The Institute of Medicine was established by President Nixon in 1970. It is part of the American Academy of Sciences and its membership is taken from that prestigious group. It was formed to help find ways to make our health care system work better. More than thirty years later their report, Crossing the Quality Chasm, concludes that we pay too much for too little; between the costs of care and the quality of care lies not a gap, but a chasm. Thirty years of help from the experts does not appear to have done too well. We all know or system needs help, examples abound on every side, but too few have any idea of how to fix it.
Some of this problem resides with these experts. They are all trained in the analytical approach to problems where one takes the system apart, fixes what is faulty, and puts it back together. That approach works with mechanical devices, but not nearly as well when the object is alive. Living agents read and adapt to their environments and machines cannot adapt. Our health care system is made up of living agents who adapt to changes in the health care environment in ways that are novel and unpredictable; such adaptation cannot be analyzed in a mechanical sense. Some in ecology, biology, and even in economics are coming around to realizing this and looking for better ways of seeing.
At Common Sense Medicine® we believe seeing living organisms as the adapting agents they are is the first step. So we need to look at how agents adapt.
Sometimes we read the environment as threatening and adapt defensively. Most of the players in our health care system see things this way and adapt by trying to insure their survival by increasing their own profit margins. That’s the way many adapt in the business world as well, especially when highly regulated, which is seen as being threatened. Regulation, of course, is a common solution when analysis is used. If used wisely regulation is not seen as a threat.
Sometimes, more often when the environment is not threatening, we adapt in creative ways. This approach is certainly what is needed in our health care. A rule for such systems is that solutions for their problems must come from within the system. This is the case because imposed solutions are mostly seen as threatening and players in the system game them to maximize their own survival; such maneuvers are generally defensive and they don’t work to help the system improve.
Finding ways to change our system’s environment in non-threatening ways is what Common Sense Medicine® is all about.