HealthCare ReformAnd the Bicycle

A two wheeler metaphor regarding the essential need for both clinical excellence and administrative sophistication for successful future

healthcare

Wells Shoemaker MDJanuary, 2016

A Bicycle is Not a Stable Vehicle

Unless:

• Both wheels work

• It’s constantly moving forward

Need Both Wheels

• Let’s say one wheel has a titanium alloy rim with aero-bladed spokes, slick bearings, & brand new rubber…

• And the other is flat, bent, or corroded…

That bike is going nowhere.

A successful healthcare systemalso needs two good wheels

1. One is sharp administration…visionary leadership, intelligently designed processes, regulatory precision, keen financial strategy, hunger for efficiency, respect for community

2. The other is clinical system redesign…go beyond the erratic performance of the past to consistent, reliable, effective services to all. That means both coordinated care and accountability, threaded with a hunger for improvement, laced with patient responsiveness

Both “Wheels” Need to Run True…Simultaneously

Reforming systems cannot place hierarchical priorities on one or the other. They need to run in tandem

• A one wheeled bike is just rusting yard art

• A healthcare system with one slick wheel and one clunker will operate at the speed of the clunker

An added thought for HIT

• Torturing this metaphor, HIT is really the chain that allows energy from the driver to be transformed to intentional, directed forward motion, synchronizing both wheels. It needs to be well engineered and well lubricated. It needs to permit gears to shift smoothly when demands change for torque versus velocity, and it needs to consume relatively little energy for its own maintenance.