Intractable Problem: A focus on illness, not wellness
The Healthcare industry is fraught with problems that keep people awake at night. We’ve picked one that runs in a similar vein to the Safety-I focus on what goes wrong and the Safety-II focus on what goes right.
In the video below, Deepak Chopra shares his views on healthcare and medicine today:
Conventional medicine’s about mechanisms of illness, and we try and find out what the mechanisms are, then we interfere with them. So bacteria multiply; interfere with that with an antibiotic. Cancer cells replicate; interfere with that the chemotherapy, radiation. It’s mechanistic. It works, but it doesn’t go to the origins of illness, and of course it never addresses the origins of wellbeing or health…
Conventional medicine is a reductionist perspective where we see the body made up of parts. Surgeons are adept at replacing hips, knees, hearts much like mechanical engineers are good at rebuilding a Chevy engine and restoring the chassis. But Chopra points out it is so incomplete:
We do not address the relationship between emotions and illness, between lifestyle, sleep, exercise, diet, nutrition, between relationships, between social wellbeing, community wellbeing, between even bigger things like financial wellbeing and career wellbeing, all of which have a huge impact on what happens in our biology.
Healthcare Funding is a Complex domain issue
All countries spend billions to maintain some level of healthcare. Despite how much is spent, it seems to be never enough so every coin going out the door is carefully watched .
In all industries the demand & supply relationship is defined by the customer and the service/product provider. In Healthcare the Investor or Funder plays a huge decision-making part on the level of attention directed to illness and wellness. In 2004 The Economist published an Healthcare article in which it stated: “Every dollar saved by using more cost-effective procedures is someone’s dollar of income.” Yet Government funders in its saintly role to ensure quality and safety burden the care-givers with costly administrative and compliance tasks.
With so much governance and oversight, the desire and willingness to take risk has decreased. This is not risk in putting patients in harm’s way but the avoidance of trying something novel. In the Complex domain, we Probe, Sense, Respond by conducting safe-to-fail experiments to discover emerging favourable patterns that lead us to new solutions.
The challenge in Healthcare is finding a sponsor knowledgeable in complexity thinking who’s willing to fund safe-to-fail experiments. Fortunately “sticking out one’s neck” isn’t necessary; experiments in the Complex domain have “less is more” approach done quickly with few resources. An analogy would a restaurant chef testing out a new dish. Try it out and see how the customers respond. If it’s a hit, add it to the menu. If it doesn’t sell, remove it. Smart chefs will offer several new dishes since it’s easy and affordable to do.
HC safe-to-fail experiments being considered include providing wellness services at a clinic or playing around with smart device health apps. These are projects that do not require a business case and large amount of resources tied up over several years.
Instead of transforming the Healthcare industry with humongous projects competing for limited resources, how about we evolve HC naturalistically. It will take up fewer resources, impact behaviour change sooner, take on less risk, and be more sustainable since the system and agents will co-evolve by learning and adapting.
John Van Aerde. The condition of the Canadian healthcare system does not have to be discouraging. The Canadian Journal of Physician Leadership. Fall, 2014.