Healthcare and the Case for Street Corners

John Backman Last month, noted surgeon and author Atul Gawande visited our region to discuss the future of healthcare. What I heard him talking about was the need to share—and hear—street corners.

Gawande, the author of The Checklist Manifesto, was in town to present the keynote for “Health Care in the 21st Century: A Community Call to Action,” sponsored by The University at Albany School of Public Health and The University at Albany Foundation. For about 45 minutes, he spoke of the sea changes in public health over the past 80 years, the extraordinary leaps forward in the care of wounded soldiers, and, especially, the value of systems.

Perhaps his most startling comment, however, concerned the use of penicillin early in the 20th century. Even as the “wonder drug” delivered tremendous benefit, Gawande noted, it also led to an overreliance on medication as a treatment model. Now, amid the advent of antibiotic-resistant strains of bacteria, the focus is shifting to a systems approach. Where healthcare is most like a system, Gawande said, is where it’s most likely to succeed.

And what does this system consist of? In part, it features groups of people delivering great results together. “We are now all specialists,” Gawande said. “We each have only a piece of healthcare.”

Or, to put it in KJCG language, each healthcare professional sees healthcare from a particular “street corner” or perspective. Bring them together, and you get closer to a 360-degree vision of the issue at hand. This applies to understanding individual patient cases as well as the field itself.

It is a textbook example of the need for one of our 12 Inclusive Behaviors: asking who else needs to be involved to understand the whole situation. Providing the extraordinarily complex care in today’s healthcare requires bringing together all relevant people, from physicians to nurses to administrators to public health experts and others, all sharing their street corners.

Yet this runs counter to the way healthcare has evolved: as a model that revolves around the autonomous, all-powerful physician. Or as Gawande put it, “We’ve trained people to be cowboys, when it’s a pit crew we need.”

If anything, today’s healthcare requires even more people contributing their street corners than ever, because a 360-degree vision encompasses more factors than ever before. After decades in which the mortality rate for war-wounded soldiers stayed the same, the U.S. Army tried new medical advances to lower the rate further, but without success.  What did prove successful were several initiatives outside the traditional bounds of medicine: mandating the wearing of Kevlar, for instance, and establishing mobile hospitals nearer the front to provide care faster.

Solutions like these might come from a team of physicians. More likely, they would come from a larger cohort of people who saw things from many different street corners.

At KJCG, we bring this message into organizations continually: The world is far too complex for a single group of people, with a single perspective, to even understand what is happening, let alone arrive at solutions. Organizations will only be successful if they hear from all relevant street corners in every situation. We find it encouraging that a thought leader like Atul Gawande would put the same approach to work on one of the most bafflingly complex systems of all: healthcare.