Tuesday, December 31, 2019

Fixing the World is Whose Responsibility?

This week I attended a session on quality improvement in healthcare practice. The definition of quality is subjective. What may appear to be "high-quality" to me, may not stand up to external scrutiny. There could always be room for improvement. But this is not a big problem. Some level of objectivity can be attained in measuring quality by using tools like standards. We can easily figure out areas that are below par and areas that are good enough. Identifying problems and areas to work on is not a problem at all.

The real challenge is in identifying responsibility. Whose responsibility is it to fix the problems? Sometimes fixing a problem is much easier than figuring out who the right person to fix the problem is. Most often it is not. Most often fixing problems require persistent effort and continuous follow-up. It takes time, energy, even money. And depending up on the scale of problems, these things can easily blow up. There are also some problems which have quick-fix solutions that are less sustainable than the proper but energy-intensive solutions.

After some months of joining Vivekananda Memorial Hospital, there was one evening when I was in the reading room. Dr Kumar who is now the CEO of SVYM walked in and asked me how things were. The conversation somehow came to my anger at the medical education system and how there was a lot of corruption in medical colleges. I was furious about my own alma mater and told him how I would never want to step foot in that college again. Dr Kumar, incidentally, had done his post-graduation in the same college and could relate to what I was talking about. But then, he told me the story of how he worked with, through, and for the system and made it better. He told me how he would challenge and oppose, yet be dear to the administrators. He told me how he could improve things at least by a bit while he was working there.

The transformation in my mind was instant (similar to how MAB once made me rethink the way I look at a disinterested audience). I, who was seething with anger at the system, suddenly saw possibilities. I could see the difference between productive contributions and blind criticisms. More importantly, I learned the concept of agency. I was no longer feeling helpless or like a hapless victim of the system. I was feeling like a person who could bring about change but was not yet utilizing my full powers.

The stories of Ananth Kumar, SVYM, Taru Jindal, Lalitha & Regi, and every other inspirational stories I've heard in the recent past demonstrate that simple principle. That if you put energy and effort, things will change. That even one individual matters.

I think the question of whose responsibility is it to fix things can arise of two things. One, the feeling that I cannot fix something because I'm powerless. That is a logic consistently proved wrong by many of these people I mentioned in the previous paragraph. But there is a second, more difficult reason people might choose not to fix problems. That is when I choose to not fix a problem because I don't have the time/energy to because I devote it elsewhere (in a place that I think is more important to focus on and solve problems in).

This second reason, is in my opinion, the bigger problem. This is the reason why even talented people can fail to deliver. Changing the system through innovation or persistence requires dedicated effort. It requires someone to show up regularly and stand up for the cause. It is the same as making a successful startup or raising healthy young children. It requires a lot of smart work. It requires productivity.

It all should start from the realization that every great person who has walked on this planet has had only 24 hours in their day - the same number of hours everyone else has in their day. What really matters is how much we can draw out of those hours. And for various reasons, not everyone is equally privileged to draw the same value from their days.

But what is really worth thinking about, is whether we are drawing the maximum value we can. Because if you can find a way to cut the cruft and get more work done, you might find just enough time to fix the world too.

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