Gary Oftedahl: Making RARE personal–another “common(s)” conundrum

In my last blog, I began to link some of the thinking from the area of socio-economics with regard to resource utilization (the “commons dilemma”) to our evolving work in addressing hospital readmissions in Minnesota ( http://www.rarereadmissions.org/ ).  While the connection is perhaps tenuous, it has created an interesting dialogue, and one that seems worth pursuing.  But as is often the case with my musings, it raises another specter that will challenge us as we move this forward.   While I spoke about the need to move beyond our individual organizational needs as health care providers, and consider how our corporate actions must begin to support the “common” good, the issue can also be taken down to the individual level.

What is the responsibility and challenge for the individual who lives near the “commons” who has a vested interest in ensuring the commons is sustained, but also has a personal need which may supersede any altruistic commitment to the betterment of the whole?

Again, I admit that as compared to being an expert in this field, I’m really a “dangerous student” but one who’s interested in how concepts, especially one as this, can be the framework for a larger dialogue.  And I use the term dialogue deliberately, because it will require an openness and willingness to consider different perspectives than those inherently comfortable to me.  Guess what, it will require that from each of us, irrespective of how intelligent, intellectual, logical, or thoughtful we are.

It is perhaps self evident to many, but as we consider the commons dilemma which I addressed previously ( http://bit.ly/r0RlIj ), it seems to have potential in our discussions on patient engagement, empowerment, health care home, or whatever becomes the principle which drives health care reform.  In a nutshell, a patient is being pulled in the same way we as health care providers are as we address the dilemma of sustaining the commons as it exists in our health care arena.

As a “patient” (quotations deliberate), if I’m confronted with a life-threatening or life- changing situation, my thinking becomes an “I” discussion in which I’m likely going to consider only what is needed for my own benefit–selfish as that may seem.  For that’s a human trait, buried beneath all the platitudes about the good of society, the betterment of man, the need for social good.  When confronted with a threat to personal longevity, or health, I shift to the thinking of the individual herder–I’m going to feed my herd, provide them with whatever they need, ensure they’re hale and healthy–and the heck with the rest of you.  As an individual, I’m going to seek out the help I need, and usually, during that type of acute situation, I’m not inclined to be concerned about the impact on others who live around that “commons.”  It indeed becomes all about me, and providing me with the resources that will maximize my health.  After all, I only have one life, it’s not fungible, and during a time of personal crisis, I focus on the immediate impact on me as an individual.

But counter that to the time when we’re in a reflective, analytical phase of our thinking–usually when healthy and life is going well.  It is during those times of relative serenity that our concern for those around us and the recognition we need to do all that we can to conserve that commons leads us to thoughtfully consider how we can be part of a social solution–”going green”, recycling, exercising, etc.–in an effort to ensure there’s a commons still viable for the generations to follow.

It’s likely too simplistic, and maybe already well understood by others, but as I reflect on our work in RARE in Minnesota and future opportunities, and begin to contemplate how we as the “health care industry” need to consider the commons dilemma, I believe the issue will require an equal amount of debate and dialogue from the individual perspective.

It’s not clear cut, it’s not universally agreed upon as a basic premise for discussion. There is controversy regarding the validity of applying this concept to the area of health care, but isn’t it worth considering what it will be required of us as individuals when confronted by this dilemma?  I’ve been in health care for more than 35 years, and have a strong intellectual understanding of the challenges of overuse and misuse and the threat this poses to our industry.  But I wonder what will happen when my intellectual understanding is confronted by a real, personal threat to my longevity and lifestyle.  Will I be ready to engage in actions that will recognize the need for preserving the commons, or will the personal need preclude and supersede all the intellectual and analytical support I’ve given it for years?  It seems like common sense, but then that’s a topic for a whole other discussion, isn’t it?

Advertisement