Prepared for the Reality We Knew, Not the One We Couldn’t Imagine

Image by Joel Worthington

Much of the U.S. health care “system” is a business, and, for many decades, we’ve been applying tools from managerial sciences to many of its problems. We focus on analyzing processes thoroughly and systematically to find the “one best way” to do it. This kind of methodical approach is used to improve operational processes, to produce truths about where to grow or invest, and, ultimately, to make the most informed decisions possible.

Nearly every problem-solving method we’ve been taught follows the logic that any problem can be broken into smaller, quantifiable parts, and, by gathering and crunching the data, we will find an optimal solution, which we can later extrapolate into future scenarios.

So, in other words, everything we’ve learned has trained us to look for the “right answer” or the “best answer”. This approach works brilliantly when you are trying to solve for matters related to addressing efficiency, productivity, or scalability of a system under somewhat stable, predictable, and known conditions. But this creates the paradox of “best practices” where something that was the right answer before becomes an orthodoxy, or an ossified best practice, that no longer applies or doesn’t help us consider blind spots beyond our known reality or future possible scenarios that bust historic assumptions. And, renowned design thinker, Roger Martin, highlights the imbalance between building for efficiency and preparing for the unexpected (resilience) that has occurred in U.S. health care:
 

“Efficiency requires us to force out duplication and redundancy, increase specialization and more seamlessly connect things together. Resilience, on the other hand, enables us to adapt to changes in our environment. Efficiency and resilience are opposing forces in our economy, and the pandemic has shown us the high price we are paying for the modern focus on efficiency at the expense of resilience: We don’t have immediate access to the needed test kits, masks and ventilators because it wasn’t efficient to have mass production of these items in the United States, and we’ve come to believe that stockpiling supplies is wasteful.”

We could easily add more key components of the system to this analysis - how we think about, with a focus on day-to-day optimization, the supply of inpatient beds, health care real estate, staffing shortages, etc. And, to be fair, many experts and open-minded leaders were able to foresee our scary new reality, but were the rest of us ever really ready to listen without experiencing the reality ourselves? And, maybe we’re currently ready to consider health care as a consistently essential service (not just a profit- or efficiency-focused business) or to create system buffers that will help us in future crises, but what about when it fades from urgency and memory? Will we return to hyper-efficiency and optimization? Or will today’s united breaking of orthodoxies in order to address the current pandemic lead to a lasting reimagining of a system built for efficaciousness, resilience, and real crisis preparedness?

We hope it’s the latter.

Co-authored with Roberto Seif

To discuss or learn more, email Joel directly at joel@jwcollaborative.com or see jwcollaborative.com.

Additional media for reference:

“The virus shows that making our companies efficient also made our country weak” (Roger Martin, Op-Ed, The Washington Post)

“Why the U.S. is Running Out of Medical Supplies” (NY Times, The Daily Podcast, 24 min)