health services in Toronto, I felt helpless, unempowered, to make a difference.  If I stepped up, how would I explain the facts to the operator?  What techniques could I use to reach the old man?  How much time would it take and would, ultimately, I be able to connect the man with the help he needed?  I didn't act; the tragedy unfolded unabated, as it does time and time again.

It's not my fault that the man was sick.  It wasn't my fault that the operator was tired and frustrated.  It wasn't my duty to act - but then, whose duty was it?  Nobody was to blame, but we were all guilty of not trying to help.

We live in a society and, like it or not, we live in it together.  What happens to each individual one of us has an aggregated impact on all of us.  That man might end up sleeping in a police office, or in a hospital, costing the public money and reducing the availability of service to the rest of us.  There’s an unlikely chance he might hurt someone else, reacting to his environment much as the operator did.  Most likely, the man might do something to hurt himself. 

When we let tragedies like this happen, we are all lessened in every way – morally, financially, service-wise.  We are all responsible; abdicating our duty to each other is not enough.  When we look beyond what we see, when we reach past our feelings of discomfort, we empower ourselves to be part of the solution.

The road to empowerment lies through education.  The people we generically label as “crazy” aren’t monsters – they are real people with real families.  They’re just suffering from illnesses, illnesses for which treatment and supports exist.  The person who is sick just needs the chance to be connected with those services. 

Here are some websites you can visit to learn more:

Schizophrenia Society of Ontario

Mood Disorders Association of Ontario

Centre for Addiction and Mental Health

Canadian Mental Health Association

Ontario Shores Centre for Mental Health Sciences

Children’s Mental Health Ontario

I am advocating for a web system that makes it easy for the average person on the street to take a photo or send a text into an online portal, connecting a situation as it happens with the local service providers who can do something about it.  We already have suicide lines in subway stations; Google Maps lets us find restaurants or theatres and rates them.  A digital mental health service system wouldn’t be much different, wouldn’t cost much to build and it would make it easy for everyone to make a difference without getting directly involved.  Such a system would help police, justice services and mental health service providers connect people with mental illness and their families with the assitance they need.  If you think this is a good idea, drop me a line here on the blog or via Twitter @__cce.  You can help.

There is lots of good work being done right now, partially by the organizations listed above but also by businesses like Great West Life and Bell Canada.  There are many, many politicians who are taking mental health and its impacts seriously – find out who your local representatives are and ask them what you can do to help.

The most important thing we can do is learn – learn about mental health and how it effects not just those with mental illness but each of us in how we live our lives, every day.  This is vital, because it does impact us;

Percentage of short term disability claims related to mental illness in Canada: 75%. 2007 figures report 72%.

Percentage of long term disability claims related to mental illness in Canada: 79%. 2007 figures report 82%.

Fastest growing category of disability costs to Canadian employers: Depression

Annual losses to the Canadian economy due to mental illness in the workplace: $33 billion

Amount employer will save, per employee per year, for those who get treatment: From $5000 - $10,000 in averagewage replacement, sick leave and prescription drug costs

We all pay the costs when we do nothing; by doing something, we can all benefit.

When you’re not part of the problem, you’re part of the solution.  Be part of the solution.