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"

Good Care Delivered via Complex System

• Individual caregivers value the patient over the system

• Bulk of the causes of low quality and low productivity belong to system

• Individual caregivers (very likely) are unable to eliminate complexity from the system in which they reside

• Individual caregivers (very likely) find ways to tolerate complexity and Failure Demand via best-efforts rather than fix the 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.

Good Care via Shared Knowledge

Synthesis

• The Importance of Variety

• Real Story: Data-Informed Decisions in Healthcare

• Use Clinical Identity to Reshape the Future

• What is the Value in Value-Based Care

Lessons

• 05/15/2022 - Cross-Organizational Functions to System

• 05/09/2022 - A Platform for Healthcare - Functions and Participants

• 05/09/2022 - Person-Centric Use of Data and Technology

• 03/29/2022 - Customer-Based or Service-Demand Variety

• 03/19/2022 - Data Omnivorous Platform for Healthcare

• 03/19/2022 - Improve Upon Things That Never Change

• 03/14/2022 - Data ⇨ Features ⇨ Model ⇨ Findings

• 02/09/2022 - Service Industry Aspect of Healthcare

• 02/09/2022 - Value Demand vs Failure Demand in Healthcare

• 02/08/2022 - How to Get Better Results

• 02/07/2022 - Optimize the Whole

• 02/03/2022 - Enabling Environment

• 02/03/2022 - Virtual Value Stream Progression

• 02/03/2022 - Identity and Behavior of Clinical Organization

• 02/03/2022 - Conway's Law

• 02/02/2022 - User-Centered Design

• 02/01/2022 - Priority for Daily Data-Informed Decisions

• 01/31/2022 - Data to Consumed Insights in Clinical Context

• 01/29/2022 - Steps to a Data-Informed Culture

• 01/28/2022 - Fundamental Design Principle for Healthcare

• 01/28/2022 - Vision for Use of Data at a Healthcare Organization

• 01/28/2022 - A Data-Informed Compassion-Guided Healthcare Organization

• 01/28/2022 - A Data-Informed Culture

• 01/27/2022 - Insight Through Making

• 01/27/2022 - Data Team in Clinical Organization

• 01/27/2022 - Emergent Phenomena

• 01/25/2022 - High Performing Clinical Model

• 01/25/2022 - Value-Based Care Risk Bearing Care and Care Mgt Capabilities

• 01/25/2022 - Recurrent Questions for Data in Healthcare

• 01/20/2022 - A Learning Organization

• 01/20/2022 - High Performing Teams