lessons and experience

The US Healthcare System

  • A disorienting combination of service industry, research industry, social-safety net

  • Alternatively, several different industries under a single label

  • So complex that unable to adequately describe its own complexity (far-reaching implications)

  • Known for incredible outcomes (both good and not-good)

  • Everywhere powered by individuals who are

    • compassionate and highly-skilled

    • conditioned to give best-efforts even when unreasonable

    • trained to accept complexity and ambiguity from the beginning e.g.

      • no option to "simplify" the human digestive system

      • no guarantee (only expectation) that an individual's digestive system will respond the same as another

      • "...make patient, the attendants, and externals cooperate"

Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.

-Hippocrates

Good Care Delivered via Complex System

Therefore, a solution that delivers good care despite known complexity will have many hidden inter-dependencies that are beyond the knowledge and reach of individuals interacting with the same system

Distortion via Complexity

The result is a system with a partially hidden network of people, process, and technology that has different visibility to different participants. Any best efforts by participants will be limited by the system's hidden network. People will be struggle with the same mental model and will be trapped to continue processes or behavior that reinforce the hidden network i.e Failure Demand. This system will demonstrate widely disparate behavior from seemingly minor changes in clinical programs, people, process, or technology i.e. emergent phenomena and usually results in one of the cases below during optimization attempts.

The partially hidden network will distort the expected beneficial effects of clinical programs, data, analytics, and tech.

Best case requires a team with hybrid clinical + data + tech expertise to arrive at correct simpler design AND supplant the original mental model

Good Care via Shared Knowledge