Evolutionary design in health care

When attending healthcare events with politicians and occasionally with senior healthcare leaders an audience member will ask “do you think X government change or Y hospital practice works”? Then immediately follows up with “what you do we should do instead?” This is the exact moment I start to get nervous.

Asking a single individual to simply explain and fix a systemic issue is tricky. It immediately assumes that they have either the knowledge and/or the power to fix it.  I think asking anyone to stand up and give an absolute unquestionably correct answer for fixing and solving issues in healthcare is wrong.

To expand on the issue I’d suggest you watch Tim Harford’s TEDtalk “Trial, error and the God complex”.

To be fair to the public, yes I think our politicians need to be educated and well informed in their scope of work. To be fair to politicians, no individual can be expected to choose the single correct answer that will fix all the complex issues in healthcare.

We need to accept that complex problems require complex solutions. Even if we may have a sense of what the answer may look like, it will not be perfect in its first iterations. A specific example of this is the Local Health Integrated Networks (LHINs), which healthydebate.ca wrote about in June.  LHINS are just one example where a single answer was implemented, and we hope it is the correct answer.

Instead what we need is an evolutionary approach. One that tries a number of solutions, compares the results, selects the best one and then tries variations of that to continue to look for improvements.

Rather than trying to ask the current or a potential future government to provide the correct answer, we need to ask our healthcare decision makers to pursue, implement and test the best potential solutions, and then to continue to improve them. Hopefully one day, audiences will ask about what the best ideas are on meeting the needs of an aging society and the answer will expand on the various approaches being tested.

The comments section is closed.

1 Comment
  • Dmitri says:

    Its important to resist using the evolution metaphor too literally. In biological evolution, variation (read, mutation) is essentially random and it is the resulting randomly generated diversity that is trimmed through the gauntlet of selection pressures into a surviving generation. Evolution is thus essentially blind. Perhaps a more fitting metaphor would be artificial (rather than natural) selection – as with the evolution of out domesticated animals, with health care we know, or we should now, what we want, and we can, or at least we should strive to, control the the selection pressures. And, of course, it is here where the challenges begin – what is it that we want out of our health care system? This is not as simple as more health, or better care – these are all but meaningless due to their ambiguity. Further, what are we willing to do to create the necessary selection pressures and, indeed, what would these look like?


Rob Fraser


Republish this article

Republish this article on your website under the creative commons licence.

Learn more