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Mischa Dick

Healthcare System Integration

Why Less is More

 

By: Mischa Dick

Last year I dabbled in the world of blogging about my perspective as a German aerospace engineer working to make the US healthcare system better, one organization at a time. Today, I am relaunching my blog, to drive interactive and meaningful conversations about the lessons that outside disciplines, such as aerospace, can teach us about improving healthcare delivery. I sincerely hope you will follow, engage, and most importantly, challenge me as we work through the current turbulence of healthcare together. 

Saturday mornings can create waking thoughts, and this Saturday was no exception. What does a motorcycle trip through Northern Africa in 1991 have to do with today’s challenge of health system integration? Everything. 

The desert has always fascinated me, and as a college student in 1991, a motorcycle trip to Tunisia scratched the itch. In preparing for the trip, which involved self-sufficient camping, the most important theme was minimizing weight and bulk on the motorcycle. Every pound carried multiplies the burden and increases the risk of injury with a more unwieldy bike. Not to mention, it eliminates the fun by making the bike less agile.

In other words, less is more in the world of motorcycle adventure travel.

As health care systems are being integrated, complexities are multiplying. New technology functionality, physician group purchases, and reimbursement models with risk assumption all create complexity. With complexities abound, the leadership challenge is how to make it all work together.

Systems Engineering is thought of as the discipline to create a system to make complexity work well, to create the system of stop lights, intersections and traffic cops that prevent chaos and bad outcomes. Its job is to create the well-organized production machine. 

This, however, is only partially true. The real magic of systems engineering lies not in the overlay of managing complexity, but in the removal of complexity itself.

Most real progress it turns out, is not about more, it is about less. Think about what is revolutionizing industries- it is the removal of complexity, that allows for ‘more’ to be delivered at much lower costs. One example is how we consume music today. It is much simpler and less complex than it was a decade ago. To consume music in the past, one listened to a song, say on the radio, then needed to identify the artist, travel to a music store and purchase the medium (for example a CD) before finally getting to enjoy the music itself. Complex. Painful. Today, we rent music, get recommendations based on our tastes, have immediate access to the music without travel and no CD racks cluttering up the living room. The complexity of enjoying music today is remarkably low. Less is more.

What does this mean for healthcare system integration? As we integrate the pieces of the healthcare system, we have a tendency to add complexity on top of complexity. We have a complex system, so we add a management system to manage complexity, which of course, now adds more complexity. We enter a vicious cycle. As part of the health system design process, the most powerful question that should be asked all the time is, what can we remove and take out? This applies to process steps, IT systems, organizational units and so forth, so really it applies to all components of the delivery system. This does not mean that we eliminate the creation of customer value, but quite the opposite, what needs to be removed to create more customer value?

Less is more. I will leave this topic with two quotes:

E.F. Schumacher is credited with saying, “Any intelligent fool can make things bigger and more complex. It takes a touch of genius, and a lot of courage, to move in the opposite direction.” 

Along similar lines, Albert Einstein said, “Make things as simple and possible, but no simpler.”