“[W]hen humans have a vital need to cross the roaring rapids of a river, as a design scientist I would design them a bridge, causing them ... to abandon spontaneously and forever the risking of their lives by trying to swim to the other shore.”


This quote from R. Buckminster Fuller captures a core tenet of good design: to introduce structures that correspond so well with human needs that they are readily embraced and, in Fuller’s words, “cause humans to abandon their previous problem-producing behaviors and devices.” 

The redesign currently under way in the U.S. healthcare system represents pursuit of that goal. Society’s needs are clear: better health at lower cost. And until now, to a great extent, healthcare professionals and consumers alike have been forced to fulfill that need by trying to swim across roaring rapids—attempting to maintain health in a system that rewards sickness care; attempting to coordinate care in a system of silos; attempting to enhance efficiency in a system that rewards volume.

The system’s problems do not reflect a lack of desire for change. Health professionals and consumers both have a deep and strong desire for better health at lower cost. The problem is the lack of bridges to help us all cross the roaring rapids, as Fuller would put it.

In the “The Structure of Value,” the cover story in this issue of hfm, HFMA’s senior writer/editor Rich Daly outlines the experiences of healthcare leaders, both struggles and successes, in their attempt to redesign health care.

One example, the BJC Collaborative, shows a creative approach to building a structure that will be easily embraced by the organizations involved while serving the purpose of improving care delivery and reducing cost. “Unlike many mergers and acquisitions,” Daly writes, “the collaborative is an initiative of similarly sized systems…. The separate health systems maintain independent boards and executive leadership teams as well as their unique services, missions, and brands.”

This approach has allowed flexibility in the alignment, but provides enough structure to foster standardization—and savings—in services from supply chain to legal to clinical engineering, while also improving access to and quality of care.

Throughout this issue of hfm, you will find examples of system redesign. For example, we show how to decide when to participate in the health insurance exchanges, and how hospitals, physicians, and payers can work together within narrow networks.

According to Buckminster Fuller, design science is comprehensive (dealing with whole systems), anticipatory (addressing present and future needs), integrative (synthesizing parts into a whole), and logical (using scientific methods). That's a high bar, but it’s also an apt description of the innovative structural changes taking place across the country as new designs for health care are tested to meet the needs of our citizens for sustainable health care. 

Publication Date: Wednesday, January 01, 2014

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