A Timex Healthcare System

Those of us of a certain age remember the Timex slogan that bragged about its watches’ durability: “It takes a licking and keeps on ticking.”  A recent article about our military, of all things, made me wish we had a healthcare system that prized that kind of durability. 

Credit: Zazzle

I can never resist analogies between the U.S. healthcare system and the U.S. military system.  They’re both huge, they’re both wildly expensive, they both rely on a combination of high tech and front-line people, and they both protect us from threats.  In some ways, both are the best in the world, and, in other ways, both have weaknesses that are embarrassing. And, as I wrote last year, both are often still fighting the wrong wars. 

The article is by national security expert JC Herz on the Atlantic Council’s website: A plea to the Pentagon: Don’t sacrifice resilience on the altar of innovation.   Boy, that sure applies to healthcare too. 

Innovation versus resilience. Credit: Stanford Social Innovation Review

Ms. Herz notes how Americans love innovation, but:

This mythos informs a narrative that what is valuable is The New—the upgrade to something bigger, badder, and sexier…What the United States needs to reinvigorate its defense base, compete with China, and win the global economy must be more innovation.

Except the United States does not suffer from a lack of innovation; it suffers from a lack of resilience.

That deserves some thought, especially to a healthcare system that has been shaken to its core by the recent pandemic, and that may never quite be the same again. 

According to a recent Washington Post-Kaiser Family Foundation poll, three-in-ten healthcare workers have weighed leaving the profession; more than half are burned out.  That doesn’t even count the ones whose practices didn’t survive last year’s turmoil.   One physician told them: “You look at staffing, preparedness, what the priorities were for many hospitals during the crisis, and it’s clear the industry is driven by profits rather than well-being of patients or health workers.  It makes you question the whole system.” 

I’d call that a lack of resilience.

You may have read about last weekend’s cyberattack on Colonial Pipeline, one of the nation’s largest fuel pipelines.  Or about the nefarious SolarWinds hack, which went undetected for months and whose breadth, depth, and ultimate impact remain unknown.  Or about any number of ransomware or other cyberattacks on healthcare targets.  Ms. Herz has thoughts that apply to them:

All the defense, critical infrastructure, and commercial systems that have been compromised in the last ten years—and that are still being compromised, surveilled, ransomed, and taken offline—are not easy targets due to lack of innovation. They are vulnerable because they are brittle and unmaintained, and thus not resilient. Military systems and infrastructure, financial institutions, energy grids, healthcare providers, and public safety capabilities—the systems that keep modern society from descending into chaos—are fragile because they are not built to recover from attack.  

It doesn’t have to be “bad actors” that take systems down, and it doesn’t have to be IT systems.  Natural disasters test resilience too.  Hurricane Katrina is widely thought to have spurred awareness of the importance of EHRs, but the February Texas power grid outage still heavily impacted healthcare organizations – even if they had power for those EHRs, they might not have had clean water.  And how many healthcare organizations are truly ready for an earthquake? 

Ms. Herz preaches:

Resilience is what allows systems to take a hit and keep going. Resilient systems are well-maintained, fixed before they break with predictive maintenance, and progressively strengthened at weak points. They have the spare parts needed to keep flying or driving. They are continuously tested and red-teamed as part of a culture in which finding cracks is a badge of honor, not a threat to the organization.

She urges: “System owners in the public and private sectors need to think about building fast-healing, adaptable, durable systems, especially the “boring” ones that people only tend to notice when they break.”

Any of that sound like healthcare to you? 

Our healthcare system suffered widespread shortages of PPE and other vital supplies and equipment, as supply chains were radically disrupted.  Primary care practices floundered as people avoided office visits.  We’re still not using primary care practices appropriately to help combat vaccine hesitancy.  We weren’t prepared for the flood of vaccine misinformation – some organically generated, some maliciously.   

How many of those issues have been fixed?  We may not know until the next crisis.

Meanwhile, investments in digital health are soaring (come on, did you really know what a SPAC was at the start of the pandemic?).  Innovation is sexy; innovation is the future; innovation is what gets you funded.  But, as Ms. Herz says about military spending:

Stellar maintenance and logistics do not get people promoted, and thus are not prioritized among program managers who are more focused on delivering novel, “sexy” capabilities…There is a naïve faith that someone more conscientious and less charismatic, perhaps, will go back and redesign the technology, processes, and procedures to make the sizzle into steak. Except it doesn’t happen, because by the time a qualified systems engineer views the horror show of taped-together, unmaintainable code, it’s too complex to fix and too politically enshrined to critique.

How many of those healthcare SPACs are aimed at “hardening” our healthcare systems and processes?  How many are prioritizing “stellar maintenance and logistics”?  Yeah, I thought not. 

Our healthcare system was once more like a Timex watch: nothing too fancy, but durable.  Over time, it’s changed in the way that the watch business has left Timex behind – more focus on new features, new technologies, more functions – and, of course, more expensive.  Whether those watches – or the changes in our healthcare system -- are really necessary, or how long they’ll survive the punishment we’ll put them to, are not questions we ask enough.

Ms. Herz warns the Pentagon: “Defense acquisitions should be less like the Macy’s Thanksgiving Day Parade and more like NASCAR, where tire-changing speed and pit-crew coordination are recognized as key performance metrics.”  The same should apply to healthcare: less splash, less flash, more emphasis on ensuring it delivers, under all conditions.   

Innovation is necessary, new technologies are exciting, but let’s not forget the importance of simply being able to take a licking and keep on ticking.  Especially in healthcare.