The Consequences of Innovation Procrastination

There is a Queen song that will have greater and greater play in future years,"Another one bites the dust." This should be in your head now as sung by Freddie Mercury as we all chime in. Another one bites the dues will continue to apply to
  • Physical infrastructure decline such as water pipes, roads, bridges, public buildings
  • Human infrastructure declines in teachers, nurses, public servants, primary care, public/mental health
If you want, you can replay the song with images of bridges falling down or Flint Michigan replayed a thousand times across the nation. There will be more infrastructure failures this year and next year... We are just seeing the poorer areas and situations where public investment has fallen behind the most. We will also only see the dramatic and not the usual as these are far from media or public attention. We have not chosen to pay attention yet, but we will have our chance as these failures impact more people and in more ways.

Innovation as Procrastination

Perhaps this is why we have Innovation Centers draining more dollars, distracting more people, and promising more for less. We may like procrastination so much that we are willing to create centers to distract us from real solutions. After all we can throw around millions or billions in grants and look like we are doing something - when real change in health, education, economics, efficiency, and effectiveness as a society requires trillions in investments.

One of the first lessons of Public Health 101 was - if you have insufficient resources, be sure to innovate or rearrange or reorganize. That way you can get your next job somewhere else before they blame you for the poor outcomes that were already shaped by lack of investment.

If you pass out enough money to primary care leaders or rural health leaders or their associations, you can even help them to buy in to innovation focus. After all, I was convinced that grants could actually make a difference in the pipelines to rural practice or primary care - but now I see more clearly that these were innovative spending distracting us from real solutions. Family medicine associations clearly have lost their focus on what matters while throwing millions after departments in every medical school, student interest groups, marketing, primary care medical home, and other innovations - without accomplishing any improvements in primary care payment impacting 80% of members.

Family medicine associations must create more jobs, more positions, and more support for primary care team members. This is also the way to more members for family medicine associations - or does this not matter?

Procrastination Is Devastation
  • Why delay needed investments in children from the earliest ages before the window of opportunity closes as the velocity of learning slows down about age 8?
  • If teachers were relieved from the burden of grading and other administrative tasks, they could actually have time to help children learn. 
  • If children had a better start, they would be well on the way to improvements in education, health, economic, and other outcomes.
Infrastructure is the ultimate if, if, if question. If only we had done this, by this time, to prevent this, to make this work better...

In health care we have had failure of investment in public health for decades. Primary care issues have helped to defeat health reform as we see now. The promise of health access offered by health insurance coverage expansion has been defeated by insufficient team members and other consequences of poor primary care payment support.

We know that these areas need to be addressed but still we delay. It takes time and money and effort to rebuild physical and human infrastructure. Most of all it takes a strong desire to make our nation better for future generations

Infrastructure must rise and innovation focus must fall.

True advocates of primary care must support payment specific to the support of team members - payment that can actually result in human infrastructure where it is most needed and most neglected.

In health care we truly appear to be willing to try everything else possible - other than investing in the basics such as team members to deliver primary care, public health, mental health, etc.

When infrastructure falls apart, it is time to invest in infrastructure - not innovation, rearrangement, cost cutting, reorganization, consultation, and more research.

Recent Posts and References  


Feeling Bad About CMS Feeling Good
It takes more than a feeling to lead in health care. Health care design must work for Do No Harm rather than I Feel Good - especially when it comes to constant changes.

The Massive Failure that is Primary Care Payment
Like past policies, ACA did not address cognitive vs procedural to balance workforce but it did take on quality payment with costs and questionable benefit.

Lack of Accountability for Accountable Care
Health Care Who Is it Good For? Count the billions in corporate earnings and the millions in CEO salaries to see who wins and who loses 2010 to 2016 and beyond

Innovation Incapacitation
We are so focused on innovation that we cannot even take care of the basics - Commonwealth Foundation is supposed to be about access. A foundation truly focused upon the access to care foundation could be powerful in shaping needed change. But why does it promote innovations that cost more and divert front line workforce from being able to deliver health access? Why does Commonwealth consider access to insurance to be access to care?

Safety Net Must Sunset and Front Line Health Access Should Rise

Experimental Innovation or Basic Infrastructure? Wouldn't it be nice if we actually funded infrastructure and basics instead of trying to substitute innovation or other distractions?

For Better or For Worse in Quality - More for fewer and less for more - thus continues the new innovative designs - same as the old designs

Are We Moving Away from Achieving Value in Primary Care? - Quality is over 60% about the patient, situations, relationships and has very little to do with clinical intervention - but this does not prevent serious exaggerations of "so-called value."

Time for Quality in Quality Studies - The Best Studies from the best institutions and journals have led the nation astray in quality studies and we continue down this pathway.

Pressures Mount for ACA Reforms or Revisions - It has taken too long for critical voices to be heard about the consequences of experimentation plus change that is too quick, too costly, and impairs access to care. Compromise may be most specific to small practice and small hospital settings and those that they attempt to serve.

IOM Should Learn About Social Determinants Not Preach Them - Too many IOM studies fail basic research design tests and often for failing to understand important influences of health care outcomes - like social determinants and patient situations and relationships.

The Federal Cause of Shortage Areas and Access Barriers - It is the Federal Design for payment that shapes the breadth, depth, and locations of shortage areas. It is about concentrations of Medicaid and Medicare patients with lowest payment for health access by federal design.


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