Unintended Consequences in Healthcare


I was honored to be invited as a speaker and panel discussant at yesterday’s Behavioral Sciences Institute Annual Conference on ‘Unintended Consequences’. The gist of my presentation and ensuing discussion are as below:

  1. Health is a complex adaptive system and the complexity, inter-relations and externalities which drive unintended consequences are beyond complete human appreciation and understanding
  2. We are also living in a VUCA (Volatile, Uncertain, Complex, Ambiguous) world and especially in health with the longevity dividend and chronic disease epidemic, these are unprecedented times with no good models to simply copy from
  3. This necessitates lots of humility and a healthy dose of what Deng Xiaoping describes as ‘crossing the river by feeling the stones’. Western readers might be more familiar with the ‘MacGyver mindset’.
  4. In the policy context, while somewhat ironic, there is much to learn from the movie character Rocky Balboa who famously said “You, me, or nobody is gonna hit as hard as life. But it ain’t about how hard you hit. It’s about how hard you can get hit and keep moving forward; how much you can take and keep moving forward. That’s how winning is done!”
  5. Hence, ideal policy makers are resilient. They are people who have been hit, and have the strength to pick themselves up, have the tenacity to keep moving ahead, and the humility to learn. The ideal policy making stance would be thus less about getting it right but not getting it irreversibly wrong, and having the “system flex” to course correct. As Jack Welch famously advised to “pick a general direction and you implement like hell”, so it is with policy making: ensure the broad direction is correct, based on sound fundamentals and have a starting position which is as good as it can be, and importantly one from which policy makers can tack as needed when reality reveals itself
  6. Two examples we discussed in the Singapore context were: Health insurance and managed care, focusing on the recent guidance by the Singapore Medical Council on fee splitting, and Medical manpower planning, focusing on the dramatic policy changes over the years affecting foreign-trained doctors and the number of medical school seats in Singapore.

Two thoughts of the wider application:

1. How should healthcare companies think about ‘Business Analytics and Intelligence’ in this VUCA world and anticipating and preparing for the inevitable ‘unintended consequences’? What sort of structures and processes would be needed to be in place to mitigate risks and seize opportunities? How do we align the BAI functions with the business units and line managers?

2. Beyond structure and process, what personalities and profiles of healthcare executives should we be actively looking for to fill key roles in our organizations? What’s the balance of short-term and long-term thinking we need in our team?

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