Joseph Ferenbok for the TRP, November 2020
I have a confession to make — I don’t like change. I don’t like leaving what is familiar and comfortable to face the undiscovered. If given the opportunity, I think I would choose a routine. Unfortunately, there are many things that bug me–and I’m not so good at ignoring bad design.
I don’t mean bad design, from an aesthetic sense—although there is plenty of that, too. By bad design I mean how things are planned out, developed, and implemented. I mean prescription on pill bottles that say “Take two pills twice a day” and then follow it up with a “Maximum dosage: two pills per day”; or a clinic that refuses to book an imaging appointment prior to an initial consultation for a patient with mobility issues only to tell them that they will need to come back once the imaging is done… and I could continue.
From small inconveniences to system-wide problems, from the implementation of innovations to the uptake of those new technologies, performances of healthcare delivery are fraught with bad design and inefficiencies. I’m writing this not to be critical or point fingers at anyone. Every sufficiently complex system that is in constant flux and depends heavily on individual contextual decision making is bound to have variations and idiosyncratic nuances that in their aggregate require constant quality monitoring and improvement.
That’s actually part of my point. Healthcare delivery is such a complex and evolving system that it has many of these inefficiencies—or opportunities for innovation. These instances of bad design, nonsensical processes, outdated technologies, these are the necessities, the “needs” that provide the pull for new and better approaches.
The trouble is that there are so many researchers, innovators, and translators who are looking for the “Next Big Thing” the novel “Disruptive Technology” that will change the very nature and structure of the health care delivery market, that they often overlook and disregard those thousand mortal cuts that complex systems are prone to. Part of the thinking, so it seems, rests on a false economy that the more dramatic the “need” and the more drastic the intervention required, the more fame and fortune await on the other side of the innovation pipeline. Why look for small incremental changes that could be applied across multiple points of a system, when one big dramatic project will bring real institutional glory, promotions, book-deals, licensing revenues.
But the scope of a “need” or the complexity of the problem is not directly tied to the impact that an intervention may have. Sometimes a small change, one that improves one little, a tiny question on an intake form can prevent thousands of falls and multiple fall-related injuries. The degree of the problem isn’t always equivalent to the complexity of the intervention needed, and the complexity of the intervention isn’t always proportional to the impact created. These notions of drastic change, the relationships between big change and big impact is a false dichotomy.
Why bring this up? Seems to be a gravitas to look for the big “need”, the ‘big’ wicked problems the drastic interventions. Deploying a disruptive innovation that transforms systems is every innovator’s dream!
But while you drift in the safety of what is routine and familiar waiting for that big discovery, that big Eureka moment that will change your life and the landscape of healthcare, remember to keep your eyes opened for the smaller needs, those inconsequential nonsensical moments of bad design that are slightly irritating. And maybe, while you’re waiting for inspiration to strike, practice addressing those incremental challenges that don’t hold as much glory and reverence but may have a tremendous impact on people’s quality of life and health.
Opportunities, needs, and innovations come in all sizes.