It’s the system you say…

Systemic and structural changes are required within healthcare.


It’s the system you say. I agree there are systemic and structural changes required within healthcare.

Who is in charge of these systems? Who can orchestrate the changes?

Who has the power and capacity to change them so that doctors’ lives can be enhanced by their work, so that work adds value to their lives instead of diminishing them, making them sick, even killing them? Who can stop the system from creating harm, stealing joy?

Anthropologist Margaret Mead thought a small group of people could do it saying “never doubt that a small group of thoughtful committed individuals can change the world. In fact, it’s the only thing that ever has”. Gandhi implored us to “be the change we want to see in the world” suggesting it starts with one person, our self.


There is a long line of people who have shown us the way when it comes to systemic and structural change.  Eddie Mabo, Lowitja O’Donoghue, Nelson Mandela, Mahatma Gandhi, Martin Luther King Jnr, Belle Hook, Ruth Bader Ginsburg, Grace Tame, Emmeline Pankhurst, Greta Thunberg to name a few who come to mind.

They did not say someone else should do something about that. They did not carry on the status quo saying ‘it’s the system”. No. In every case they took personal responsibility and began asking questions. They were personally invested, they asked questions that mattered to them, curious to learn and eager to share what they learnt with others. They understood that many voices were needed to change the system and they understood that included their own voice, their own actions.

The fact that the system was complex or huge did not stop these change makers from asking questions, being curious, building their skills or developing their understanding.

The system is a product of the interactions within the system, the synergies and feedback loops within, the emergent properties. Peter Senge suggested in 2006 to engage in systems thinking we need to have a consistent commitment to learning, a willingness to challenge our own mental models and an ability to hold multiple perspectives. These skills can be learnt, but are not assumed.

I wonder if healthcare workers operating under pressure from lack of resources and lack of time can ever truly generate a learning organisation willing to challenge its dominant stories or be curious about other possibilities.

My experience as coach of healthcare workers is that the dominant story (mental model), blames forces bigger than the individual (the system), is as a consequence perhaps, blind to other perspectives and unwilling to challenge (take responsibility), leaving the system to reinforce itself, maintaining the unsatisfactory status quo.

If it is the system that is dysfunctional, how is it that different versions of healthcare systems all over the world create the same problems when it comes to doctor wellbeing? How can it be that my book The Thriving Doctor has resonated with doctors in western countries and even a couple of others, across the world, despite their differences.

The system is made, enabled, disabled and perpetuated by people. The system will not break itself, does not see itself, is not capable of reflection or a reset. People do that. For people to move a system they need curiosity, skills and each other.


So how do we change the System?

Mabo, Mandela, Thunberg all started the change they wanted to see by being curious, using their voice, taking action, welcoming others to their vision, helping them build their skills.

Imagine if every doctor was skilled in curious questions, deep listening and collective action. If every doctor prioritised these activities.

What kind of healthcare system can you imagine when you pause long enough to reflect and ask? What might you notice, who might you engage in conversation with? How might your new curious perspective lead you to behave?

What might you seek to learn today, from a different perspective?

P. Senge (2006) The Fifth Discipline: The Art and Practice of the Learning Organization. NY Random House







The Thriving Doctor book on a wooden table


The Thriving Doctor

Sharee Johnson’s new book The Thriving Doctor is available in all good bookstores or online.


Sharee has been coaching doctors since 2014, find out more about her work