Experience: There is no easy way to reform our institutions

One of the significant limitations of newspaper columns is that it over-generalises. Partly due to lack of space or substance or partly because of the readership that wouldn’t engage with a deep dive of issues.


Most of us would probably prefer a surgeon who has done thousands of operations to one who has performed just a few, yet experience can also bring overconfidence and complacency.

The example of the surgeon mentioned herein is that experience teaches us to deal with the unknowns better. There would always be a surprise for anyone who goes in to operate. Experience also shows taking calculated risks so that the fallout can be contained.

In many areas, experienced people who have made a decision may be reluctant to change their minds. Several studies have shown that “people are likely to continue on the same course of action, even when they receive negative news”, a paper last year in the journal Management Science said.

It is again challenging to generalise the contexts in which decision-making operates. Not everyone has the time and leisure to brood over issues.

Once managers have committed themselves to a course of action, they are often reluctant to admit they have made mistakes, even when the evidence piles up. “Individuals resolve this dissonance by rationalising that their prior view was correct,” the paper said.

As for the institutional reforms in the hospitals, throwing more money at the problems won’t necessarily solve the problem. Deep infrastructural issues require extensive analysis of the problems that could range from how teams are structured to disjointed leadership. However, a sure-fire recipe for disaster is when you let the bureaucrats run the place without domain expertise.

Institutional reforms can better be adjudged if we shift towards value-based-healthcare (outcomes measures), rather than volumes. It is the topic of my next long-form; especially in the context of developing countries.

via There is no easy way to reform our institutions | Financial Times

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