The US Healthcare System

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

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 i.e superheroes

• 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"

Individual caregivers value the patient over the system i.e. go around 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 operate

Individual caregivers (very likely) find ways to tolerate complexity and Failure Demand via best-efforts rather than fix the 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 the individuals interacting in the same system

Partially hidden networks of people, process, and technology that have different visibility to different participants.  

Best efforts by participants will be limited by hidden networks. 

People will (likely) continue same processes or behavior that reinforce the hidden network i.e Failure Demand. 

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.

Partially hidden networks of people, process, and technology that have different visibility to different participants.  

Best efforts by participants will be limited by hidden networks. 

People will (likely) continue same processes or behavior that reinforce the hidden network i.e Failure Demand. 

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.

1. Worst case: Intervention deployed → End-to-end good care gets harder for all → Aggravation of all

2. Usual case: Intervention deployed → End-to-end good care shifted for some → Aggravation for some, relief for some

3. Best case: Intervention deployed → End-to-end good care gets easier for all → Confused relief for some, delight for all