The defining behavior of an organization or organism is that it will resist change that is perceived to threaten its existence. Few organizations (or organisms for that matter) fail to do so, or ever consider cases beyond which the need for their existence ceases to be present. This is also true of work groups, committees, and organizations, even those built to address temporary situations, unless there's some very specific hayflick limit assigned to them during their creation (and even that isn't always sufficient).
So very often as change agents, we fail to take this into account when we envision change. For example, this recent post from Z-Dogg MD on Medicare for All talks about the hidden consequences of Medicare for All. I can't fault Z-Dogg's logic here, but what I do fault is the fundamental assumption that "other things remain the same". Yes, if Medicare for All were to become a thing, the existence of hospitals, and medicine as a profession would certainly be threatened.
But here's the catch. Hospitals are organizations, and medical professionals are organisms. There's an appropriate meme for this:
And the challenge for many is that we won't actually understand how, or in what way the organisations and organisms threatened by these changes will adapt to the change. But adapt they will.
One thing routinely taught in both User Experience and Informatics classes is an awareness of unintended consequences. With any big change, there will be consequences. In a complex system, some of those consequences are certainly going to be undesirable to those organisms or organizations whose existence is perceived to be threatened by that change. But simple logic that assumes that the system isn't going to adapt to the change is isn't going to cut it. Yet few will think beyond it.
In the case of Medicare for All, I can honestly say that I haven't a clue what will happen, but if hospitals are threatened, they will actively seek out ways to remain profitable. And physicians who are accustomed to a certain level of income may in fact leave medicine, but they will eventually be replaced by others who never know that the same level of compensation (see this summary). Other impacts might be to pressure institutions that train physicians to do so in a way that doesn't leave them with crippling debt. We know this will happen because a hole in the ecosystem ... or the economy won't be left vacant for long.
So very often as change agents, we fail to take this into account when we envision change. For example, this recent post from Z-Dogg MD on Medicare for All talks about the hidden consequences of Medicare for All. I can't fault Z-Dogg's logic here, but what I do fault is the fundamental assumption that "other things remain the same". Yes, if Medicare for All were to become a thing, the existence of hospitals, and medicine as a profession would certainly be threatened.
But here's the catch. Hospitals are organizations, and medical professionals are organisms. There's an appropriate meme for this:
And the challenge for many is that we won't actually understand how, or in what way the organisations and organisms threatened by these changes will adapt to the change. But adapt they will.
One thing routinely taught in both User Experience and Informatics classes is an awareness of unintended consequences. With any big change, there will be consequences. In a complex system, some of those consequences are certainly going to be undesirable to those organisms or organizations whose existence is perceived to be threatened by that change. But simple logic that assumes that the system isn't going to adapt to the change is isn't going to cut it. Yet few will think beyond it.
In the case of Medicare for All, I can honestly say that I haven't a clue what will happen, but if hospitals are threatened, they will actively seek out ways to remain profitable. And physicians who are accustomed to a certain level of income may in fact leave medicine, but they will eventually be replaced by others who never know that the same level of compensation (see this summary). Other impacts might be to pressure institutions that train physicians to do so in a way that doesn't leave them with crippling debt. We know this will happen because a hole in the ecosystem ... or the economy won't be left vacant for long.
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