One of the biggest challenges in the healthcare system is that it vests disproportionate power in the hands of a few – the medical practitioners. Doctors are at the top of the knowledge hierarchy in the system and hence, wield significant power in decision-making, relegating the rest of the players to marginal roles of following orders.
A patient, during her journey through the healthcare systems across the world however, interacts with the doctors just around 10% – 25% of his time. Most of the time, the interaction is with nurses, technicians, support staff and administration. Given so much of the patient experience and wellbeing is linked to what happens in the non-doctor interaction period, it is time to question the power equation in the system.
Healthcare systems around the world are unlikely to change unless we address these issues head on. And I don’t mean just more delegation to the non-doctor teams; it is truly the shift of power which is needed, the power to make decisions, the power to override decisions and ultimately, the power to set priorities for their organizations. I would wager that a truly transformative healthcare system would be run entirely by nurses, with doctors and other providers reporting to them. Of course, we need more nurse practitioners who practice primary care, more nurse administrators who run hospitals, and so on. But the key here is to build a system where decision-making or power shifts from doctors to other players in the system: a system where everyone plays.
Unless the power shift happens in a manner that it addresses these pressing concerns of power shift, awareness and preventive care, we are unlikely to see changes in the outcomes, in spite of the billions of dollars being pumped into improving healthcare each year. Unless everyone plays and towards a common goal, change is difficult.
In my book – The Healthcare Gamechangers, you will see how Dr. Rushika Fernandopulle in the United States has built just such a system with self-organized units of nurses and customer care executives that provide primary care in their neighborhood, or how Edith Elliot is empowering patient attendants and their families to take control of their own health and be ambassadors of correct information in their communities, or how Dr. Suresh Kumar is training volunteers in the community to self-organize and care for their loved ones. Be it palliative care, preventive care or immediate care, involving everyone else apart from a doctor is the need of the hour. Each nurse, volunteer, or staff can make a difference to the life of another human being, patient or not. Every healthy person educated and made aware is one potential patient averted, perhaps one family of potential patients dodged. And though this might appear to be a small number, it is substantial when we calculate the positive ripple effect that such information can bring about.
Each of these game changers is chipping away at the old system in their own way, battling a different devil, building capacity, shifting power and ensuring everyone plays, one person at a time.
Dr. Fernandopulle and Iora Health are redefining how primary care is played out. Today, insurers tend to influence medical decision-making, which is absolutely wrong. By taking complete charge of the person’s health, not just the outcome of a consultation, Iora Health is changing the outcomes right at the primary healthcare level, avoiding expensive, invasive and often unnecessary, procedures, reducing healthcare expenses and improving overall healthcare. Not just this, there is greater job satisfaction for the entire team of caregivers that attends to a patient right at the primary care level, making the person’s goals for their health and life, their mission. In Dr. Fernandopulle’s model of healthcare, not just the primary caregiving doctor, but nurses, behavioral coaches, psychologists, nutritionists and the person himself plays.
Edith Elliott of Noora Healthcare identified an unexpected ally in the patient’s recovery process — their attendants. By training the patient’s friends and family who are waiting in the hospital as the patient gets better, Edith is not just empowering the immediate caregivers with correct knowledge to reduce complications and expedite recovery, but also sending these persons, armed with accurate medical information back to the community, where usually myths and misinformation abound. In Edith’s model, friends and family participate and play towards better health for the community at large.
Dr. Suresh Kumar and the Neighborhood Network of Palliative Care is breaking down institutionalized palliative care to mini local armies of self-motivated volunteers that are trained to care for those in need from their own local community. The safety net of doctors and nurses that drive the decision-making in this model in Kerala, India, is truly delivering health with care. Using the fuel that motivates volunteers each day, Dr. Kumar has channelized this caring concern to help reduce complications, improve outcomes, provide gentle but accurate palliative care. In Dr. Kumar’s model, local volunteers and nurses play to give better end-of-life and palliative care to their very own community.
What Shifts when Everyone Plays
Decision making: Select few to distributed
When people organize themselves into smaller teams that can decide what’s best for the people they are caring for, the care delivered is much more precise, it can address issues being missed by bureaucratic hierarchy sitting miles away, and is much faster. This can mean a world of difference as far as a person’s health is concerned.
Power: At the top to the front lines
A significant amount of power is a must for every person who has a responsibility to ensure that they are doing complete justice to the job at hand. Their opinion matters.
Organization structure: Hierarchical to flat structure
A flat world might be preposterous as far the Earth is concerned, but in healthcare, it means more rapid decision making, faster execution and individualized healthcare.
Organizing principle: Command and control to self-organizing
Having rules is great and unavoidable when dealing with masses. But if rules become suffocating enough that they choke creativity, individuality, and optimization at the cost of consistency, it’s time to do away with them.
Structures: Formal employment to informal associations
The way care is delivered matters. Clean but cold environments that have all but a precisely calculated amount of care being delivered isn’t the best for recovery. The term ‘healing touch’ was coined for a reason.

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