More and more over the past 5 months I have been answering the question of why I wrote this book – I guess this is a natural part of sharing my work. And each time I am asked the answer becomes more and more refined. Here is the background story I tell in the book:
More and more over the past 5 months I have been answering the question of why I wrote this book – I guess this is a natural part of sharing my work. And each time I am asked the answer becomes more and more refined. Here is the background story I tell in the book:
“With each symptom, injury, or illness you expect that the pieces of the healthcare system will come together immediately, seamlessly to ensure that you receive the optimal care you need. But the healthcare system is an amazingly complex orchestration of people, systems, and information that lies concealed from what you see as you walk into the physician’s office or the hospital. And rarely does it respond immediately or seamlessly to provide anything close to care that is optimal.
I will accept that this may not be the most promising way to begin a book on healthcare, but this is the reality. Throughout the vast majority of healthcare institutions in this country healthcare is provided through a patchwork of variably skilled teams and largely uncoordinated processes. Making matters worse, the challenges with our healthcare system seem to be getting worse, not better.
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So I fret each day over what will happen the next time my father’s cardiac condition worsens or as my mother-in-law, my extended family, or my close friends get older. What is the likelihood that they will have access to the care they need? This question keeps me up at night. And perhaps you have the same concern for your health or that of your family and friends. If nothing else, perhaps it helps to know that I am just as worried as you about how the healthcare system will respond to the needs of my friends and family. And maybe the fact that I am sharing my fears and concerns will bring you some comfort and reassurance that you are not alone. Maybe the fact that I am sharing my ideas and vision for a future healthcare system that effectively cares for your health will provide you some understanding and knowledge to leverage within the current system when you or a family member are in need.
The ultimate goal of this book is to begin a dialog about the need for dialog and to begin to share evidence about the need for sharing evidence. Realistically, not every element of the healthcare system can be fixed overnight, but by opening up to one another, by building a collective story and history about what works and why, and by becoming engaged in a community of like-minded patients, physicians, or even scientists, we can all move the healthcare system forward ― and perhaps together we can get it to the place it needs to be by the time we next need it.
This book offers what some have called ‘a Goldilocks solution’ for healthcare ― your healthcare. For years the solutions for the emerging healthcare crises have been focused on two fronts: broad policy or individual empowerment. But the truth is policy debates will not be resolved in short order ― they can’t be, democracies are not built for revolutions like the one we need in healthcare; this approach is too big. On the other hand, individual empowerment will never have the impact that is needed ― it can’t, as we will soon learn behavior change is difficult and it is inconceivable that 300 million Americans can be separately enticed to sustainably make better choices; this approach is too small.
Instead, I will provide a roadmap to overcoming our healthcare quality crises by leveraging communities and collective intelligence. And only when we have built systems to support sharing across these networks and we have adopted new skills to leverage collaborative models will we see real, meaningful improvement.
This book is not about technology, though technology plays an important role. This is a story about the way information flows, the forces that restrict information flow (either intentionally or unintentionally), the systems that can be built to optimize information flow, and the skills we would all need in order to make use of this new data stream.
So what is SOCIALQI (pronounced “social Q I”)?
It is a model for healthcare empowerment and improvement that leverages the new and emerging science of social networks and the countless lessons provided by behavioral scientists to create a simple roadmap for change.
SOCIALQI is a belief that:
• Patients need other patients, physicians need other physicians, and scientists need other scientists.
• To maximize wellness and healthcare quality, we must have a system architecture that simplifies social engagement and collaboration.
• As the system architecture is built we must support the end-users (patients, physicians, and scientists) such that they can effectively leverage the system.
• As new collaborative healthcare models emerge they cannot be left to chance ― we need broad, intelligent engineering to accelerate change”
As these systems evolve the very definition of being a patient, being a physician, and being a biomedical scientist will evolve. In some way we cannot stop it ― it is that natural of an evolution. What seems avant-garde and innovative today will be the basic expectation tomorrow and this is my greatest hope. The intelligent pursuit of collaborative models of innovation and empowerment through networks and communities will fundamentally change the healthcare system in the United States, and perhaps the lessons in this book support that transformation. When the dust settles, you can find that special kind of comfort that comes from knowing that your family and friends will have access to the best care in the world, no matter where they work and live.”
As I wrote the book I was struck by not only how broken and fragmented the current system is – this is addressed through the first half of the book – but also by how many great examples there are of collaborative models of information flow, learning, and healthcare improvement – these are presented through the second half of the book. To be frank, there remains a tremendous gap between ‘what is’ and ‘what could be.’
So how do we cross this gap? This is what I present as my simple solutions. By accepting the existing systems failures and my embracing the identifiable ‘silver linings’ we will begin to see the world in a new way. First, we must work to evolve the systems infrastructure supporting collaboration and rapid learning. Though the perfect system has not yet arrived, there are elements that we can learn from that will be crucial to the success of this roadmap:
“…building broad, sustainable, collaborative models of information flow, learning, and healthcare improvement requires new systems-based solutions to be engineered. And, … there are six fundamental elements that must be woven into the fabric of successful system solutions: systems must be integrated, open and connected, social, controlled, incentivized, and able to leverage a culture of improvement. The very good news is that that in 2012 we are not starting from scratch. Our challenge is to move from this collection of fundamental elements, to learn from the best practices shared in the subsequent chapters, and then to begin to develop increasingly advanced and logical pilot programs that address the frightening variation in care, outcomes, and costs that undermine our healthcare quality.”
Second, we must acknowledge that in order for the end users (patients, clinicians, scientists) to leverage these emerging systems that they too have some work to do:
“[We] must be able to establish credibility and reputation; filter, curate, and search within these new knowledge streams; provide and receive feedback and criticism; accurately assess their own “topic” literacy; and critically think through their high-stakes decisions… These skills are as important in healthcare as they are in business or any realm where new online communities are evolving. In short time there will be new standards set to support these new skills. Moreover, the engineers of these new systems are becoming increasingly aware of the need to provide support to new community members to help them more effectively participate and contribute in meaningful ways. The message again is that, as individual users, these skills are important, but thankfully we are no longer going to be isolated in our efforts.”
The story ends with a clear vision of what we could achieve by embracing the lessons shared throughout:
“When we move information more efficiently to all of the stakeholders in healthcare ― to patients, to physicians, and to scientists ― and when end-users are empowered to learn and share more effectively, then the lessons learned once could be learned permanently. And in short time all of our patients would be strong, all of our research would be groundbreaking, and all of our healthcare systems would be above average…”
My ultimate goal is that by simplifying this story, by simplifying the needs, and by simplifying the solutions, we may all move forward with a common understanding of the challenges that lie ahead. This transformation will not be easy, but the stark reality is that if we want to partake and support the best healthcare system in the world, then we have no other choice.
