- solidarity and conformity / individuality and autonomy
- deep trust among common interests / thin trust amidst transacting selfish interests
- bureaucratic governance / market incentives mechanisms
- policy compliance / entrepreneurial deviance
Maccoby's findings match my own intervention in a troubled merger between two pediatric health care providers. Some doctors operated private practices through their hospital and found ways to increase their revenue and profitability while giving superior service to patients and their families. The other physicians were paid salaries by the second institution which dictated practices, policies and procedures over them. These two cultures clashed and saw no way to compromise the values, ethics and success patterns.
Maccoby suggests that neither camp is supported with the necessary information, feedback and shared data to learn together. Everyone is perpetuating what they already know and working closely only with those they trust intimately. He foresees the transformation of the culture by making learning the norm which could dramatically increase collaboration beyond the confines of medical specialties. Yet he admits, the physicians conflicting values, social identities and camaraderie will impede unified efforts.
This chapter, Health Care Organizations as Collaborative Learning Communities, imagines the collaboration only among the experts providing medical services. The patients are the mere recipients, beneficiaries and consumers of those services. There is no exploration of the patients learning, trusting and collaborating more when also supported by additional information access. Likewise the patients are not envisioned as becoming more responsible for initial self diagnosis, periodic self medication and ongoing self management of chronic conditions. There's no exploration of community health programs, support groups and preventative efforts.
I expect the viable solution to emerge from the decline of privileged professionals, due to crowdsourcing and other P2P dynamics. We only need experts in charge of our health when we are feeling personally helpless and very much dependent on them. As information, tools, working arrangements and community support all come into play, collaborative efforts to keep each of us healthy and to orchestrate quick recoveries -- will result from everyone around us, including experts, contributing to those outcomes.