THE BLOG
07/20/2008 01:43 pm ET | Updated May 25, 2011

A Plague of Systems Stinkers

We all need to be systems thinkers. Many are, but not the bureaucrats and regulators in Washington and State capitals. You may call them systems Stinkers.

Systems Stinkers think in straight lines. They see a problem; reason their way to an answer without evidence that it will work; and implement their so-called solution. Then they are done, or so they think. Their straight-line thinking usually produces "fixes that fail," and we pay for their failures.

Systems stinkers
do not follow-up on their decisions. They order, someone implements, we pay, and they walk away. They do not consider unintended outcomes. There is no feedback to them, certainly none with effect. If you or I make a bad decision, we get the feedback ("request for payment") and we have to pay the bill. Systems Stinkers do not. The original space shuttle cost more than 380% over budget. The cost of Medicare was 800% over what was planned. Who paid and is still paying?

Systems thinkers see loops rather than straight lines. They understand that their actions can come back and bite them in the rear. They develop evidence LINK: thesystemmd.com/?p=18] before they act. Their systems have feedback built in. They consider unintended consequences and plan for them.

Nice theory you say but what does it mean in the real world of healthcare? UMRA and HIPAA are two so-called solutions created by our friendly systems Stinkers.

UMRA (Unfunded Mandates Reform Act of 1998) was Congress' solution to the problem of medical care that they required [mandated] for which they allocated no money. It was like passing a law requiring gas stations to fill you up with no one paying. How long could gas stations stay in business? UMRA was a fix that failed. There is still no money for mandated care and no consequence to Congress for ignoring their own rules. Systems Stinking in the real world.

HIPAA the hippo is new low. Originally intended to protect us from losing our health insurance, HIPAA is now supposed to secure our medical privacy, but doesn't. It costs hundreds of millions of dollars, and the only thing it produces is medical errors. The systems Stinkers' so-called solution made things worse.

Systems thinking has loops not lines; evidence before action; plans for various contingencies; and proper feedback. Systems thinking would have fixed unfunded mandates as well as insurance portability, in contrast to UMRA and HIPAA.

Systems Stinkers need to become systems thinkers.
Otherwise, we will all drown in red ink and dead bodies.