Andre Picard has led an extended conversation in the Globe and Mail on the many questions respecting the quality of healthcare in Canada.  In Friday, February 7’s column he focusses on two  successful healthcare systems in the Netherlands and Denmark.

He observes that virtually all their people have access to primary care, that there is a far more effective distribution of care duties between physicians, nurses, and practice assistants—and they guarantee same-day appointments for urgent matters! Picard quotes Dr. Kiran from the Netherlands as saying: “There is a cultural expectation of timeliness of care.”

When we discuss culture we often address only the values, beliefs and practices shared by those within the system. Dr. Kiran’s comments point to an important source of cultural values: the expectations of users of the system. There is a natural difference of viewpoint between “we do it this way”, and “they don’t do it well”. The two perspectives are reflected not only in our language but in the ways in which we approach problems presented by the system. It is natural for insiders to be conservative and seek incremental improvements that preserve the basic architecture of the system and achieve better performance. It is easier, and perhaps more natural, for outsiders to question fundamental features of the architecture of any system.

In relation to justice efforts to have ‘user-centered’ reforms seem to have an ‘outsider’ quality to them. Access to Justice Week in BC was just held from February 3 to 7 and emphasised person-centred design. The A2JBC approach calls for a “culture shift in the justice system.” In many ways this movement is an attempt to reframe the broader cultural expectation of our justice system.

Advocates for timeliness are both insiders and outsiders. What is important to note from the healthcare example is that winning over the general population to the need for a cultural expectation of timeliness may be central to implementing enduring solutions.