Elon Musk is redefining how we make automobiles, rockets, and even how we engineer things in general. I wanted to share some of his core philosophies and highlight how they are just as relevant to healthcare as they are to engineering.
First Principles Reasoning
Elon and many other intellectual powerhouses often discuss the importance of reasoning from first principles. Essentially, complex things can be broken down into their essential components. For a rocket this might be building blocks like aerospace grade aluminum, titanium, carbon fiber, propellant, and other basic materials.
In healthcare this can also be utilized. For instance, you might ask, “what is needed to make a person healthy”. I would answer healthy fuel (food), regular activity (exercise), meaningful relationships (connections), and purpose (why are we here). In trying to build the perfect healthcare delivery system, one must first keep these values in mind.
If instead, you tried to build the perfect healthcare system by analogy you might think CT (imaging) machines, expensive cancer medications, hyperspecialized providers, teams of business people, and crumby computer systems are needed. Building a healthcare system this way would and has not lead to optimal outcomes. But yet, it is what everyone continues to do in the healthcare space.
You Are Always Wrong; The Goal is to Be Less Wrong
Elon is never satisfied with designs or outcomes. Things can always be better. I find that so many doctors and healthcare systems do not view their work in this light. In fact, I have met surgeons who do not believe they have ever been wrong. For this reason, healthcare has continued to get worse all while the health of the average person is deteriorating. If your goal every day is to be “less wrong”, you will always be improving.
Do Not Optimize a Thing That Should Not Exist
The best designs are the simplest ones capable of solving the problem at hand. In healthcare there is so much noise from all the red tape. So much of what we do, is done to collect billing from insurance, because some administrator thought it was a good idea, or to click checkmarks for regulatory compliance. Sadly, many of these things add no value to patients, providers, society, or the environment. Therefore, by optimizing them, we are wasting our time. This is why Wonder Medicine does not take insurance and has no administration. We truly want to optimize healthcare. Of course, per above, the way we are optimizing healthcare is wrong. But we hope to keep getting better and better.
Engineering Steps from Elon
1. Make the requirements less dumb
2. Delete the part; delete the process. Then add back things that turned out to be necessary. Per Elon, if you do not add back at least 10% of things removed, you are not removing enough things.
3. Simplify the process
4. Accelerate the cycle time
5. Automate
When Elon described these things to me (on a youtube video I watched) it seemed just as relevant to the process of building a clinic as it does to building a rocket.
Question Everything
Elon says that it is much more dangerous to learn something from an intelligent person. This is because people are less likely to question something coming from a smarter person. This can lead to big problems if subsequent steps are built on this information.
Requirement Must Come from a Name and Not a Department
So much of what we do and think has been passed along with little thought or question. So much of this is wrong. Information should always be traceable back to its trusted source. In healthcare, we often do things because it is the way the people that taught us and the people who taught them did it. This is bad logic.
Everyone is a Chief Engineer (Medical Director in Healthcare)
If everyone understands why things are happening at a very high level, this will result in the highest optimization of performance.
Summary
I believe that healthcare is in somewhat of a dark age right now. Our hospitals are operating as they have for 100 years. Our IT systems are primitive compared to more advanced industries. We do not utilize big data to solve big health problems on an entire population/world scale. New information gets disseminated to providers painfully slowly and medical practice changes even more slowly. Payers dictate what can and cannot be done to patients, even though they have no idea how to decide this.
If we want to fix our broken healthcare system, we have to go back to first principles. Just like Elon did with rockets and electric cars.
Need a clinic looking toward the future and striving for constant improvement? Want a clinic that knows they are wrong, and that it is just a matter of how wrong?
Bill Brandenburg, MD
Wonder Medicine’s Longevity and Performance Program improves your lifespan and healthspan with a research-driven proactive program that focuses on the big picture of your health so you can perform at your highest potential.