Are we brave enough?

19 February 2018


Greater focus on patients’ individual needs.

More collaboration and flexibility.

Lesser administrative burden.

This sounds good, doesn’t it? Is there anyone out there who wouldn’t sign up for a healthcare system where this is the norm? I don’t think there is. So… what’s stopping us from getting there? A lack of trust?

Trust-based governance and management. I don’t know about you, my colleagues out there in wider Europe, but at least in Sweden trust-based governance and management seems to be the word on everyone’s lips – at least in the public sector. The government has appointed a Trust Delegation to study and suggest how the governance of welfare services may be developed to better make use of professionals’ competence and achieve greater quality for residents, and my experience as a management consultant is that we’re being asked to visit organisations to talk about trust-based governance and management: Why have it? What is it? And how to do it?

Trust-based governance and management has risen as a critique against New Public Management which has left healthcare professionals with a sense of increased bureaucracy and micro management: rather than spending their time focusing on their core task of meeting patients’ needs and delivering high quality healthcare they are required to spend their time documenting and reporting what they do all day long. Can we just pause for a second and ask ourselves, is that really the way to increase efficiency and quality in our healthcare services?

What if we instead reduce healthcare professionals’ administrative requirements and allow them to use their competence and commitment to make the most of every meeting with every patient in order to find solutions to meet patients’ needs in a flexible and individualised manner?

What if we don’t financially monitor each healthcare department or unit separately but rather apply a systems perspective and collaborate across organisational boundaries driven by the purpose of meeting our patients’ (often complex) healthcare needs as opposed to our organisational financial needs?

What if we simply govern and manage our healthcare systems primarily based on trust, trust in healthcare professionals on all levels and their ability, integrity, and willingness to do the right things in the right way?

Trust has been defined as “the willingness of a party to be vulnerable to the actions of another party based on the expectation that the other party will perform a particular action important to the trustor, irrespective of the ability to monitor or control the party” (Mayer, R. C., Davis, J. H., & Schoorman, F. D., 1995)

So, for the sake of our patients, are we brave enough to be vulnerable?

Vania Ranjbar – EHMA YAC Chair, February 2018


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