On Revolutions, Rebels and Reshaping Healthcare

In a world of constant change, transforming healthcare is a topic that receives considerable attention. We talk about how we can improve, what solutions to adopt and how to implement change. Then we find ourselves trying to sustain the changes and we go back again to the drawing board: a continuous PDSA cycle within an infinity Enso circle.  This is the fight: against the status quo, to protect our ethical principles as healthcare providers. Our passion guides us like a flag into a war. But is a revolution necessary? Who are the rebels and what do they do?

Interestingly, over the last few days I seemed to stumble over the topic of revolutions, rebels and radicals, and on how this concept is being adopted for healthcare improvement. For example, NHS Improving Quality brings a series of free webinars and online modules for activists in health and care through their School for Health and Care Radicals. It’s a platform for radicals to learn together "the art of rocking the boat and staying in it", and it has become a movement, travelling with the high-speed of Internet connections all over the world. It connects people who think alike, and strengthen a community invested in one idea: to improve healthcare and make change possible.

I have learnt few things about revolutions, as a direct participant in one of the 1989 Eastern European insurgencies.  Romania was one of the countries on the revolutionary wave and the only country that used a violent solution to the totalitarian regime (by ultimately executing the dictator). I learnt that a revolution starts insidiously, by people who think they are different (or alone), but then realize they are not.  The movement gains momentum, until it can’t be stopped. I will always remember the energy surge of revolutionaries marching on the streets, and the burning desire for change in their eyes; change had to be done by any means. It was a time when revolutions meant getting out on the street, standing in front of a tank, demolishing a brick wall. They were fast and furious in development and consequences.

But revolutions can be quiet, simmering over the years but by no means less powerful. A great example is Mexico’s Zapatismo, who built momentum in the shadows, mobilizing a powerful group of women leaders. They sought to challenge the status quo and make change happen in a participatory way, from the bottom up. Solnit wrote a thoughtful essay on this unique movement, and she reflects:

“More and more of us now understand that change is a discipline lived every day […]; that revolution only secures the territory in which life can change. Launching a revolution is not easy, and living one is hard too, a faith and discipline that must not falter until the threats and old habits are gone- if then. True revolution is slow.” (Revolution of the snails, 2008)

Revolutions today can be as different as the environment we live in, and the individuals involved. Elizabeth Warren is rewriting US politics by creating her own institution, in her own personal revolution, choosing not to run for president and instead follow her ideals. On a more personal note, in an essay on TheEdge, a nurse talks about her own experience with authority in Malawi, and believes that with age we find it harder to activate the ability to challenge the status quo. I, on the other hand, believe that with age we become more focused in directing our energy into what we are really passionate about. There are many paths, and diversity is a requirement rather than an impediment.

It is undisputable that nowadays revolutions happen every minute under our own eyes, whether we like to acknowledge it or whether we choose to just watch. But this revolution is not televised. To all my colleagues in healthcare, I dare you to remember your passion and motivation that brought you were you are. You know there is a better way of doing things, for our patients and for us as providers. You have THE idea; you are an innovator, we all are! Revolutions are creative acts, and history shows in infinite examples that human beings are by nature inventors and tireless improvers. Therefore, we are all rebellious in nature. It’s time to connect to your rebel community and make change happen. Because if not now, when? If not you, then who?