The Foundations of Healthcare

At its most fundamental view, healthcare is a process of understanding and responding to changes in a person's state of being.

Healthcare always starts with a person. At any given moment, a person can be in a certain physical or mental state, and that state keeps changing. Therefore, healthcare has always been a continuous loop.

There has always been one fundamental question:

How do we understand the current state of a person well enough to make a useful decision, act on it, and know whether it worked or not?

1. Learn what is happening

You cannot respond to a condition you do not fully understand. So care always begins with finding out what is happening to the person.

2. Decide what should happen

Information by itself does not provide care. Someone has to make sense of it and decide what should happen next. That may be a doctor, a team of practitioners, a set of rules, a system, or some combination of these.

3. Act on the decision

A decision that cannot be carried out does not complete the process of care. The right person, procedure, medicine, equipment, place, time, and access may all matter here. This is where the real, physical and regulatory side of healthcare starts to matter the most.

4. Follow up

After some action is taken, the person's state may get better, get worse, stay the same, or change in a way no one expected. So care cannot simply be "know → decide → act" It has to be "know → decide → act → know again"

Healthcare is therefore a continuous loop

For example, most people prefer to stay with the same doctor. They were either referred by someone, or they simply got used to the doctor and built some context and trust over time.

But a preference is not something the loop can depend on all the time. The moment a patient needs a specialist, moves cities, changes jobs, changes insurance, or just tries a different hospital, that preference breaks.

This largely differs at population level. People are always switching doctors, needing specialized care at a certain recommended hospital, or change of provider due to changes in job, business, family, and more. It depends on individual requirements and convenience.

Therefore, Healthcare works best when information, judgment, and action can stay connected across time and distance.

A continuous healthcare loop can break when it scales beyond it's limits

As stated above, once care involves a large group of people, places, events, and ailments, something is needed to hold all of it together, make sense of it, in a way that it helps both patient and everyone involved.

And most times, the limits of these individual parts that make a loop complete, are the direct result of the underlying tools, regulations, and the systems around them.

Healthcare is not one clinical event

A diagnosis, a decision, a treatment may all be individual clinical events, inherently dependent on each other.

For as long as healthcare has existed, people have created different ways to carry information, decisions, actions, and results from one moment to the next. It may look as simple as a conversation, a written record, an EHR. Some of these are still in use today. Others have been replaced by newer and better ones.

The tools may continue to change, but the reason the continuous loop exists did not. A person's state keeps changing. Healthcare has to move with it.

In this piece, I tried to explain the nature of healthcare from the most fundamental view possible. Over the next few pieces, I will go through what really drives each part of this loop and how they all come together, because healthcare is a much larger ecosystem than it first appears.