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Systems Thinking

April 18, 2011
Complex Systems

Complex Systems require Systems Thinking

Those who want the government to provide healthcare are right – and wrong. Those who want to turn things over to private markets are right – and wrong. And each “camp” is wrong to excoriate the other camp. Further, each camp is wrong for the same reason – they do not understand and do not practice “systems thinking”. They do not have their “minds wrapped around this problem” properly. Screaming at each other, sticking to tired old dogma and ideological positions is not helpful.

Clayton M. Christensen is a recognized leading thinker around the topic of disruptive innovation. His landmark work, Innovator’s Dilemma, and the many HBR articles on the topic of innovation have demonstrated his deep knowledge of how things are “shaken up” in our businesses and economy. He has applied the same systems thinking approach to the healthcare industry in our country and has outlined his findings in The Innovator’s Prescription, A disruptive solution for Health Care. I have not yet read the book, but it is certainly on my list. Mainly because this topic keeps coming up in my circle of colleagues and there seems little chance that one side will find anything good to say about the other side’s point of view. So I’ve been thinking about this topic for some time now.

Then this morning, on my jog, I was listening to a podcast and the interviewer was speaking with Clayton about his recent health problems (let’s be honest, health crisis!) and what he had experienced in his own personal interaction with the healthcare system. As usual, Christensen pulled it all together and made a cogent case for why no approach being discussed (The Patient Protection and Affordable Care Act or Rep. Paul Ryan’s plan) is going to solve the problem. In fairness, when pressed, he stated that he believed the present legislation is a step in the right direction to make sure we don’t leave folks behind while we get on with “blowing up the present system” and putting in place what is needed going forward. Also when pressed, he stated that the Ryan plan was not going to work. His reasoning was simple – the market modularizes the services provided, optimizing each “subsystem” in the healthcare system and thus makes the overall system totally un-optimized. Systems thinking requires that we recognize that some sub-systems will have to be “unoptimized” for the overall system to be optimized. Healthcare is definitely a complex system.

Christensen, who has long dealt with diabetes, found himself at age 55 unexpectedly dealing with a series of other health crises – heart attack, stroke, detached retina and several other issues. His experience in the healthcare system worked for him and he could see firsthand how it was also not working for others. While he had already been working on his book before being stricken, this experience helped him to solidify and express his concern for disruptive innovation in the healthcare system. What he found was that only those who step back and look at the whole system have come even close to understanding the issues, let alone solving them.

Christensen held up Kaiser Permanente in Northern California as the right model. Because Kaiser controls the whole system for providing the services, they can optimize and provide cost savings over the long term. They can force communication about what is needed for each patient and care regimen and follow up to make sure things are done right. The example he gave was that children in the Kaiser system are given treatments to seal their teeth. There are essentially no cavities when the teeth are sealed. This has been known for a very long time. But your dentist will likely not recommend such a treatment simply because they make their money on fillings. Kaiser can say, “no, we are going to save money in the long run by preventing decay in the first place.”

There are many more examples of why health care, rather than our present system of sick care, makes sense in keeping costs down. We will not, however, see a move to that system if we simply tinker or let “markets” determine costs. Christensen worries that by taking the first step in the process with PPACA, we will ossify and further embed the present system – which is dysfunctional from a cost containment point of view. What is needed is disruptive solutions, and they will be hard to implement as long as this is a political issues. With both sides calling names and vilifying the other side, we will make no progress.

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