Suboptimization as a Healthcare Strategy
In an industry focused on numbers, it may be what's unmeasured that sets a healthcare organization apart
Good morning. I want to apologize for my radio silence over the past few months. Things have been crazy here as we prepare to open Texas Children’s North Austin. As you remember, I took the position of Chief Medical Officer nearly two years back. We’re now closing in on some 148 physician hires and 900 staff. We’re deploying equipment and preparing for system simulation — the drill where we walk through every scenario faced in a full-service children’s hospital. We open February 6th. I’m losing a little hair but having a blast.
So I’ve had to put Digital Exhaust, my weekly curation letter, on hold since I don’t have the bandwidth for the digging and reading needed to make it good. I’ve been torn between the discipline and practice of shipping something every week and shipping something that I think has real value. So here I am.
The journey in Austin with Texas Children’s has been interesting. I have interviewed many of the hundreds of physician candidates (several interviews for every position) for our hospital. What I have heard and learned has been completely unexpected. It’s offered me a lens on the hearts and minds of physicians looking for change. The desperation for meaning and mission has been palpable — heartbreaking in some cases. But there are opportunities here if we listen and act. I really believe that we’re are at a critical flexion point in human care. So much is evolving so quickly and we’re not stopping to look. Few are leading change.
I’d like to share some of this as my energy allows. So stay tuned and I’ll try to put it into a shape and form that makes you think. And usually under 400 words : )
I thought I would share this idea of selective suboptimization in healthcare. I think we all practice it, but we’re not intentional with it. Let me know what you think.
Optimization has become a defining feature of modern healthcare.
We optimize, review, tweak, and measure our systems and ourselves against a super-optimized standard. Better, faster, safer, more productive, efficient and effective.
We’re always looking for improvement. And for good reason. 21st century healthcare has worked to prioritize safety and quality improvement, and the results have been remarkable. Small changes in equipment sterilization or preoperative timeout processes, for example, can have a dramatic impact on patient safety.
But not all corners of the hospital should be subject to six sigma scrutiny. And what do we do when the movement of patients through pre-op or recovery approaches perfection? How will healthcare systems remain competitive? Or even be defined?
The greatest opportunity may be found in the things that are scarce. The winning variable may be what industrialism looks to take away: Connection, touch, presence, and the unfolding of experiences.
The real money may be in selective suboptimization. That is, intentionally thinking about what we want to leave unmeasured and unperfected. Advantage may be found in those parts of the patient care journey left to the serendipity of human engagement: the conversations, connections and experiences that unfold between people in real-time during the time in our facilities.
Let's not analyse the speed or efficiency of our end-of-life discussions. The skin-to-skin time between a mother and her newborn infant may not have a place on a graph. Seth Godin in The Song of Significance had it right: “Part of the challenge of leading a significant organization is getting clear about the right proxies.”
We have to know what to measure. Or what not to measure.
Think of selective suboptimization as the ‘elbow room’ found during the time under our care. Those elements of intentionally slow medicine baked into a system sworn to throughput and efficiency.
Real human engagement can’t be operationalized. Presence and depth of connection evades measurement. This generation’s experiment of human caregivers measured with stopwatches has left us with unions and epidemic levels of burnout.
In an industry focused on incrementalism, it may be the scarce, unmeasured part of the patient journey that sets a healthcare organization apart and affords a competitive advantage.
Thanks for reading. And pass this along to someone who needs it.
Photo by Jimmy Conover on Unsplash
Dr V - Best of luck with the opening and I think you are spot on w selective optimization. I once heard someone say about their company’s product: ‘It’s like a premium-trim-level Toyota Camry, not a Cadillac, not a Ferrari… and we wouldn’t have it any other way. It just works.’ I see this in my work as well. Some things really do need to be perfect, but many things just need to be good enough. The time and effort and expense invested in making everything ‘best in class’ across the board could be better invested in ‘good enough’ for many things and in getting more things done that otherwise fall off the table entirely. An unspoken related issue, though, is the question of value-based payment and incentives to improve performance against specific markers. This can create a couple of problems. For example: (1) Things not specifically incentivized can fall off the table even if they’re important. (Could be clinical-related, payor-related, labor-related, etc.) (2) Payors keep moving the goalposts, so even achieving perfect scores might put you back in the doghouse the next year.
I really do hope everything works out extremely well for you, with the opening.
I am impressed with what you are doing...and it takes a quite a lot to impress me.
I think your words have such great meaning; as we are all dealing with trying to perfect things, while dealing with each of us as incredibly imperfect humans.