Healthcare Ecosystem – Wild & Messy

At coffee my brother-in-law, an architect, asked

“What describes an ideal healthcare system?  An airport? Airline?  A factory?  Something else?“

I paused.  He’d probably heard the healthcare-is-like-the-airline-industry line before…

“An ecosystem,” I said.  “Everyone loves to compare healthcare to  airplanes. You fly a plane over and over to figure out the safest, most efficient way to do it.  But healthcare is messy, relational, contextual.  Air travel serves people in high risk situations, but the similarity ends there.“

Pundits often complain, “If only healthcare could behave like airlines and embrace safety and protocols…”   Healthcare procedure should be as certain and precise as flight schedules.  Steve Harden starts his Never Go to the Hospital Alone: And Other Insider Secrets for Getting Mistake-Free Health Care from Your Doctor and Hospital with airlines and crashes.

Our love of precision might explain why patients love lasers.  Laser-anything adds credibility.  Laser surgery, laser vein treatments, laser smoking cessation…(what?)  Lasers aren’t new, but they sound precise, exact.  Humans crave certainty.

Ecosystems defy certainty.  Impossibly interconnected, ecosystems teeter such that change to one variable impacts everything.  Raise the water level and you flood burrows, nests, and change spawning beds.

Healthcare Ecosystems are

• complex
• interrelated
• adaptive
• resilient to some changes
• delicately fragile to others
• non-linear
• dynamic
• unique

Healthcare serves individuals from different communities with peculiar risk factors, varied social supports and unique genetic material.  While patterns exist and outcomes should be measured, healthcare will always resist the amount of control desired by bureaucrats and analysts.

Many physicians crave precision, too.  They see improvement with checklists (see The Checklist Manifesto) then apply lists to everything.  They find protocols improve outcomes and decide every patient needs the same treatment for diagnosis, all the time. It appeals to pundits in love with tick-boxes, check-lists and airline analogies.

Healthcare will never squeeze into rigid process because people don’t.  It will always defy utopian ideals of uniformity and certainty.  As tax dollars run short, healthcare gets asked to perform more and more like an airline or factory.  We need to remind planners and pundits that healthcare is an ecosystem, wild and messy.

(photocredit: movethechannel.com)