Only wet babies likes change…

Why is it so hard to drive disruptive behavior out of healthcare institutions? It's because organizations are like living, adaptive organisms; they resist change, but adapt even to the most dysfunctional circumstances, if necessary. You were born with two kidneys, but can do pretty well with just one. If the second kidney starts to crash your body will fight to the death to work around the problems with electrolytes, red blood cells, acidosis, etc. In fact if we took out your bad kidney and gave you a good one, your body's immune system would immediately go to work to attack it. Organizations like living, adaptive organisms resist change. The healthcare industry has adapted to a lot of very bad behavior for a long time. So long in fact that it feels normal, and regardless of how dysfunctional it is, changing it won’t be easy. Here is one humble theory on just one aspect of what is driving this…

Technology and increases in knowledge are forcing a shift from a centralized complexity management strategy to a distributed one; and like a healthy kidney transplanted into a dying patient, the organism is fighting this change as best as it can. Healthcare is complex by its very nature. Organizations generally manage complexity in one of two ways; they either centralize it in the hands of “an expert few” or distribute a little of it across the masses.

Consider the example of fly versus driving for a trip across the country. In the first case, you have a half-billion pound piece of steel flying at 500 MPH and trying to land on a 50 foot wide piece of pavement. Very complex, but none of the passengers need to worry because all of the complexity is centralized across just a few people; pilot, co-pilot and air traffic controller. In the latter case you have millions of vehicles on hundreds of thousands of miles of highways, rural roads and streets, running in every direction, in varying states of repair, across varying kinds of terrain, and in all sorts of weather. No person or super computer could manage this amount of complexity, nor is it necessary. Instead, small pieces of this complex challenge are distributed across the millions of drivers; each only needing to concern themselves with safely getting from point A to point B. This is centralized complexity versus distributed complexity.

So how does all of this tie in to doctors and change and wet babies?? Rapid advances in technology and huge increases in knowledge are making it impossible for one individual to cenrally manage the complexity of treating human disease. They are being forced to move from a centralized complexity management strategy to a distributed one. For some people it feels normal, some will like it, but many find it very distasteful. They endured years of sleepless servitude to attain their position, only to find that everything is changing. Operating in this new environment demands a new mindset and new skills. Greater collaboration, new routines for gathering, interpreting, and redistributing knowledge, and a good process for resolving conflicts when they arise, just to name a few.

So we have a shift in the way complexity is managed, but just to keep things interesting, we must also contend with the unique power structure of hospitals. Doctors who are essentially individual contributors and often not even employees, wield enormous power and are being forced to change. The power they hold makes their ability to resist change a key challenge to work with. This really is a huge change management issue, and fixing it will require a unified approach. More on that next time…