Three obstacles to change in healthcare


What’s so bad about what happened yesterday?

If you’re lucky, nothing at all. However, nothing particularly extraordinary probably occurred either. And therein lies the problem.

The routine mundanity of the everyday is unlikely to shake us from our lethargy or inspire us to change those elements of the design, delivery, or management of healthcare that we are responsible for.

The probability is high that we will do today what we did yesterday, because we did it yesterday. Our course is set by the line of least resistance, the means whereby we can find the capacity to afford ourselves the indulgence of a little more time to do things we may find more diverting than that which we are paid to do.

That’s fine if what we did yesterday also happens to represent the apogee of our personal and professional aspirations for healthcare in the best of all possible worlds. If you work in healthcare and that describes the way that you have managed to conjoin your personal and professional goals, I salute you. I’d also politely suggest it might be time to wake up from your pleasant reverie.

Only those who have looked the likelihood of their non-existence squarely in the face are likely to have a genuine appetite for making a difference tomorrow, because they’re grateful for the opportunity to be able to do so. It’s also why those living with chronic disease want to manage their condition optimally. They want tomorrow to be as good as it can be for them and those they love, and they realise that that is determined by their actions today.

Forget about what did or didn’t happen in healthcare yesterday. Resist fruitless conjecture about what might happen in the future. Think instead about what you can do tomorrow. Today, do what you can to create the conditions of possibility for it to happen.

Iterate, don’t speculate.


“Really? Communities are an obstacle to change? Have you lost your mind?” I hear you ask.

I love communities. I am a member of many. I’ve founded one or two.

However, whilst I appreciate that communities can be great as meeting places and offer wonderful opportunities to connect people and share information, they can also be a barrier to change.


Firstly, communities have a tendency to become more conservative over time. As relationships develop, we become wary of saying things that may upset or inflame those with whom we are connected.

Whilst change frequently evolves from a sequence of deviations from the norm rather than from momements of crisis or rupture, despite the avidity with which such terms are deployed in reality nothing is less likely to ‘disrupt’ or serve as a ‘change agent’ than an established community, for whom the notions have come to assume a reassuring symbolic value only.

Change is born of ideological conflict. Where there is no conflict, there is no change. However, the community’s default response is to appease, not to challenge, and whilst it’s nice when we all get along, sometimes that doesn’t get much done.

The problem is compounded by the fact that this isn’t usually how communities see themselves.

Generally speaking, communities envisage themselves as the progressive vanguard, despite the fact that they’re not actually changing anything substantively. In healthcare, this has the unfortunate consequence of increasing the likelihood of transposing our individual desire to find fulfilment through action into the undertaking of communal acts of thematic worship as part of a community, particularly the reification of abstractions: the quantified self, gamification, and so on.

It is possible to be a responsible collectivist and an ethical individualist.

In fact, to be the latter may be the only way to be the former.


We all have the potential to be an obstacle to change in healthcare.


Because we are risk averse.

Because we have to make the rent.

Because we have responsibilities.

Because we waste our time on minutiae and repeating the mistakes of the past.

Because we tend to do that which is expedient rather than that which is right.

Because sometimes we care more about being employed than we care about being able to look ourselves in the eye.

Because we choose not to see the determination of those aspects of our own self-governance we consider to be under our control as in reality being compromised or undermined by our complicity in things that we are less than proud of serving or being associated with.

Because we collude in the continued propagation of broken business models and legacy bad practices in healthcare, and don’t feel that we personally can do anything about them.

Because we don’t question the extrinsic validity of the concepts we bestow an intrinsic logic upon through their continued use.

Because we don’t mind propping up the business models of pointless conferences as they afford us a couple of days out of the office somewhere warm, and we can live with the fact that our continuing patronage graces their monotonous, cyclical agendas with the appearance of relevance.

Because tomorrow we might be offered the opportunity to be a part of something better that someone else has created that will make us feel good about ourselves.

Because we balk at our desire to turn our qualms into challenges.

Because we are afraid.

Because we lack the courage to change.

Because in reality we don’t care as much as we claim we do.

To the legion of the ‘passionate’, we say: prove it.

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