Tom Blackwell (National Post Health Care columnist) writes last month about the trends to bring Toyota-like efficiency into hospital and health-care environments. The successes are clear and are often demonstrated in reduced wait times and higher through put. Both of these offer defense to such criticisms as “you can’t treat people like automobiles” because you can treat processes like processes.

One of the perspectives that Mr. Blackwell introduces is that of consultant Tim Hill, who works in the implementation of such programs. His criticism is that, as the worm turns toward “everybody’s doing it,” clients may not be getting the value that they should (or, as Hill puts it, “A lot of health care facilities are getting ripped off.”). Needless to say, the eHealth initiative in Ontario has raised the level of scrutiny on consultants to the health-care industry, including perhaps myself and Mr. Hill.

Accountability for “providing solutions” has always been a tricky one for consultants and service providers. How many software executives would take payment from the efficiencies their product generates? Or how many advertising executives would link compensation to the sales impact of a campaign? With a larger understanding of shared interests, consultants can be encouraged to try to “solve the problem” rather than simply “provide the solution.” This may override the obvious tension of the pay-the-least vs. charge-the-most divide. Again, both sides need to be reasonable.

The bigger challenge is where “the problem” stretches beyond the area of the organization that hired the consultants. The natural temptation for any service provider is to give the client “what they want,” which may not be the solution they need. To use Mr. Hill’s example, the hospital may get the rigour of Lean processes (that they asked for!), but some important underlying issues remain unsolved.

Managing the tension of collaboration is possible when there is an understanding of the shared interests. This likely means that: (1) the customer is not always right; and (2) for consultants, there are no one-size-fits-all solutions… but we all knew that already.

THIS ORIGINALLY APPEARED IN THE MARCH NEWSLETTER OF THE CANADIAN SUPPLY CHAIN SECTOR COUNCIL (www.supplychaincanada.org)

Both doctors and parents, one can assume, have the best interest of the child at heart. But it may be more complicated than that: I recall hearing commentary on an instance in Vancouver–raised in the above article–whereby the parents of sextuplets refused blood transfusions because their Jehovah Witness faith did not allow the procedure. The commentary (I will try to find the source; you will have to trust me for now) was that in such instances, loving parents need to be legally forced, because it allows them to save the child, while also saving religious face.

If, in fact, both parties are focussed on what is truly best for the child, both are responsible and accountable. Parents need to be ready to make their case with more than just “this is what we want” or, worse “this is what our child wants.” With all due respect, it should not take a psychiatrist to determine that a child is unfit to determine the cancer-fighting procedures that they will receive. The medical profession must be granted some degree of trust and authority to make these decisions for people. This sort of latitude should be granted, but also needs to be earned.

Information is everywhere, and Google could probably help find a source to support that a diet of raw vegetables beats chemotherapy or that alternative care in Mexico will be more effective than Ontario hospital care. If these sources of information are being given the nod over what the doctor says, the doctor has some “selling” to do. Understanding the real concern takes time, and usually requires (1) creating a relationship of trust and (2) asking questions. Did the doctors do this? Did they have the time? the skill? Not everyone is going to take a doctor’s word as gospel; nor should they.

Medical research and past results are not the only forms of evidence, but will only be effective if the other party is listening. Fostering a dialogue can get people to open up to some grim realities. It must be a horrible decision to pick between a grueling medical procedure that might help, and a less extreme treatment that almost certainly won’t. That decision, however, should not be the parent’s, and definitely shouldn’t be the child’s!