From Rhetoric to the Road
President's Column - The Specialist, Issue 88, September 2011
As the pressure goes on to medics and ministers to demonstrate outcomes that are more than outputs, the hype and hoopla begin to beg tangible turnarounds. The reformation is now being asked if it is truly touching those most in need. Whether it has gone far enough. Whether it has bypassed an underclass. Whether it has side-lined some professionals for the benefit of others.
As the rhetoric translates into rubber hitting the road, are we more together or more apart? Have we forsaken tribal behaviour in our flotilla of fiefdoms that make up the New Zealand health system?
Tribes are strongly protective inventions of humanity. They serve to look after their members in the face of threat and against the dangers of otherness. They have evolutionary imperative and advantage to our existence. They develop their own whakapapa to explain and strengthen their importance. Especially when under real or perceived stress.
Professions, specialties, generalists, partialists, Colleges, craft groups, consortia, patient support groups, age-specific lobbyists, collaborations of chiefs and CEOs, councils, associations, societies, networks, reference groups, alliances, boards, departments, divisions, directorates, ministries, MSOs, PSOs, PHOs, RTHs, TLAs, FLAs.
All tribes. All well meaning. All believing. All eager. All imploring.
Walk their way.
Sometimes their path appears to be religious fervour. An attempt to convert outsiders to their doctrine. Hospital specialists telling general practitioners which protocol to use. Telling them which referral form to fill in. Or else the patient will not be seen until the right information is in the right box. General practitioners telling hospital specialists that if only there was direct access to radiology, all would be well. That if there were no niggling special authorities, fewer would need to clutter the clinics. In these crusades one is portrayed as either for, or against. And agnostics will have no place in the nirvana of the new way.
Sometimes their path appears to curry political favour. The flavour of the month, year, or election cycle. To tap into the dollars slushing around and divert them to the just cause. With much gaming of contracts, alliances, inclusions and exclusions. NGOs forming and reforming, DHBs sharing and caring, Colleges training and restraining. Ribbons cut while budgets slashed. And crabs will still refuse to walk forwards.
Sometimes their path appears to seek social status. Find a position to show off to the new found friends. A title within a committee, organisation, board, network that might confer a semblance of power. A chance to share a drink with another acronym, to be seen on the arm of another mover and shaker. To know the goss before the next reshuffle. And avoid the lonely landmines of the solo climber.
Which tribe will we join? Which path will we walk? How will we measure our success? What will become our whakapapa?
Will our walking together be a religious pilgrimage?
A political march?
A social promenade?
Or can we become one tribe, sharing one walk, down one path? Unite the patchy togetherness, the occasional bursts of shared tribalism. The profusions of good intent, stymied by exigencies of pilgrimage, march and promenade.
The path does not even have to be known, to be there. If we believe our rhetoric, together, we can walk enough times, enough of us, to bring the road into existence.
One tribe. One vision.
Jeff Brown
National President
