We need a radical change in the way health care is delivered

Many of you are familiar with the famous “invisible gorilla” experiment, wherein an audience, being instructed to watch closely for the number of passes made with a basketball, fails to  see a rather large and deliberate gorilla march slowly across the screen, stop in mid  picture and thump its chest.

In fact over 1/2 of those tested failed to notice this obvious action.  The predominant response is one of suspicion and denial—”you showed a different video.”  It is all part of an eloquent piece of work that raises several issues regarding “illusions” predominant in human behavior.

In a remarkable and somewhat disturbing book, The Invisible Gorilla, Christopher Charbis and his co-authors address the six illusions of human intuition, which should cause us to reflect and consider the confidence and commitment we have in regard to our senses.  It’s an entertaining sojourn providing multiple enlightening and often frightening examples of how these six illusions have unintended consequences.  As in many of my other posts, this understanding of the foibles of human behavior creates many concerns about the assumptions we’ve made in the past.   In fact, I hope I’m never in a position where an eyewitness account of my behavior is taken as “gospel truth” in a serious situation.

That being said, I was pondering if any of these six illusions (as opposed to the seven deadly sins) might raise additional concern regarding the evolving work in health care reform, specifically surrounding the high level of energy around the patient-centered medical home/health care home which is spreading  across the country.

Now I’m not a naysayer, and in fact am firmly in the camp of those feeling we need a radical change in the way our  health care system is structured and health care delivered.  I’m just struck after reading this book that there are perhaps examples of the issues raised by the authors in some of the thinking and planning presently underway.

First, the six illusions–attention, knowledge, confidence, cause, memory, and potential.  The book spends a great deal of time, and quite convincingly, making the case that our  “intuition” about our behaviors in all of these areas is not consistent with our true capabilities and leads us into some dangerous and dark corners.  Shackled with the challenge of being a human and the associated behaviors of our species, we exhibit some or all of the illusions mentioned in our behaviors.

Hence the invisible gorilla identifies that our  “attention” is often focused, and limits our ability to see or sense the unexpected.  Multiple studies have demonstrated that we notice what we’re looking for or what we expect to see.   Our “attention” is actually limited and often misses issues which are obvious to others–but which we’re convinced we were considering.

Is it possible that while well motivated, we may be missing details regarding essential attributes of our work in medical home–that there may be an “invisible gorilla” which needs to be seen?  We’re attending to the details we think are important, and I’ve no doubt they are.  But what about the things we’re not attending to?  I’m not certain I can even list them well, because then they wouldn’t be “invisible.”

Are we fully using asynchronous technology—smart phones, iPads, social media—in creating our models?  Are we cognizant of the diverse cultural differences, both ethnic and generational, which need to be addressed?  As the population ages, do our “homes” come with assisted living where necessary? Have we begun to address the persistent duality of mental health/physical health which permeates our system, and perpetuates approaches which would preclude many from taking up “residence” in that proposed home?

It’s my nature to be reflective, and to rarely see things as black or white or absolute truths, but understanding the insidious and pervasive nature of this one illusion–attention–I often wonder what will surprise me soon as something which should have been considered but wasn’t.

And that’s only one illusion–consider the others.  The illusion of knowledge–thinking we know all we need to know–and that of confidence–we’ve got the answer–are often voiced by proponents.  They speak with some certainty about moving the medical home efforts forward.  From what I’ve read, it’s perhaps natural that I feel an urge at times to run the other way—my inherent fear of invisible gorillas I guess.

What’s frightening to me is that this is only touching a few of the illusions.  But even these should make us step back and take the time to consider if this exciting and potentially transformational approach is already inhabited by what might be a danger to it’s long-term success–that “invisible gorilla” which we all miss in one way or another.

For this reason, among many, the need to collaborate and engage others is paramount  Creating an environment where we can share ideas, challenge concepts and approaches, engage in spirited discussion that promotes disagreement is key.  Only then can we be better positioned to appreciate that big hairy animal standing amongst us that alone we’ll not notice.

Gary Oftedahl is Chief Knowledge Officer of the Institute for Clinical Systems Improvement.

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