Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Accelerating Adaptation in Healthcare


Efficiency erodes our ability to respond to the uncertainty of life. The messy world of clinical care requires time, patience, and creative experimentation.

Media executive and author Dr. Margaret Heffernen gave a TED Talk in July of 2019 titled, “The Human Skills we Need in an Unpredictable World.” In it, she explains the downside of efficiency. While efficiency and technology can be effective at streamlining processes and increasing production, it’s limited as a strategy for managing the complex problems of today. Efficiency erodes our ability to adapt and respond to the uneradicable uncertainty of life. The global COVID-19 pandemic is a good example of this.



Experimentation is critical

Healthcare has focused on efficiency with an emphasis on hospital throughput, minimized wait times, and length of stay dashboards. While these are reasonable as stand alone goals, Heffernen urges us to adopt a mindset of experimentation to accelerate learning how to do things better.



One of Heffernan’s examples is that of Jos deBlok in the Netherlands, who experimented with how homecare nurses are managed. Instead of the efficiency model of scheduling them to the minute, nurses managed their own time and appointments. The results of this individualized approach led to patients getting better in half the time with a 30% reduction in costs.



Adaptation in response to change

Despite the gains in efficiency that technology offers, the world needs people that have the capacity to adapt, invent, and flex in response to whatever comes next. These human, messy, time-consuming skills are essential to learning new things and managing constant change. As attributed to the Greek philosopher, Heraclitus:



“The only constant in life is change itself.”



In response to the pandemic, overnight, healthcare professionals transitioned to remote healthcare models using telephones, video visits, and asynchronous coordination of care. As described in Thomas Lee’s NEJM Catalyst article, the experimentation with telehealth may be creating a new normal—perhaps mitigating provider burnout, allowing clinicians to be creative, and in some cases improving the care of patients. The crisis has also fostered a strong sense of solidarity and purpose, possibly even starting to resurrect the public trust in medicine. Thus, a silver lining of the global COVID-19 pandemic is accelerated learning about new models of giving care through imaginative experimentation.