I’m about to do a keynote in Washington State. The location is Lake Chelan, and the venue is a resort.
This is the view from my room.
It’s hard to think about work when you have that kind of view to wake up to. I usually get up around 4am when I’m in the US so as not to change my body clock too much (I go to sleep about 8pm). It was amazing to watch the sun slowly work its way over the hills in the distance.
This is corporate speaking in the US. Leaders of all sorts retire to places where they can disconnect from the day job and think about the bigger picture, the longer term goals. It’s in this environment that it becomes possible to communicate to people that focussing on risk factors is not enough, that we have to look deeper into why people are healthy or sick.
The message is not an easy one and I’m iterating my slide deck all the time (I don’t have “standard” slides as I tailor to each audience). The emphasis today is on public accountability as the key to true value in health care as it speaks to how things are arranged in rural Washington State. It’s time to meet my hosts and deliver my talk so I’ll add some reflections afterwards.
The thing that really stands out to me is how much people are yearning to hear someone from a podium say that what we’re doing is not working, and that it’s time to think radically differently. I think people know that but somehow ‘experts’ get on stage and say things like “evidence based” or “pilot studies” and it inhibits others. Those terms are the proverbial clothes on the naked emperor.
But people want more than new thinking. They want to know what to do. They need some kind of model, some structure, to follow. It’s perfectly natural and, as much as we don’t like to think of the principles as a model, their very existence helps some people get a handle on what a new way of working might look like.
To some, our work is so obvious (that it’s almost insulting). Those folks have been working with communities for years and they know what the real issues are. There were two such people at the meeting.
The first was clear that the key issue was power. The people getting sick early and dying young are the ones without power. But, her question was, how do you equalise power, how do you overcome the differences, especially when you – as she admitted – are the powerful one? That was a really perceptive question (my answer was, “I don’t know, this is really hard stuff”).
The second was a community organiser. Those guys get it. For them, they just need health care to get it. Their interest in our work is our ability to engage health care (as doctors) in ways that they can not. I always feel like those folks are just waiting for the health system to ‘get it’.
Enthusiasm, but so what?
My interest is how our work goes from keynotes to action. The importance of agency, the way of working the principles describe, the field of practice, they all exist. The challenge is how it goes from rhetoric to action. I don’t yet know how to do that but I’m hoping the fledgling relationships created off the back of the keynote hold enough (relational) capital to get us into doing.
We shall see.
It’s time for me to enjoy the beautiful scenery, publish this blog post, and then head back to Seattle as the start of my journey home. It’s been an interesting trip that included another keynote in Alabama and some time with my new nephew, Filippo. It’s been fun. But I remain impatient to get into the doing.
I’ll leave you with my view right now.