10 proposals to transform our hospitals

Nacho Vallejo
 

The history of the NASA pirate group

In the 1980s, the space agency NASA began work on the development of space shuttles. Responsible for landing man on the Moon, it zealously maintained the use of the Apollo-era operating system. At that time, a group of young engineers who had recently joined the agency questioned whether the system was going to be able to respond to the challenges posed. Calling themselves "the Nasa pirates", they proposed an alternative mission control. The agency's mantra "we've always done it this way, so it must be the best" didn't stop these rebels from writing their own "manifesto" challenging the status quo.

The story, a priori far from the orientation of this blog on healthcare management, may not arouse the interest of our regular readers. But an unexpected turn of events encourages me to share it because it can serve as an example for change in our health institutions.

The initial rejection of the "hacker" ideas ended when a legendary director of mission control and the group's efforts provided an opportunity: the pirate operating system would coexist with the official one for a few months. And it did it with remarkable results. While there were continuous falls and blockages of what had been the operative star of the agency, the new system not only continued to serve but also facilitated the execution of projects and ended up being the seed for the development of the future international space station.

Transforming our hospitals

The history of these mavericks teaches us that innovation and change do not usually have an easy path. The same thing happens in our organizations. Although most of us are capable of original and novel ideas, we are not usually confident enough to bring novelties to healthcare. Improving what we do and also doing better things usually finds natural barriers: our culture, the hierarchy, the bureaucracy, the need for resources and time, the managers, the professionals themselves and the "here it has always been done that way".

Trying to change the system is not easy. It is a journey we undertake to test ourselves by expanding our comfort zone. It is a real adventure. We have to trust that we can bring something new, find partners who facilitate the journey and try to offer the best of ourselves in improving care for our patients.

The story of change also needs a certain sense of self-criticism, tenacity to modify some rules in the interest of the organization itself and the search for catalysts that help in the transformation. In my case, it was a chance encounter on social networks with other committed professionals. With them, and using the hashtag #cambiahospital, we have talked over the years about the need to respond not only to what is urgent but also to what is important; what it means to build together, to surpass prejudice; to work as a team; to manage people. We talked about the value of service leadership, the search for results relevant to our patients, that we must care for ourselves and encourage them to care for us, that we must give the patient and the professional a voice and that we must look for new ways to organize ourselves.

And, together, we have built our rebel manifesto. A decalogue, some rules that can serve to light the way. To challenge the growing inertia in our organizations and face the current and future challenges presented by healthcare in our hospitals, we propose…

...A decalogue of rules to change the hospital

1. Hospitals must have a clear and inspiring mission that overcomes bureaucracy, prejudice and egos and helps unleash the full potential of professionals and managers, facilitating co-creation with patients.
2. Hospitals must orient the organizational model towards a fluid network of teams, changing roles, providing new skills to their workers and making it easier for them to acquire responsibilities. In this task, it is important to incorporate patients and front-line professionals.
3. Hospitals ought to share authority to facilitate the work of those who are willing, from humility, to lead by example, to build and guide teams.
4. Hospitals must facilitate experimentation, make it visible and reward it. Incorporate innovation as part of the process, with its risks, successes and failures.
5. Hospitals must facilitate the autonomy of workers, with accountability, and trust that people work in the best interest of the institution, helping patients and families in the best possible way.
6. Hospitals have to facilitate the flow of information and have greater transparency, avoiding fearful silence, normalizing the conversation, supporting an environment with psychological safety and increasing the precision and speed of decision-making.
7. Hospitals have to let people work in what they like best and that best suits their interests and strengths. Make it easier for talent to grow and let people grow.
8. Hospitals must take action on patient-centred care. This is not making people and families happy; it's about instilling confidence in the way we do things every day.
9. Hospitals have to lower the barriers between managers, professionals and patients, making it easier for the latter to join governance bodies on an equal footing.
10. Hospitals have to share a purpose, which goes far beyond a vision and mission. It is to go straight to the bowels and hit a part of the most primitive being of each one. It's working to bring people together with similar primitive purposes and getting them all moving in the same direction, it's doing incredible things, it's doing the impossible, the inevitable.

To change, in short, is to have the humility to identify what we do not know and the curiosity to rethink the way we have always worked. It is about grow making grow. Together we must create the right conditions for things to happen, for patients, professionals and managers and for us to move forward and contribute positive new ideas for the benefit of people's health care and the much-needed care for professionals. And we must always involve patients because if we do not include them in the design and decision-making, it is very likely that we will develop brilliant paths elaborated by experts, but without any value for people.

I share in the post the video about a conference focused on this topic at the San Jorge Hospital in Huesca on October 20, 2021.