Since the pandemic healthcare has undergone a remarkable transformation. Before COVID dropped in as our latest wicked problem, technology was upending everything we do. I’ve been thinking a lot about the burnout, confusion, uncertainty, and exhaustion that we’re facing. I’ve been thinking about the conditions that define healthcare.
When we talk about these challenges that we’re facing there’s a tendency to blame isolated issues — we believe that our problems can be solved with targeted changes. The belief that perfecting the electronic health record would fix burnout in physicians is a great example.
But considering the broader conditions that define healthcare is an important starting point for tackling some of these downstream problems. Examining the broader social and technological conditions of healthcare helps us manage expectations and allows us to set the stage for understanding what we might ‘fix’ and what we need to just understand better. Perhaps more importantly it sets us up for what we need to get used to.
Three conditions that define healthcare
Three that come to mind are complexity, uncertainty and exponentialism. These are not isolated and each one feeds into the other. There are other conditions that we can probably identify with but these are a start.
Our healthcare delivery system is a complex system. A complex system is one whose behavior is difficult to model due to the dependencies, competitions, relationships, or other types of interactions between their parts or between a given system and its environment. Increasingly healthcare is marked by shifting variables and competing values.
Our healthcare system has always been complex. But it seems we’ve always been able to work around it. Traditionally, the strategy for healthcare leadership has been based in logic around known options and variables. Increasingly, these don’t exist or are in flux. The maps and traditional strategies that carried us in healthcare won’t work now.
Complexity breeds uncertainty. And uncertainty is the new core operating condition for healthcare leaders. In a system as complex as healthcare the thing that just happened isn’t helpful in understanding what’s ahead.
This is new territory for us. As doctors and healthcare leaders we have traditionally operated in a field of relative certainty. In fact, prediction is firmly institutionalized (to quote Nassim Taleb from The Black Swan) in health care. In the past we could think of healthcare as linear. While no one was ever truly able to predict the future, the fact that things didn’t change all that much year-over-year made strategy a matter of following a straight line.
One of our defining conditions is the rate at which healthcare is changing. Here we could refer to technology itself as well as the information it generates. Beyond the amount of information we face is the ambient nature of that information — it’s everywhere. The rate of change and explosion of information could easily be described as exponential.
This rate of change in data and technology only fuels the uncertainty we have about the future of healthcare. This difference between what’s happening and our ability to process what’s happening creates a kind of dissonance for leaders and even doctors.
Our current health systems respond to change at the speed of 20th century bureaucracy. But the dynamic nature of healthcare will not wait for 20th century processes to adjust. The challenge is to shape leadership structures that are immediately adaptive to change. Mindsets and expectations as mentioned need to change. And above all there needs to be a sense of urgency in leading this change.
Instead of attempting to forecast the future, we need to design systems that are nimble enough to thrive in a number of possible futures. These systems need to be centered around flexible leadership structures, fluid boundaries between service lines and a more risk-tolerant mindset.
We need to consider management structures that defy traditional command-and-control systems and leverage the distributed power of a broad-based leadership. This power of distributed authority was evident at points during early COVID and was even more evident to me at my own institution during the polar vortex of 2021. Crisis creates the kind of urgency that challenges existing structures and forces change.
Adopting the change mindset
Most importantly we have to recognize what we don’t know while remaining open to what we are coming to know. We’ve got to operate in dynamic state where we are willing to move with the unknowns and change our views on a regular basis. We are, as suggested by Kevin Kelly in The Inevitable, in a state of becoming as healthcare leaders. We need to move from a static to a change mindset.
The change mindset calls for a different way of leading and helping others imagine their role.
Considering the broader conditions of healthcare allows an entree to discussing some of our most challenging problems. They allow us to frame our problems in a new way. The elements of technological change and data volume that contribute to physician burnout, for example, may have specific solutions. Or, more importantly, they may require us to manage expectations — sometimes our response to foundational change is the only thing we really can control.
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