What the health system can learn from an old concrete pipeline?

I’ve been asked to speak at a health conference in Brisbane about the difference collaborative approaches can make to achieve better outcomes in the health industry. I’ve been urged to talk about a non-health example – just to mix it up a bit and to remind participants that collaboration is something being explored in all sorts of industries and sectors.

After giving it some thought I recalled a project I was involved in about ten years ago – the Glen Davis Pipeline Project. I will share the story with you here as a way of preparing for my presentation later this week.

In the 1940s a massive concrete pipeline about 42 km in length was built from Oberon Dam, just west of the Blue Mountains, to Glen Davis in the Capertee Valley (a valley longer than, but not quite as deep as, the Grand Canyon) to supply a new Shale Oil Refinery. The decision to do this was premised on the belief that there was an imminent world oil shortage.

Anyway, in the 1950s they realized there was plenty of oil available and so the refinery was shut down, leaving Glen Davis as somewhat of a ghost town, with one significant difference – they had the luxury of town water supplied from Oberon Dam.

In the late 1990s authorities measured massive water loss between the top of the escarpment and the reservoir at Glen Davis. Engineers identified a green grassy line underneath the pipe in a few areas and it was deemed that the pipeline was falling to bits. The economics of replacing the pipeline to service about 40 permanent residents did not stack up at all. The solution? Offer residents water tanks for free and disconnect the pipeline.

Bullet proof vests needed!

News of the situation and the announcement of the most cost effective solution did not go down too well with the Glen Davis community. As a consultant working then with the NSW Department of Land and Water Conservation, I was warned by the local president of the Progress Association that we should bring our bullet proof vests! The outrage was palpable!

Owing to lack of trust in the authorities the public insisted on an independent inspection of the pipeline. And so, a dozen or so residents, engineers, public servants and I spent a day driving down this spectacular escarpment and inspecting the pipeline. We needed to co-define the problem to be addressed. After several hours there was consensus – the pipeline was still in fairly good condition. Some minor repair work for a fraction of the cost of replacing the pipeline was recommended and ultimately carried out.

However, this didn’t explain the dramatic water loss identified.

Somewhat reluctantly, one resident shared some useful information. It was his belief that some local farmers were illegally tapping into the pipeline to irrigate their crops – mostly being used to produce whisky. This proved to be true. A memorandum of understanding was drawn up between the authorities and the community to make it clear that if such illegal activity occurred in the future the water supply would be disconnected. If they did the right thing, the pipeline would be repaired and maintained.

The story had a surprising and a somewhat amusing ending. But there were some clear learnings that have served me well ever since.

• Firstly, there is no point offering an expert solution when there is no agreement about what the problem is.
• Secondly, local knowledge needs to be valued – they are experts in their own communities and this knowledge needs to be tapped (no pun intended).
• Thirdly, where there is passion about an issue there is also energy to appreciate the dilemma and a willingness to be part of finding a solution

There were lots of other lessons as well; but how might this relate to the health industry?

The same lessons apply. Patients, consumers and citizens are a resource for the health system, not merely a drain – if we choose to regard them as such. For instance, research suggests that compliance with care plans depend almost entirely on the quality of the relationship they have with their physicians – and the skills of the physicians to generate trust and work collaboratively. (If you are interested in this research check out Lambert (2011), p12-21.)

Citizens are a resource for the health industry in many other ways as well. Here are just a few examples.

• I am also working with Griffith University to facilitate a citizens’ jury with regard to difficult ethical choices health administrators have to make on a daily basis.
• Capital Health in Nova Scotia relies on citizen panels to gain invaluable advice about business planning and financial decisions.
• The Shoalhaven community became so engaged in the process of gaining a Cancer Care Centre they helped design it, and also raised over $1Million toward its construction.

There are dozens more examples I could share.

What it shows is that it takes more than excellent clinical skills to achieve an effective health system, just as it takes more than engineers to retain a town’s water supply.

This blog was first published on Twyfords website 8^th April 2013.