The internet is an example of the power of embracing complexity. Healthcare is in a similar position to the computer industry in the late 1980s and can learn important lessons that will dramatically improve quality and cost.
Success grows from matching the system to the reality of its environment
Prior to the internet, several large computer and information systems companies competed to create and deliver value to customers. Like healthcare, this involved very technical products needing expertise to develop and maintain. That expertise was primarily in-house at the companies which controlled the products and defined how they were used. Internally these companies worked hard to ensure efficient process so that products had the highest quality and lowest cost. And competition worked to keep their focus on delivering more value. And then something happened.
Work that began in the late 1960s on computer communication protocols began to take hold and an open, resilient network began to grow. In Figure 1 we see the inflation index for information technology, hardware and services beginning to fall dramatically in the late 1990s.
Related inflation indexes in communication and personal computers / peripherals reflect the same trend. These indexes represent the first components of a bigger engine of change.
Today we know that businesses that use the complex network we call the internet supercharge productivity and change the way we live.
Online environments keep track of what people want in real-time and adapt to make that available. Competition is much more transparent. This keeps prices lower and quality at levels that customers want. The favorable results – lower prices and higher quality - is in line with what system science would predict and a validation of Ashby’s law of requisite variety.
This dramatic improvement is because computer sector management moved from a hierarchical control system to an agile complex adaptive network. It takes a complex system to manage a complex environment!
Healthcare: an opportunity to change the game
The medical care inflation index followed the CPI until the mid-1980s when it became consistently higher, shown in Figure 2. If fact, medical care became the highest category of inflation in the United States. And costs continue growing faster than the economy supporting it. What happened to put medical care inflation on this unsustainable trajectory?
What changed was the adoption of a more rigid industrial model of delivery. The focus was to limit what patients could ask for and get based on centralized authority. Ashby’s law would predict that such a system would lose control; a result that is more evident and real every day. Contrast this to the sharply different Internet system. The adaptive network approach used transparency around cost and value to optimize service to every customer. This created more and more value at less and less cost.
Healthcare continues on the path of control and ever more complicated rules. The irony is that beneath complexity are simple rules. Achieving the best results at the lowest cost isn’t about finding the best practice for each individual part. It is about playing the game differently. It is about managing the overall system so that it creates transparency and the best outcome for each person. Healthcare serves a Complex Adaptive Environment, it will not achieve control until it operates as a Complex Adaptive System.
The Curandi Way
Curandi is Latin for “Caring”. The Curandi Project to heal healthcare is a not for profit organization dedicated to transforming healthcare into a living system that works. It offers a new approach based in system science for the critical task of changing the trajectory of healthcare costs that are disrupting communities everywhere.
A first step is to re-consider our assumptions from the perspective of the community and healthcare’s purpose within it.
Learn more about Curandi and become part of a new way forward.
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