Why is our Government always firefighting and infrastructure inadequate when it comes to dealing with healthcare challenges? (Learnings from the second law of thermodynamics)

The second law of thermodynamics states that, on their own, systems naturally become increasingly disordered. To prevent entropy/ disorder requires energy, that is, work. To reverse disorder, to create and maintain order, requires the continuous application of even more energy (effort, money, time, etc.). What one learns from entropy or the second law of thermodynamics is that our healthcare systems would naturally become increasingly disordered with time and lack of energy (our governments and systems are always firefighting, energies are consumed in something totally mundane to at times silly, or what can be seen through this pandemic they lack the necessary plans and hence the knee-jerk reactions in dealing with adverse situations).

Though India is a land of miracles, better healthcare or an integrated one does not magically appear or evolve naturally but requires a fundamental transformation of our care delivery approach and mechanisms: a shift in focus from acute, hospital-based care to early identification and prevention, population management, community, and home-based care; much stronger participation of citizens in their own care process, and participation of healthcare professionals, but most importantly what central and state governments should be looking at are totally new approaches and methods to deal with mega-scale systemic challenges that we face today or may face in the future.

If this remains the approach to deal with healthcare challenges then these entropies or disorders will keep increasing with time and we may face challenges that are beyond our comprehension. New governance models, advanced warning systems, deep insights, agile integrated planning, and deployment methods backed by robust and customised healthcare technologies are the way forward.

Tightly integrated models between payers, providers, and consumers of care that incentivise co-delivery of care and results (including performance-based payment models), supported by innovative technologies are the ways we can go beyond the problem and design newer systems. There is a tendency to think that we can overcome the entropy in our healthcare systems just by building or buying technology solutions. This is why I highlighted, “supported by innovative technologies.” We can’t fundamentally transform healthcare without innovative health IT. But we can’t lead with it either.

There is an urgent need to look at the entire situation from thirty-five thousand feet with fresh eyes. We need robust systems design approach and design thinking at every level to, identify intervention points for a totally new blueprint and then redesign all the system components.

Albert Einstein once said we can’t solve our problems with the same thinking we used when we created them.
We need a paradigm shift!

(This Perspective was originally published on April 22, 2021 by Shekhar Badve on LinkedIn)