Malcolm Gladwell challenges healthcare to improve its weakest links

Photo: Mike Coppola/Getty Images for The New Yorker

Malcolm Gladwell, who has challenged how we think in numerous best-selling books, challenged healthcare leaders on Tuesday to think about their organization's strongest and weakest links during the opening keynote for America's Health Insurance Plans Institute and Expo Online 2020.

The notion that "your organization is only as strong as your weakest link," applies to the team sport of soccer, whereas basketball is a strong-link system in which the team is as strong as its strongest players, Gladwell said.

Healthcare operates as a strong-link system, investing money in research and other priorities.

The weak links in healthcare include the opening of community clinics, reducing barriers to access and reducing the numbers of uninsured, he said.

"The U.S. has pursued a strong-link strategy over the past 50 years," he said.

Yet, it was the overlooked weak links that hobbled the nation's response to COVID-19.

"COVID-19 is a weak-link problem," he said.

This is because, as strong as hospitals and health systems are, they were damaged by a weak link in the supply chain for tests, masks and medical supplies.

By July, the United States will need 20 million tests a day. There's also a shortage of nasal swabs. But there are only two major suppliers of nasal swabs. One is located in Italy, which was in lock down for six weeks.

Most of the N95 masks needed come from China and take six weeks to manufacture.

"The pandemic is a wake-up call," Gladwell said, "how to make the world stronger."

Healthcare needs to start looking at the weak links.

For instance, if diabetes and obesity were better controlled, there would be fewer cases of COVID-19. Improving access to primary care, nutrition, and general health and well-being – and making health insurance more affordable – would help change the paradigm.

Insurers and providers have been focusing on the social determinants of health.

"The health insurance community is the furthest along in recognizing the weak-link paradigm," he said. "They need support from other parts of the economy."

For instance, biking to work would improve the health of millions of people, but in New York City advocates have a long way to go in convincing the government to make this weak-link problem a priority. They've not gotten far, Gladwell said.

It's good to promote biking to work, he said, but first local governments have to commit to building bike lanes.

Gladwell has been included in Time's "100 Most Influential People" and as one of Foreign Policy's "Top Global Thinkers." He is the author of five New York Times bestsellers – "The Tipping Point," "Blink," "Outliers," "What the Dog Saw," and "David and Goliath." He is the cofounder of Pushkin Industries, an audio-content company that produces the podcasts "Revisionist History" and "Broken Record" with Rick Rubin and Bruce Headlam, who interview musicians across a wide range of genres.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com