The Laws of Subtraction – Are they applicable to healthcare?

imageEarlier this week I had the opportunity to attend a lecture on the Microsoft campus given by visiting author, Matthew May (The Elegant Solution, In Pursuit of Elegance, The Shibumi Strategy). Matthew May’s (left) latest book is titled, The Laws of Subtraction: 6 Simple Rules for Winning in the Age of Excess Everything. Although this is really a book about business, especially applicable to industrial design, art and music, I found myself pondering the idea that perhaps this book could be equally relevant to the field of clinical medicine and healthcare delivery. It also picks up on an important theme that I have been delivering when I speak with healthcare executives and clinical leaders these days—that instead of focusing only on “doing more with less”, in healthcare we need to transform clinical practice by “doing more with new”.

Matthew May, and his group of more than 70 contributing guest authors, provides numerous examples of how businesses or individuals have become far more successful when they do fewer things better and with more elegance. He bases his 6 simple rules by expanding on one of the laws found in another author’s popular book on business; John Maeda’s The Laws of Simplicity.  One of those laws states “Simplicity is about subtracting the obvious, and adding the meaningful”.  Matthew May builds upon this with these 6 rules that headline each chapter in his book:


What isn't there can often trump what is.

The simplest rules create the most effective experience.

Limiting information engages the imagination.

Creativity thrives under intelligent constraints.

Break is the most important part of breakthrough.

Doing something isn't always better than doing nothing.

I won’t attempt a full review of the book. There are plenty of excellent reviews available on-line.  But I will comment on why I think we have something to learn from the Laws of Subtraction that may equally apply to clinical medicine, healthcare delivery and, most importantly, healthcare information technology. You see, the longer I live and the more time I spend working in the fields of healthcare and IT, the more I believe that the scourge of our industry is making everything way more complex than it should be, or perhaps needs to be.  I often see this play out when I visit other countries, and discover perfectly elegant healthcare delivery systems and IT solutions that focus on the necessary rather than the possible.  By that I mean that these systems and solutions have zeroed in on the absolutely necessary and have removed or subtracted everything that doesn’t add value.

I think most American physicians would agree with me that our complex payment systems, rules, regulations, coding systems, documentation requirements, and other factors are not always making the practice of medicine or the quality of care we deliver any better. How many times have I heard clinicians say that our electronic systems are overwhelming them with information, slowing them down, and getting in the way of caring for patients.  In some cases these systems are even introducing errors that might not have happened in an earlier era. Perhaps we would be better off with fewer codes, less but more meaningful documentation, fewer but more efficacious medications, and perhaps even fewer super-specialists and more general practitioners.

Every time someone in my family becomes ill and has to navigate the healthcare system, I see the chaos of what we call healthcare. I’m always mindful of the fact that because I am a physician, I am much better prepared and more knowledgeable than the average consumer in helping myself or my family members find their way through the complexities we have introduced into the system. Surely, what ails healthcare is as much about “too much” as it is about “too little”. What can we learn from The Laws of Subtraction, whether its designing a new healthcare facility, crafting a new service line, inventing a new kind of electronic medical record, or developing a better treatment or procedure, that would be superior in every way, including lower in cost, because it is simple and less complicated, rather than more so?

Bill Crounse, MD                      Senior Director, Worldwide Health                       Microsoft



Comments (4)

  1. sir,

    may i suggest you something about microsoft health vault cant you introduce electronic medical records if it is possible and can i involve in this project plus also intersted in telemedicine with medical device telemetry

    thank you

                                                                                                                                    yours faithully

                                                                                                                            Dr . Anil Kumar A.D.

  2. Sir,

    you can revolutionize only by massively implementation of telemedicine with EMR  and it should be free of cost for atleast for 10 years . you can digitalize entire global heath care industry by making it for free atleast for 10 years. all these are possible if we could change SKYPE WITH CLOUD STORAGE.

                  i am Dr. Anil Kumar A.D. i am govt doctor in primary health care center in india. as govt of india installed  cisco's telehealth presence . As it is huge machine consists of pc , server, multiparameter monitor, webcam and it has a simple software webconference. as doctors should come to desktop to give online treatment .no body comes to online at large hospital as they were busy in rounds or in opd.As it is use less TELEMEDICINE DEVICE in indian contest. so i suggested lot of improvement in this but in vain. As SKYPE is free and its bandwidth are free it is downloadable software with members profile and inbuilt social networking software is there . only two thing are lacking electronic health records and telemetry of medical device.

                      sir Skype is wonderful software please add electronic health records and telemetry of medical devices so that rural population around the globe will get benifited from it . you can make GLOBAL HOSPITAL , DOCTORS NETWORK AND TELEMEDICINE WITH TELEMETRY OF MEDICAL DEVICES ( ECG, STETHOSCOPE, BLOOD PRESSURE MONITOR, TEMPERATURE) , MEDICAL IMAGING SERVICES.


                              hopefully you may implement it

                                      thank you

                                                                                     yours faithfully

                                                                                           Dr. Anil Kumar A.D.  

  3. hlthblog says:

    Dr. Kumar,

    Thanks for writing.  Re HealthVault.  HealthVault is a platform for personal health records that can be securely shared with others, i.e. caregivers, family members, medical professionals, etc.  Although Microsoft does not sell solutions for telemedicine or electronic medical records directly, our technologies are widely used around the world by industry solution vendors who do produce and sell such solutions.  If you have ideas you wish to share, I suggest contacting your nearest Microsoft office.

    Bill Crounse, MD

  4. but i tried but no result . thank you sir for your response but i will try in other company

    Anil kumar A.D.              

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