Getting Serious about Community Development (Part 11)

In this article we are looking at how healthcare could benefit from social architecture and community development. 

In the previous post I talked about presence and permission as key characteristics of making a difference as an organizational change practitioner. In a sense it comes down to being connected to different Wifi-networks in a certain sequence: being present, being an expert in what you do, building a relationship of trust, and striking a balance between the existing organization and new roles. This is the sequence that we need to follow in order to develop a community within an organization.

In this post I want to show another example of a setting where this type of community building is useful: hospitals and the medical profession in general. The doctor-patient relationship is one that is defined by status differences, much in the same way as an organization is defined by status differences in organizational positions. We already know that this leads to communication gaps and hence a loss of quality. This is one of reasons to call for social architecture.

However, we know very little about the opportunities for quality improvement for healthcare if we were to focus on a patient involvement. In another article I introduced Dave deBronkart, also known as ePatient Dave. His slogan is ‘Let patients help’, thereby underscoring that patients are the most under utilized resource in healthcare. There are clearly some benefits to patient centered care and patient involvement. Patients can help a great deal in improving the quality of their own health records. Next to that they can benefit from the knowledge that resides in patient communities. All it takes is a physician who acknowledges these inputs as valuable.

However, there is an enormous status gap to cross and it blocks all the contributions that patients could be making. It is simply not safe for patients to contribute. Another way of putting it is that there are no permissions granted to connect to the Wifi-antennas of social architecture. And if all of that sounds a little too complicated have a look at the drawing below where I have tried to draw a parallel between my world as a change practitioner and the world of healthcare.

There is a deference gap to cross between the physician and the patient before the patient can start to contribute to the quality of healthcare.  Let’s go over the sequence that I introduced in the previous article:

  • Presence
    • This is the visible part; the part of the iceberg that is above the water surface.
    • Is the physician present with full attention, contribution and listening?
    • Is the physician physically present – also when there are no meetings planned?
    • Is the physician approachable, even when he did not make a request or ask a question?
  • Permission
    • This is the invisible part we often take for granted. The only time we notice that permission is important is when it is lacking.
    • In most cases we can assume that a physician is in a position to use his/her expertise?
    • But is there any space to relate to people and to earn their trust?
    • On top of that, is there any space to assign a different role / voice in the relationship, other than submissive patient? Do we actively seek how patients can contribute? (aka social architecture)
    • The three levels of permission are achieved in that exact order.

Sure, we don’t have all the answers, but switching on the Wifi-antenna of social architecture and searching for these specific signals may be a good conversation starter.