The Health Care Organizational Machine and Human Beings

View your system through the lens of complexity – Health organizations are not like a machine or military organization. Reform is about dealing with complex, often fickle, human beings.

This is not a program that you roll out in organizations with banners and coffee mugs. It is a new way of thinking and seeing the world – and, hence, a new way of working with real organizational and health care issues.

Edgeware: Insights from Complexity Science for Health Care Leaders, by Brenda Zimmerman, Curt Lindberg, and Paul Pisek, VHA, Inc, 1998

With health care organizational machines, the wheels are aligned, the gas tanks are filled, the gears are engaged, the motors hav been fine-tuned, and the GPSs are set.

The trouble is, of course, that health reform is not a machine. It involves variable, individual human beings, each with a mindset of how things ought to be done.

Nevertheless, despite the resistance of the status quo and the reluctance of human beings to change their ways of doing and thinking about things, the wheels of health reform are in motion.

The wheels are embodied in these movements.

One, the movement towards bigger, more consolidated organizations. The big are getting bigger. The bigger organizations engaged include hospitals, health plans, government, and physicians. It takes an organization to get things done. Formerly independent physicians have recognized this and forming concierge organizations to combat health reform trends.

Two, paradoxically, a movement away from centralized organizations towards smaller , independent, free standing institutions – emergency rooms, urgent care centers, surgery and diagnostic centers. The large institutions often control these free-standing entities, but the smaller entities are geographically removed from the center. The entities cater to consumers and offer convenience and easy access. They also tend to be more efficient than what takes place at bloated centers of care.

Three, again paradoxically, the movement of physicians and surgeons towards creating their own free-standing groups and diagnostic and surgery centers. These free-standing groups and centers are formed so physicians can control their own economic and clinical matters .achieve greater efficiencies, and market directly to consumers.

Four, the movement towards marketing and branding. Marketing of hospital services and physician services has become the order of the day. Hospitals tend to vigorously market their medical groups via TV and stress their high-end surgical and cancer services. Physicians may collaborate in the hospital marketing effort, but increasingly are doing so on their own.

Five, the movement towards alliances of major medical groups and cancer and orthopedic with other other hospitals. The Mayo Clinic and Sloan Kettering are spearheading these alliances.

Six, the movement towards the use of megadata to determine treatment approaches and to improve outcomes rather than intuitive and clinical experience at the point of care. This is a quantitative rather than a qualitative mindset. It is a spin off the expression, “In God we trust, all others use data.” It is often expressed at value-based or evidence-based care as opposed to volume-based or empirically-based care.