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Have you ever looked from very closely at an oil painting, perhaps from a few inches away? You will see, colours, lines, the texture of a brush stroke, but will have difficulties identifying the object(s) depicted, not to speak of appreciating the entire composition. You have to step back, create some distance, to stand not too close, but not too far away either; you need to stand in just the right distance to appreciate the art-work in  its entirety.

In our jobs, we are all working hard and are focused on what we do. If we want to serve our patients and be successful as a department and an institution, this is mandatory. However, by being (too) focused and working (too) hard, we risk losing ourselves into details of administrative processes, getting bogged down by daily routine, and missing the big picture of which we are a part. To work effectively, as with viewing art, we need the right distance; we need to appreciate how our part fits into the entire picture.

An oil painting is usually completed when we look at it. Our work, however, is usually a work in progress, composed of areas more completed than others, and hardly every finished in its entirety. In addition to distance, we need to understand the common goal we are working towards and as a department, as an institution, are aiming for. Only then, can we work on our individual part and assure that our individual contribution fits into the big picture. Knowledge of the big picture is essential in order for each of us to add value to the enterprise and keep moving it closer to its goal.

One of the real big picture items I cannot emphasize enough is the way we interact with each other at work. Call it respect, civility, professionalism, call it decency – it does not matter. What matters alone, is that we live it, each of us every day; that we value being questioned, that we listen before we respond and chose our words carefully, that we try to understand a dissenting opinion, and that we argue based on data not on judgement.  If we are able to create this type of open, collaborative culture the issues that may come our way, however big they may be, will (almost) solve themselves… if not, even the best strategy to tackle them will fail.

Everybody working in our Department expects a professional working environment. This includes a civilized tone in dealing with each other, respectful behavior, and fair assessment of performance. That said, holding each other accountable is absolutely part of a professional working environment and should under no circumstance be dismissed as unprofessional or threatening, provided it is done in a factual and respectful manner. All this applies equally to everybody: providers and patients, executives and frontline personnel, academics and non-academics, learners and teachers.

These days, learner mistreatment has gained priority attention and there is zero tolerance for it in our Department. It is good that the times are gone when flying scalpels and public scolding had to be accepted as part of one’s learning experience. It is good that sexist remarks or asking for personal favors has become an absolute no-no.  It is good that there are processes in place allowing those who perceive witnessing or experiencing them report such events without exposing themselves to retaliation. And it is good that any report on anything the like will trigger an investigation.

Professionalism, however, applies, in my opinion, equally to both, learners and teachers. Not only can learners expect to be treated in a civilized manner by their teachers, but also the teachers by their learners. And there I have recently seen occasions that make me ponder whether we might have thrown out the baby with the bathwater. Is it not also mistreatment if a learner anonymously scolds a teacher on a feedback form without having to provide any factual proof, thereby negatively affecting the teacher’s performance review? Is it right when a teacher can be anonymously blamed for having held a learner accountable for a substandard performance and therefore having failed that learner? And finally, is it good that we seem to have forgotten that somebody is innocent until proven guilty? – Some food for thought.

Improving the efficiency of what we do is on everybody’s radar these days. Our health care system, our hospitals, and our clinics are no exception. Efficiency stands for doing things right. Doing things right is per se not wrong: nobody can reasonably argue with seeking to eliminate organizational waste in order to deliver health care in a sustainable fashion.

Sustainability, however, pertains to aspects beyond economics and from a provider perspective includes, in my opinion, things that are more difficult to assign a $ value to, such as work place satisfaction and employee engagement. “The only way to do great work, is to love what you do”, as Steve Jobs is quoted having once said. Seeking efficiency by top-down defining the route to the goal in every detail and forcing to fill in yet another form to prove compliance, whether on paper or electronically, adds more often nothing than administrative waste. In fact, it may hinder true productivity of health care delivery to our patients. Too many regulations lead to disengagement of those who do the work, as they become frustrated by feeling forced to just follow the rules (often in front of a computer screen) set by some remote administrative body and no longer being able to focus their energy on what is dear to their heart, e.g. caring for patients. Do those who do the work on the ground not often know best how to reach the goal by adapting their approach to a changing situation/environment? Would it not often be better to clearly define the goal of the organizational unit, not the path to it, and just hold frontline staff accountable for reaching that goal? In many countries, even prototypic hierarchical organizations such as the military have learned their lesson and adopted a goal oriented command model.

Moreover, delivering health care is not a simple assembly line and consists of more than a series of technical processes that are amenable to optimization by engineering. Thus, trying to optimize efficiency in health care delivery using a similar approach to that established for a production plant or an assembly line of cars may defeat its purpose. In fact, it may create new organizational waste – and potentially more than it intends to eliminate. By feeling forced to shut down common sense, providers run the danger of bringing to perfection complying with a “system” and its “administrative processes”, i.e. focus on doing highly efficiently what hinders efficient delivery of care to the patient.

Effectiveness is another fashionable word these days. And efficiency and effectiveness are often and wrongly used interchangeably. Effectiveness, however, stands for doing the right things. We can hardly dispute that health care delivery should be effective. But what is the “right thing” in delivering health care? In a very broad sense, one may say, the right things are to help an individual to stay healthy (prevention) and, if that fails and the individual falls sick, to support the healing process (treatment); sometimes healing (cure) is no longer an option and minimizing suffering (palliation) has to suffice.

Prevention, healing and palliation require content competency with respect to knowledge and technical skills. One may call this the science of Medicine. Effective prevention, healing and palliation, however, go far beyond scientific content aspects and encompass not only interpersonal skills, but even broader domains of human existence. All too often we seem to forget about these. We all have anecdotally witnessed that the best delivery of evidence-based interventions can be futile if a patient has given up fighting. Healing is not fully promoted by efficiently and effectively delivering an evidence-based intervention. Healing encompasses more including promoting the well-being of a sick individual in all his/her dimensions. Only this enables a patient to add his/her part to the healing process and allow making the evidence-based intervention a success. Terms such as Medical Humanities and the Art of Medicine try to address these other dimension of healing. These may include supporting the healing process by healthy food (would you order our hospital food for dinner?), a view of or, even better, spending time in a hospital garden (where have they gone?), exposure to the soothing atmosphere of music or visual art (could you relax on one of our wards?), the company of a caring support person (is there room for them in our patent rooms?), or a comforting chat with a provider (do we have time for that?).

Our hospitals may have become and may continue to become more efficient, but doing efficiently what is not effective, misses the point and is the worst that can happen in an enterprise. Let’s not forget about the other than fiscal dimensions that contribute to effective health care delivery, let’s strengthen the art of medicine and the humanities component of health care.

Recommended reading: God’s Hotel by Victoria Sweet (https://www.amazon.ca/Gods-Hotel-Hospital-Pilgrimage-Medicine/dp/1594486549)

Professionalism is an “in” word these days. It stands for more than political correctness. When googling it, one can find “professionalism  is the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well”.  Alistair Cooke (1908-2004), who was a well-known British-American journalist, television personality and broadcaster, is quoted as having said ”a  professional is someone who can deliver his/her best work when he doesn’t feel like it”. The latter, of course, is hard, but, I guess it is what separates the wheat from the  chaff.

Creativity on the other hand can be defined as “the ability to transcend traditional ideas, rules, patterns, relationships, or the like, and to create meaningful new ideas, forms, methods, interpretations.”  Creativity is the basis of every innovation and as such is indispensable for sustaining the success of any business in an ever changing environment. This holds particularly true for our Department’s situation in the middle of the ongoing health care reform in our Province.

Creativity is easily mistaken to mean disorganized spontaneity with little or no accountability, and to be incompatible with professionalism which stands for predictability and trust. However, creativity and professionalism, as defined above, do not only go well hand in hand, but, are, in fact, mutually complementing each other. A creative professional finds new solutions to challenges, brings them respectfully forward and acts in a way that always has the greater good in mind. This does not mean having to enter a popularity contest or having to abandon (constructive) criticism, but to be mindful of one’s own (unconscious) biases and always respect a dissenting counterpart.

The best solutions are not owned by a single individual/party, but created through respectful argumentation between engaged – albeit initially dissenting – professionals.  Engagement is key here, our Department needs yours!