Richard Sennett on Generational Change and Agency in HealthCare

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Greg Van de Mosselaer

COVID-19 has caught us all with our system in a state of unpreparedness.

Is this because we don't evolve rapidly enough as a healthcare industry in Canada? or is it possible the problem is that we evolve too often.. more often than it is safe?

That is the argument that Richard Sennet, a prominent American sociologist, makes towards the end of part 2 of CBC's Ideas podcast; Flesh and Stone. Much of the podcast has nothing to do directly with Healthcare but touches on related issues. Flesh and Stone is primarily a meditation on how the varying approaches of public and private sector institutions affect their workers through their work environments. It's a good listen from a brilliant mind... (but who has 2 hours these days - plus, you will need a Flash Player as CBC didn't bring it along with its current PodCast collection).

Sennett explains ~ 45 minutes into episode two how the cycle of change in medicine used to be based on a generational model.

In a generational model, change happens once every 30 to 40 years. This change would naturally result in about four years of chaos as it would bed in and becomes tacit knowledge. After the four years of chaos and reduced efficiency had passed, society would then begin to realize the benefits of the change. These benefits would go on for the rest of that generation. The natural evolution of need would cause this process to refresh generally 30 to 40 years later.

Sennett then notes that in the Clinton era, the pace of change in health systems changed. The generational model was thrown out, and a new four-year cycle was adopted. This was based on a new political need, borrowed from the business world, to show new change within a four-year cycle to avoid being counted as inactive by your evaluators. Until the 90s, there was a general awareness that craft-based professions like health systems were complex enough that they could be disrupted in unanticipatable ways were they to be subject to this pace of change. As such, before the 90s, health systems were given a pass and allowed to follow need-driven change cycles.

This is problematic because the one thing that hasn't changed is the duration of lost productivity due to chaos whenever a change occurs. This can lead to a perpetual systemic tumult where there is constant change for the sake of change, but the system and its stakeholders only get to live in the chaos phase.

The workers and their patients never reap the benefits of these changes because the cycle resets before the changes get past the chaos phase to deliver the intended improvement. Though need-driven change probably no longer follows a generational period, Sennett's point is that the cycle is no longer tied to need. It is now driven by something more external, such as a political cycle, so it happens at inopportune moments. 

As a sociologist, he is also concerned with understanding and mitigating the effects that unhealthy change can have on workers. His areas of academic pursuit also include inquiries into how organizations can foster a sense of an individual's agency and avoid the subsequent corrosion of character in the workplace when you get this wrong as an institution or society. If you're just in it for the medical parts, listen to the end of the 2nd podcast ~ 38 minutes in for the agency explanation and 45 minutes in for the Jeffersonian explanation.