Tuesday 12 May 2009

My intervention - Public discussions on Healthcare reforms

Thank you for inviting me – I must say that when I received and read the introductionary presentations I really got seriously enthusiastic. Rare for me.

This is really good work done both with environmental assessment modeling by Katerina Pavlokova as well as the description of how to manage a change process by Ondrej Matl. Of cause I have objections on how it’s done, what’s in there and conclusions etc. But that is not the main point. The thing is to actually have some form of both things! This should be a given but it certainly isn’t in healthcare policy.

1. Ondrej Matl´s presentation –on how to practically run a change processes. In processes of change you need a vision, a strategy, the facts and an implementation plan before even start thinking of going there. Now politics are local so partly and what I have to say is based on my Swedish and Pan-European experiences. If I would try to build an alliance in Sweden I would invite different players. But one remark goes for all countries - you have to realize that if you want to change you cannot please everyone –it has to be enough to see your proposals go through and be accepted. Friends you get at the pub. Now how do you do it? For one – all communication is done on the terms/conditions of the other part – the other part here being the voters. Two – timing. Three –go for the stomage.

So back to no1 voters: Your ideas needs to be seen in their communications channels, formulated in their language, and your examples needs to be in line with their interest areas. Now Peter remarks Internet is not enough – no not if Internet is used just like print media with newsletters and postings on the website – basically push information. Socialmedia on the other hand means something different. Socialmedia has its background in the discussions to convince your friends – when you besides the fact are out there investing your face, your reputation your personality. Its real communication/dialogue. And today, at least in my home country Sweden, voters expect this from their policy leaders. It will come to you all.

Timing: What I didn’t see from the presentation but as Professor Peter Mihalyi so rightly pointed out there is only a small window of opportunity so you need to build your 51% before the elections:

Alliansen in Sweden, the 4 party coalition that are currently in government, was created based on the experience in this area from the last time they where in government and their working groups before the election lay the foundation to quite a lot of radical change directly after the election – not in all areas but in some.

Here in Czech Republic we seen the efforts like Healthreform.cz -Im convinced one of the reasons Senator Thomas Julinek was one of the longest lasting health ministers in Czech Republic since 1983 despite his tough reform agenda is his preparation. Good and needed initiative and quite a lot of change have been taking place

The reason for this is that if you start building these alliances after coming into government you do not have time to also implement the changes – and you cannot get acceptance until after implementation. Not real public acceptance. Only acceptance from those that lift the phone to call a politicians or who answers and consultations on the web. Normal people just don’t do that – the moment they do they stops being normal.

Why that’s because of the third point. The stomage: Whats acceptable healthcare policy is about the citizens trust and perception of security the day the need it – our perception of security is very much an issue of gut feeling. I worked with nuclear waste management – all the money invested in R&D and communications programs in the world do not help unless you take people to the site, let them see the waste with their own eyes and notice that there is no reaction on the radioactivity meter on their chest. Then you break through the fear and can start arguing rationally and prove your case with facts and figures.

In Stockholms with regards to the the privatization of the St Görans hospital also shows this. When the social democrats won the election and they was faced with the situation that the nurses union was against the county taking back ownership. When people have lived with a new system they adapt - they might kick and scream in the beginning but if you like Peter Pazitny point out stand strong - they don’t want to change back. If after a couple of years where people tested out your new healthcare system in real life you still face opposition where probably wrong from the beginning.

1. Environmental assessment modeling – of cause in these estimations will not be correct, it’s impossible due to what is known as the butterfly effect (or as someone quoted yesterday – things happens). You cannot correctly predict the future. But in management and policy leadership you need to control the commandohights if you are to be able to lead the discussions in your directions and for that you need a description of reality to use as a starting point. Otherwise you will find yourself in meetings/debates where you have to start from someone else’s description/ model or similar. And trust me for people like me this is bread and butter business that we do for various organizations in order to facilitate their lobby activities….

Because those that lobby you know that if you set the agenda, if you own the problem formulation if you manage the commandohights you stand the best chance to reach your goals. And the way to do this is often by offering models like this but if they have build them it have been with their values, ambitions etc as a starting point. So you might not find the answers but you will be better equipped to win the debate.

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