Metaphor : how 'nesting ecology' can inspire great patient centric hospital design
Continuing on the theme of our last blog and building from the Commonwealth survey results as reported by the C.D. Howe Institute, the reality of Canadian ‘healthcare’ is that it is more akin to ‘sickcare’ with a system that focuses its limited resources on reactively handling ‘emergencies’.
While the system’s focus on ‘collision coverage’ has become an accepted metaphor for its’ emergency orientation, patient stories illustrate a darker reality. A ‘collision coverage’ focus means ‘urgent care’ will also take second place to ‘emergency care’. In other words doctors will need to prioritize between ‘collisions’ based on how immediately life threatening the damage to the ‘vehicle’ is. This has the ‘urgent care ‘ patient, unlike the emergency patient, experiencing healthcare as ‘a waiting game’.
To help illustrate what this can mean from a patient experience standpoint, here is a story from a recent patient self-ethnography study. Ted, a previously healthy adult runner comes down with pneumonia and experiences complications that damage one of his lungs. Laparoscopic lung surgery is needed to restore function to the lung and to rule out a possible life threatening malignancy. Ted is admitted into hospital where the only bed is on a surgical ward of older male patients suffering from dementia. Once in the ward, the ‘waiting game’ begins for Ted. Each day he is told surgery will likely happen only to be bumped by more ‘life threatening’ collisions. Ted, eager to avoid contracting more germs and in need of restorative sleep asks if he can play ‘the waiting game’ from home. The answer is no for if he leaves the hospital he loses his place in the queue. Waiting time in the queue can be anywhere from one day to seven. In Ted’s case he waits three full days for ‘urgent’ surgery.
Both ‘collision coverage’ and ‘waiting games’ represent potential ‘holes’ in the healthcare ‘net’ rendering it unsafe. Attaching real life scenarios to the metaphors from patient ethnography bring clarity to the problems being solved and make solutions work tangible.
We would say, not very on both scores. Recent results from The Commonwealth Fund’s international health system ranking show the Canadian healthcare system fairs poorly compared to other developed nations. The 2017 results has Canada in 10th place among the 11 nations surveyed, with countries like Australia and the Netherlands among the top tier performers. However, more importantly the scores across many key dimensions such as timeliness of care and costs are in the lowest of the three tiers.
The rolling survey of patients, doctors and the public is conducted every three years and perceptions and experiences of Canadian healthcare suggest this year’s scores are a continuation of system weaknesses identified in 2014.
While one could argue this survey tool is somewhat of a blunt instrument given its forced ranking structure, the availability of provincial data sets allows for eye opening domestic comparisons. These comparisons highlight the areas and extent of provincial shortcomings and point an encouraging finger to look for answers at home.
The metaphor of the safety net captures the reactive versus proactive nature of the Canadian system as evidenced by the low scores across the provinces on access to primary care physicians and the high number of visits to the emergency department by people with conditions that could have been treated by a regular family doctor. The burden placed on emergency services creates holes in the net rendering the system unsafe.
Policy makers and innovators may want to innovate using a new metaphor. These results point to the potential of the metaphor of ecology as a serious contender. We need to look at the problems and the competencies. We need to see the provincial systems in the context of the larger Canadian setting. Let’s be inspired by such ecological terms as adaptive, endangered, renewable, sustainable, interdependence, community and mobilization.
This blog is the first of three on healthcare in Canada.
This year Canada celebrates its 150 anniversary and it seems fitting to begin 2017 with a blog dedicated to exploring objects and imagery that speak to ‘acceptance’ as a value in our series focussing on Canadianness.
In a world where the focus too often seems to be more on what divides us than what brings us together, the value of acceptance, that of welcoming ideas, beliefs, cultures and practices different from our own is precious. World events of the past year underscore this.
In studies exploring Canadianness images like the one above of the little monkey stroking the dove are offered up as an entry point to the ‘story;’ of what it means to be Canadian. Cultural diversity is considered a strength and Canada is depicted as a cultural mosaic and not a melting pot.
In storytelling conversations with New Canadians, the vastness of the Canadian landscape and the diversity of the geography were considered to be physical representations of Canadianness. Like the open, vast country, the people are characterized as open and tolerant, embracing and accepting diverse cultures.
In another exploration, a ‘loving cup’ was introduced as an object that evoked the value of acceptance and the idea that Canadianness means effortless imbibing or drinking from the cup of cultural diversity.
While Canada can genuinely claim to be a beacon of tolerance, the words of an RBC CEO ring so true for the year ahead. ‘Simply having diversity is interesting; doing something with it is powerful’ That is our wish as we celebrate the past 150 and anticipate the year 2017.
Next year, Canada will be celebrating its 150th birthday and many brands will try to capitalize on the heightened feelings of national pride. Over the years our work has explored objects and images that evoke metaphors of identity and which give insight into ‘Canadianness’ relevant for brand building.
We have had people share stories of themselves through objects they selected as important to them. In one case it was a young man’s canoe paddle. It helped him describe Canadianness. The paddle spoke to his great love of the outdoors, the pristine lakes and rivers that he retreated to regularly to connect with the Canadian wilderness and himself. His story revolved around the discovery of a great land, which he saw as synonymous with Mother Nature and her nurturing of his own hero journey of self discovery.
This young man’s narrative, evoked by his paddle, is thematic and emerges time and again. Nature, the expansive and pristine landscape of this country represents the value of ‘freedom’ that drives Canadian pride across demographic groups. This country’s beautiful landscape represents physical, emotional and psychological freedom necessary for nurturing possibilities and potential. While the objects introduced differ from person to person: a beautifully rendered Haida eagle tattoo, a river rock, a photograph of the Rocky Mountains, the shared value of freedom emerges and its manifestation as a source of pride.
It is because of this work using evocative objects and metaphoric imagery that we were not surprised by the findings of the latest Havas Prosumer Report. ‘Pride and Prejudice: Shifting Mindsets in an Age of Uncertainty’ suggests that Canada was one of the few countries where its values at 69% and not its history or culture, are the top drivers of pride. It is consistent with our exploration of ‘how customers think’ and reaffirms that values and their associated emotions are the unconscious drivers of behaviour.
In the best selling book, ‘Art as Therapy’, authors Alain de Botton and John Armstrong discuss the important role that objects play in communicating our identities to the world. “We don’t just like art objects. We are also, in the case of certain prized examples, a bit like them. They are the media through which we come to know ourselves, and let others know more of what we are really about.“
Next we will explore objects and imagery that deal with ‘acceptance’, another Canadian value that drives pride.