Optimization has become a defining feature of modern healthcare.

We optimize, review, tweak, and measure our systems and ourselves against a super-optimized standard. Better, faster, safer, more productive, efficient and effective.

We’re always looking for improvement. And for good reason. 21st century healthcare has worked to prioritize safety and quality improvement, and the results have been remarkable. Small changes in equipment sterilization or preoperative timeout processes, for example, can have a dramatic impact on patient safety.

But not all corners of the hospital should be subject to six sigma scrutiny. And what do we do when the movement of patients through pre-op or recovery approaches perfection? How will healthcare systems remain competitive? Or even be defined?

The greatest opportunity may be found in the things that are scarce. The winning variable may be what industrialism looks to take away: Connection, touch, presence, and the unfolding of experiences.

The real money may be in selective suboptimization. That is, intentionally thinking about what we want to leave unmeasured and unperfected. And advantage may be found in those parts of the patient care journey left to the serendipity of human engagement: the conversations, connections and experiences that unfold between people in real-time during the time in our facilities.

Let’s not analyse the speed or efficiency of our end-of-life discussions. The skin-to-skin time between a mother and her newborn infant may not have a place on a graph. Seth Godin in The Song of Significance had it right: “Part of the challenge of leading a significant organization is getting clear about the right proxies.

We have to know what to measure. Or what not to measure.

Think of selective suboptimization as the ‘elbow room’ found during the time under our care. Those elements of intentionally slow medicine baked into a system sworn to throughput and efficiency.

Real human engagement can’t be operationalized. Presence and depth of connection evades measurement. This generation’s experiment of human caregivers measured with stopwatches has left us with unions and epidemic levels of burnout.

In an industry focused on incrementalism, it may be the scarce, unmeasured part of the patient journey that sets a healthcare organization apart and affords a competitive advantage.

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