22 September 2017
Dr Ayman Shenouda
Influence or overload
We spend a lot of time trying to influence policy makers around what’s best for our patients. Advice which is always well-intentioned and usually offering the right policy fix, GPs work hard to influence and bring about positive sector change. We are passionate advocates for the patients and families we care for. Too often we see for ourselves the impact poor policy has on people’s lives. The solutions mostly lie in the evidence-based care that informs our everyday practice making us important policy participants.
a political perspective, it must be quite hard being on the receiving end of all this advice. Having to work through submissions from every health organisation in the country with their list on how best to fix it. Sifting through the detail trying to find some common ground against their own checklist of whose voice beckons their closest attention politically. Then trying to work through the conflicting areas of advice, where the bias may lurk, to find the most workable solution.
What’s really in the message?
The Political Alerts allow us all to participate in this spectacle checking online what each has had to say. If you’re like me you sit back and try to see if there is alignment in any of it. Next, comes the quick filter on who’s come up with the best response to the actual issue at hand.
The media too has its favorite. The go-to spokesperson on just about every health issue that impacts the sector. Not always the actual peak or expert on the issue either and for those at the grassroots the message sometimes seems a little apart. But then those real issues are just reduced to sound bites and random visuals if there is time around the spokesperson. In the end, the message is either oversimplified or reduced and likely to confuse.
Unfortunately, there will always be that competing tinges leaving an identifiable stain that prioritises first the organisation it represents. This almost always comes through and sometimes only subtlety but easy to spot for those within the system.
Finding common ground
Perhaps this could be made so much simpler – not only for the policy maker but in terms of outcomes – if we just came together as a united group and settled policy first.
This is not to say that collaboration doesn’t occur around issues. It does and usually at the highest levels. There are a number of unifying structures in place: The Council of Presidents of Medical Colleges, United General Practice Australia and of course on rural issues, the National Rural Health Alliance.
Often finding that common issue or cause is not all that hard. We already have it and it lies in patient centred care and that focus in primary care is what unites us. But this simple message becomes distilled when there are parts of the system vying for their space, sometimes even survival.
Primary care and collaboration
Primary care is just one of those areas where we can’t afford to lose focus.
It is a sector, which relies on teamwork. We already collaborate well by working together to share our expertise or to find ways to integrate for stronger outcomes but we can become easily undone by professional interests.
Over the past two decades, I have been involved or have been a director of a number of peak organisations involved in primary care. Obviously, an organisations first priority will always be to make sure it is able to achieve its own goals and aspirations. As a director, you learn to work within these boundaries. But these organisational-level priorities sometimes make collaboration more difficult.
Some strategies for collaboration
For collaboration to work, respect and trust are key.
Quite often it is the lack of trust among organisations in terms of intentions, which makes it so much harder to find common ground. We need to create a shared vision of the future and move towards it together. Have an agreed common goal and sign up to it.
It’s also important to look to the other influences that help us collaborate.
Take the time to build the relationships that support collaboration. This often means to value and embrace difference and healthy conflict. There can be great value from opposing points of view in terms of finding new solutions to tired problems.
We should also challenge the status quo together so no one has to face difficult change alone. And always strive for win-win outcomes where possible.
Finally, strong interpersonal skills among leaders are important to build the collaboration required to influence change.
More effort in bringing together the right mix of people to respond to issues impacting on our sector would support stronger outcomes. We have such a great diversity of talent within primary care which can be tapped into relatively easily bringing stronger depth to so many issues.
Sometimes referred to as coalition building it is about forming coalitions with those holding similar values, interests and goals to combine expertise and resources for a common purpose. In our case it is about having a ready-made alliance structured around targeted areas of expertise or the various issues our sector is likely to face.
It is well understood that a broad-based, grassroots coalition enhances credibility. Bringing together diverse participants with similarly diverse skillsets and access to target populations for stronger reach makes sense. Encouraging broad participation also ensures we can bring new ideas and fresh energy to an issue.
These types of strategies help bring a united voice to an issue. We should be supporting each other across issues that impact on primary care as a whole – at both the local and national levels. It would be great to start a discussion around this and we can start now. I’d be interested in your views around how we might be able to better facilitate these types of policy alliances in the future.
We’re better together
The whole is greater than the sum of its parts. It’s quite simple.
I think most working in primary care would consider that the whole is greater than the sum of its parts. First coined by the philosopher Aristotle, I love this phrase as it reminds us that we are better when we work together. And I really think that should guide our future policy contributions, particularly in primary care. It’s not always easy to implement but I think we need to get much better at it. It’s really just a case of an overcrowded agenda, which needs uniting or risk being overlooked. We most certainly need a united front in primary care.