At The Forefront

This is the second article in a three-part series exploring the shortage of hospital beds in the U.S. and what’s causing it. In Part 1, we focused on the factors behind the shortage—understanding these is key to finding real, lasting solutions. In this article, we'll look at some of the major design flaws in the way healthcare systems are set up, which make the problem worse when combined with these causes. To understand why the usual approach of small, ongoing improvements isn't enough in this case, it's important to first understand what a system is and what we mean by "design flaws."

Deming, a key thinker in this area, described a system as "a network of interdependent components that work together to try to accomplish the aim of the system." This means that each part of the system must work in harmony with the others to achieve a common goal. A "first-order design flaw" refers to a basic mistake in how the process is built from the beginning—these flaws can lead to inefficiencies, poor patient experiences, or higher costs.

To create lasting solutions, we need to meet three key conditions:

• Understand how each of the factors mentioned in Part 1 is impacting the system.

• Understand how the design flaws discussed here interact with those factors to make things worse.

• Recognize that healthcare systems are complex and adaptive, they can evolve, learn, and respond to both internal and external changes.

In Part 3, we’ll explore why small, gradual improvements fall short in this context and show how these three factors can be used to create an effective system redesign.