Lead
- André Bruggeling
- 29 jun
- 4 minuten om te lezen
Online VanDale reports: 1. (theater, film, tv) substantive, artistic direction 2. coordination, steering, leadership; to lose control, to no longer have dominance, to no longer be in charge, and 3. (Belgium) public utility: Regie der Gebouwen. In this, we forget point 3.
Direction is about managing, taking responsibility to successfully bring a film, assignment, or project to completion for the company and the client, in collaboration with many. A goal has been set, a timeline for realization established, possibly a budget available, applicable expertise, processes, and procedures that are applied and utilized, possibly reformulated if necessary or evaluated and adjusted on-the-job, knowledge and third parties engaged. Best practices to quickly and effectively show results. A job to be done, a customer to be satisfied (and to be kept satisfied). Financially: benefits that exceed costs over time. It is the director (i.e., (project) manager) who has a helicopter view from above and oversees and directs the whole.
What's going on
Back to practice, specifically regarding the issue of physical inactivity: who is in charge? Or rather, who should actually be in charge? A client comes with a complaint for which a solution is sought. The first point of contact, the primary care level, usually starts with the general practitioner or sometimes the emergency department. If, after investigation, it turns out that the cause needs to be found within "the client" themselves—particularly how they embrace life—is it then the primary care level that should take the lead, or is it "the client" themselves, managing their own problem complexity, who needs to shop for the necessary solutions? Can "the client" do that, and is it accepted that "the client" consults, coordinates, and leads their own problem-solving efforts? And who pays for this, where does the budget come from, and especially who determines what budget is sufficient and acceptable?
Conversely, "the client" is assigned to a lifestyle coach (sometimes this is the primary care level itself!). Connecting certain expertise (i.e., colleagues) to provide help with specific behavior changes, for example, psychological, should be feasible and acceptable. Issues such as budgets and where the costs will ultimately fall or who will pay remain significant challenges. An even greater challenge is who acts as the final responsible party regarding the process of solving the total problem (the client). The complicating factor is that "the client" may experience such a process as "paternalism," often resists it, and subsequently withdraws—problem not solved, money lost.
Is it a dilemma, or is there denial of the complexity of behavior change?
Care, organized from expertise, is therefore not really equipped for complex, cross-domain requests for assistance, aside from the (work) pressure already exerted on healthcare. "The client," who cannot play their own doctor, will encounter many (insurmountable) barriers while seeking help. Third parties who want to engage may underestimate the complexity of such problems and may not have access to everything. Throughout this all, the financial situation plays a role and determines where the costs will ultimately arise. Finally, when is it "job done, customer satisfied, profit realized"?
Where does it hurt
Certainly, it is not always a complex or comprehensive change that needs to be undergone, where curatively the problem can be addressed and “the client” receives valuable advice to work on the problem and prevent recurrence (preventive). In other cases, multiple disciplines are needed to reorganize and consolidate the life of “the client” into new behavior. It starts with “the client” being informed about the entire process, accepting it, and committing to the solutions. Part of the information is that the responsible party provides a financial justification, but also indicates where costs are incurred and budgets are available. “The client” also benefits if this process is discussed and actively monitored by the responsible party.
That party, in coordination with “the client,” seeks expertise to guide (parts of) the change process and report to the responsible party. In evaluations between “the client” and the responsible party, results are discussed, and adjustments are made. Evaluations may also include (medical) measurements and checks.
A possible and desirable condition here is that the expertise meets a standard or qualification for the product or solution to be delivered. Expertise does not necessarily have to be professional care; it can also involve non-care-qualified contacts who are well able to guide “the client” on a specific aspect, such as a gym, yoga class, physical activity consultant, or budget buddy. The standard, qualification, and effectiveness for these contacts will anyway result from the evaluations between “the client” and the responsible party but could, in the long run, also lead to a specified standard & qualification to which a contact must be accredited.
As a precondition, “the client” should be involved in decision-making on equal footing with the responsible party for this process, thus not imposing a mandatory treatment process. “The client” should always be in control of their own process, albeit with the restriction that when seeking help or being forced by urgency, the commitment of “the client” is a conditional prerequisite, from which potential repercussions may follow.
The result of a genuinely changed lifestyle that supports the person and provides a chance for stable health may reduce the pressure on healthcare and costs. The outcome for “the client” is a more enjoyable opportunity to grow old healthily. An additional effect could be that “the client” may become a role model for their environment.
The question who
There are still a few "points and commas" that will come up in such a scenario, for example, who is the most appropriate responsible party. From the current perspective, that seems to be the health insurer, which already has a more or less overarching overview in care and finances. At the same time, this is a form that must not depend solely on commercial or public (healthcare) parties. Ideally, it seems to be a somewhat ombudsman-like structure, an independent organization that takes on the problem together with "the client."
