Thoughts from Ken Kaufman

Healthcare’s Wicked Problems

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One of the great things about my job is getting the opportunity to talk with healthcare CEOs around the country on a regular basis.

Lately, every CEO I talk with tells me how hard it is to run a healthcare organization in 2023.

These are people with long experience, people who over time have pushed the right buttons and pulled the right levers to make their organizations successful and to give their communities the care they need.

Hearing these recent comments from CEOs takes us back to the concept of “wicked problems,” which we’ve referred to in the past, and suggests that the current hospital operating environment is overwhelmed by wicked problems.

As a reminder, the wicked problem concept was developed in 1973 by social scientists Horst Rittel and Melvin Webber.

Unlike math problems, wicked problems have no single, correct solution. In fact, a solution that improves one aspect of a wicked problem usually makes another aspect of the problem worse.

Poverty is a common example of a wicked problem.

According to Rittel and Webber, all wicked problems have these five characteristics:

  1. They are hard to define.
  2. It’s hard to know when they are solved.
  3. Potential solutions are not right or wrong, only better or worse.
  4. There is no end to the number of solutions or approaches to a wicked problem.
  5. There is no way to test the solution to a wicked problem—once implemented, solutions are not easily reversable, and those solutions affect many people in profound ways.

Healthcare is one of our nation’s critical wicked problems, and the broad and persistent effects of COVID have made that problem worse.

Like all wicked problems, the wicked problem of healthcare can be defined in many different ways and from many different perspectives.

If we were to frame the wicked problem of healthcare just in the context of hospitals and health systems coming off of their worst financial year in memory, it could look something like this:

Hospitals and health systems need to make a margin in order to carry out their “duty of care”—that is, their responsibility to improve health for communities, which increasingly include public health undertakings.

However, in 2022, more than half of hospitals in America had negative margins due largely to macroeconomic factors related to labor, inflation, utilization, and insufficient revenue growth.

The actions then needed to improve financial performance likely involve reducing labor costs and eliminating unprofitable services.

But these solutions in the hospital world are seen as another wicked problem, and actions taken to improve financial and clinical operations are often cautiously approached in order to protect the organization’s duty of care.

As you can see, the very actions to solve the wicked problem of provider healthcare may likely make aspects of the strategic problem worse.

Everyone reading this blog is dedicated to solving these and other wicked problems related to health and healthcare and the provision of sufficient care to the American community.

Solutions to healthcare’s wicked problems are never clear, and those solutions are not easily tested and eventually can affect many.

And in the wicked problem lexicon, once uncertain solutions have been implemented they are very hard to undo.

And healthcare’s many and varied dissatisfied stakeholders demand rapid solutions and then complain loudly when those solutions fall short, as any one solution inevitably will when the problem is as wicked as the current healthcare environment.

This is the new role of healthcare leaders: solvers of wicked problems.

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