Systems Thinking

I recently read an article titled “Cowboys and Pit Crews” by one of my favorite writers, Atul Gawande.  I was turned on to Gawande’s writing, specifically the books Better and Complications by son Derek.  He is in his fourth year of medical school and apparently they assign some of his writing to the students.  Gawande writes insightfully particularly around policy and process issues in medicine with the objective of improving the overall system – training, practice, etc.

The main point of the article is that medicine has evolved from a field where individual doctors “could hold all the key information patients needed in their heads and manage everything required themselves” to one where clearly that’s not possible.  Anyone who has experienced even something as common as a torn ACL can think about the number of people who take care of them from internist, radiologist and orthopedic surgeons to the MRI tech, nurses and physical therapists – easily more than a dozen.

Success then results as much (or more) from the system working properly as from the individual e.g. the surgeon performing well.  The places that have the best results for, say cataract surgery or ACL replacement are well run systems that, of course, have competent surgeon members. Having grown up in a family of physicians (both parents, 2 siblings, many cousins etc.) suddenly what they do seemed to more and more like what I and members of my team here at SugarSync do.

In managing a system, the first thing you need to do is know your goals and measurement criteria then set up measurement systems to know if you are meeting those goals.  Our VP of Engineering Brock LaPorte popped into my head as I thought about systems engineering as this is his primary mode of operation.  Sure – he can solve individual technical problems but his main contribution is making sure the systems – hardware, software and people, function well.    That always starts with instrumentation – without that data you can’t improve the system.    This is part of the engineering discipline both academically and in practice.  As I’ve chatted with my two sons in medical school – this is notably absent in their training.  It might be part of advanced degree programs in public health but not medicine itself.

Any experienced, successful manager of a major internet service builds in instrumentation capabilities from the start.  They needn’t be expensive – at SugarSync most of our measurement tools are open source – built and contributed over the years by practitioners.    As much as possible is captured in the logs – even data that may not be analyzed at the time – for future use.  With the digitization of health care records – more data should be available for measurement and analysis to allow us to have better functioning systems.  Hopefully medical educators will include these key skills into the training.  I believe there is an opportunity for more cross-pollination with industries such as internet services that do this well.  The stakes are high both in terms of health and dollars.