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The Healthcare System and Managing Complexity

Stanley Feld M.D.,FACP, MACE

 Many readers were confused by my last four blogs, It Is Easy To Forget, How To Manage Complexity, Aligning Incentives Is A Must In Creating An Efficient Healthcare System and How Home Depot Learned To Manage Complexity.

I have received comments like, What does this have to do with the healthcare system? Who cares about Mechanism Design? What does the healthcare system have to do with Pareto efficiency?

One person wrote; “Dr. Feld, I do not get it. None of this relates to the healthcare system.”

All of these blogs relate to the dysfunction in the healthcare system. The healthcare system has a larger “Blind Spot” than many large corporations in America. 

My brother and I have been discussing his analysis of the Blind Spot in corporate America in detail. The subtitle of his book is “A Leader’s Guide To IT-Enabled Business Transformation.”

It dawned on me that his transformation model could be applied to the healthcare system. Everyone knows the healthcare system has to be fixed but no one knows what to do.

President Obama and Dr. Don Berwick are making the dysfunction worse as they impose their complicated ideas on the healthcare system.

A reader wrote in response to my Home Depot article,


Yeah, this is good stuff–consumer oriented.  Obama & those ox#70 professors he listens to don't get this at all.” 

I often get comments that the Healthcare System is impossible to repair. It is too complex.

Medicine is going through a transformation. There is conflict between vested interests and between learning systems.

1. Stakeholders are fighting to protect their vested interests. The fight has intensified as a result of the transformation. The conflicts must be resolved.

2. Physicians continually learn through the experience of daily medical practice. The experience gained increases physicians’ medical judgment. This learning system is important for the physician-patient relationship. It promotes the confidence patients should have in their physicians.

 As a result of the dysfunction in the system physicians are abandoning their medical judgment in the pursuit of defensive medicine and patients are losing confidence in their physician’s judgment.

Data should be accurate and informative for patients and physicians to improve care. Instead the data collected has been punitive to both patients and physicians.

3. Advances in medical science and medical technology represent complicated learning systems. New advanced techniques are developed in surgery, medicine, genetics and therapeutics.

Information technology offers a chance to enhance experiential learning but has not been deployed properly. Instead it has led to disinformation and increased stakeholder mistrust.

Healthcare insurance companies, hospital systems, and the government have installed complicated data collecting information systems to gather insight into the cost and quality of medical care.

In the past, much of the data has not reflected the true value of the care of physicians. The data has been used to the disadvantage of patients and physicians.

4. No one has understood the patterns of behavior that have resulted from these conflicting learning systems and vested interests. No one has figured out how to manage the complexity generated by these interactions in the healthcare system.

The Home Depot example of learning to manage complexity can be applied to the healthcare system.

The physician is the store manager. The patient is the customer.  All the rest of the stakeholders should be the supporting cast.

Once everyone gets it, a sensible conversation can begin. Only then can the healthcare system be on its way to achieving Pareto efficiency.

Readers should think about their recent healthcare system encounters. I would guess many have walked away with an unpleasant feeling toward the healthcare system whether it was the encounter with the insurance company, hospital, government, pharmacy, or physician.

 Navigating the healthcare system has become an unpleasant chore.

It is also unpleasant for all the stakeholders. Yet none of the stakeholders see their Blind Spot.

These unpleasant and inefficient activities are created by the complexity of the healthcare system. This complexity can be broken down into components parts. Only then can the complexity of the healthcare system be managed. 

The most important asset all of us own is our health. Every effective effort must be made by the healthcare system to maintain our health. We as individuals must be responsible for maintaining our health.  Individual responsibility can be achieved.  When it is everyone will win.

Central control of our healthcare system with government imposition of rules and regulations to control patients’ freedom and physicians’ medical judgments will not work.


The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  




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