As I suggested in my blog post The Animosity Towards BigX, although I am skeptical towards BigHealth, I don’t hate them—partly because big problems of the world, such as CoVid will need big institutions to help deal with it.
However, I do think it’s important to recognize why BigHealth seems to have so many problems.
And what do I think the key reason is?
Size.
Specifically I believe it’s the large number of employees, which leads to increased complexity and therefore the increased likelihood of having more challenges.
(This may seem so obvious it doesn’t even need to be mentioned, but we do tend to anthropomorphize large institutions and corporations, so it is important to keep front of mind that large entities aren’t an “is”, they are an “are”.
For example, let’s consider small size first. Consider my French Bakery down the street. It’s privately owned (yes, by an actual French baker!) and employs perhaps about 20 people. This owner is an expert in the product and can ensure quality control of everything that the bakery produces. He also hires each employee individually, knows all of their names, and observes them directly—so it’s unlikely a “bad apple” is going to last to long. Simply put, the small size of the organization allows for relatively simple interactions and management feedback loops.
Now let’s consider a BigHealth institution that is affiliated with 50,000 physicians not including their their administrative and clinical support. Unlike the French Bakery (or the small, self-owned medical practices of yesteryear, which seem to be headed towards extinction) the number of interactions and feedback loops will be exponentially greater, guaranteeing “bad apples”, dysfunctional people interactions, and periodically broken management feedback loops.
Effectively the larger the size of an organization, the more the complexity, and therefore the more likelihood of periodic breakdowns.
Heck, I will even go a step further. I think when an organization reaches a critical mass of people (5,000? 50,000?) then there will necessarily be periodic significant dysfunction independent of the quality or intentions of the employees or leadership.
So, as I said before, I will continue to be skeptical of BigHealth, but if I want big problems in healthcare solved, I am going to expect (if not fully accept) that the cost of this will be BigHealth’s inevitable mistakes.