Earlier 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