Big Med (2012)

Talking from a slightly different perspective - the public health sector (so not the US) - I can also confirm that a number of the major problems in healthcare stem from entrenched cultural values. Most healthcare staff I work with or have met are really adverse to change. One must understand however that it is not change itself that they usually dislike, it is everything that comes with it.

Historically, healthcare, particularly the public kind, has proven to be riddled with senseless bureaucracy, and trust me, I don't mean that lightly. A simple change to a procedure will require filing forms upon forms, countless layers of approval (often from people who have little to no relevance on the matter), using completely antiquated systems, etc. The first step to facilitating the acceptance of change is to cut the bullshit, to let people do their jobs, but that too is made very hard.

When ills and death are at the core of your field, it's easy to see how people will constantly look to assign or shift blame. Bureaucracy, in its own very messed up way, attempts to fix this but instead ends up tripping over itself, repeatedly and increasingly. Costs that should have been divided and spread instead end up being multiplied and painfully reworked to match the different sources of funding.

Another major pain point in the public health sector (at least in Canada) which the OP indirectly touches on is the drastic lack of common business skills among leaders. In fact, the hierarchy and the "power pyramid" are completely and utterly devoid of any common business sense. Authority and management positions are aquired purely on the basis of seniority and academic fame (a whole story by itself...), but not a single drop of management skills is ever required. It is not uncommon to see well networked researchers make it to the top while having no social skills, no business experience and no leadership skills, all the while directly or indirectly, and often unknowingly, affecting hundreds of healthcare workers, and ultimately the patients. Redundant effort (duplicated research, processes, etc.) is rampant, entire departments can have several, unrelated heads, or conversely, exist in near vacuum with nobody to be held accountable (again, worthy of a dedicated story).

In this convoluted context, people will seek to bypass the rules or bend them so far that the rules themselves stop making sense. People at the top will often officially hold different supposedly full-time positions (!) to get their salaries increased (because the current process, particularly with recently-enforced unionization, no longer allows for individual raises, and because funding is so fundamentally messed up). The "ground" staff will often do whatever it takes to satisfy the rules, often in ways that don't satisfy the original aim of the rules but that allow work to be pushed through. As an example, I pointed out severe security issues in our organization ; the response was to create a security council that would decide how to act on it. The result was official (ISO) standards are now being implemented (more than a year later) with people scratching their heads to find the most creative ways to meet those standards, so swaths of new standard operating procedures are being designed, which will themselves require validation, through validation processes that do not yet exist. Meanwhile, nearly all the security issues I identified back then are still well and truly alive, but the illusion (or rather, public appearance) of security apparently matters more politically than actual security.

The topics I have discussed here barely blow the dust off of the old proverbial healthcare book. As much as I feel rewarded by my professional position in a technical way (and there is obviously a lot to do), I can't help but feel bitter about the state of the system as a whole, about people's attitude towards healthcare on all sides of the equation. My personal efforts and suggestions to improve public healthcare are often met with the perennial "eh, what can you do?" that disillusioned, blasé healthcare workers have grown accustomed to.

Should anybody out there want to hear or discuss some of my thoughts on how to fix (public) healthcare, or is already actively working on it, please feel free to contact me, I'm kinder than I may appear :)