When the System Is Broken, But Nobody Intended to Break It

 

When the System Is Broken, But Nobody Intended to Break It

By Dr. Flavius A. B. Akerele III, EdD, MBA

Working in healthcare has caused me to think differently about what it means to say that a system is broken. Sometimes when we use that phrase, people immediately look for someone to blame. But what if nobody deliberately broke it? What if most of the people working within the system are good people trying to do good work? And yet, somehow, people still fall through the cracks.

Healthcare and supportive services can be incredibly fragmented. One organization provides one service. Another provides something else. Eligibility requirements differ. Funding sources have different rules. Programs don't always communicate with one another. And the person needing help is somehow expected to understand how all the pieces fit together.

But what happens when they don't?

Certain communities remain underserved or underrepresented. Some people know how to navigate the system better than others. Some have advocates. Others don't even know what questions they should be asking. And then there is the human element. Two people with similar circumstances can sometimes have very different experiences navigating services.

Why?

Part of it may be discretion. Part may be communication. Part may be workload. Part may be unconscious bias. And yes, part may simply come down to the relationship between the person seeking help and the person responsible for helping them navigate the system; and I don't believe most of this is malicious.

Sometimes this is simply what happens when complicated systems are administered by human beings, but lack of malicious intent doesn't make the consequences any less real.

When Nobody Sees the Whole Person

This may be one of the fundamental problems with fragmented services. Each program sees the piece it is responsible for:

·         Housing sees housing.

·         Healthcare sees healthcare.

·         Nutrition sees nutrition.

·         Mental health sees mental health.

·         Employment services see employment.

But the person receiving those services doesn't experience life in departments. They experience all of it at once.

Someone struggling with a chronic health condition may also be dealing with food insecurity, transportation problems, unstable housing, employment challenges, family responsibilities, or difficulty understanding a system they have never had to navigate before. Solving one piece doesn't necessarily solve the problem, and referring someone somewhere else doesn't necessarily mean they received help.

So, What Do We Do?

Perhaps the first step is admitting that good intentions aren't enough. We have to ask better questions:

·         Are we designing services around programs or around people?

·         Do organizations providing related services actually communicate with one another?

·         Do the people we serve understand the system we've created?

·         Are outcomes consistent regardless of who someone's caseworker happens to be?

·         Who isn't accessing our services and do we know why?

And perhaps most importantly: are we measuring whether we provided a service, or whether the person actually got what they needed? Those are very different measures of success.

I don't pretend to have all the answers. In fact, working closer to these systems has given me more questions than answers. But perhaps that's where improvement begins. Not with assigning blame, not with assuming bad intentions, but with being willing to acknowledge that a system can be filled with good people doing good work and still produce outcomes that aren't good enough.

Leadership Reflection: If the people working within a system don't understand why people continue to fall through its cracks, who is responsible for asking why? And once we see the cracks, what are we willing to change?

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