The places that get the best results are not the most expensive places. Indeed, many are among the least expensive. This means there is hope—for if the best results required the highest costs, then rationing care would be the only choice. Instead, however, we can look to the top performers—the positive deviants—to understand how to provide what society most needs: better care at lower cost. And the pattern seems to be that the places that function most like a system are most successful.
By a system I mean that the diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.Does this apply to universities, to history departments, too?
Universities too have a problem of high costs and disappointing outcomes. But so far the university response has mostly been to insist improvements will only come from getting more money for the same thing. The only issue universities want to talk about is "underfunding" -- though surely it is obvious that no university will ever get the money it would like to have in order to maintain itself in the conditions in which it would like to be maintained.
Research in the social sciences is still pretty cowboy-like, isn't it? Scholars pretty much get to study what they choose to study. I have no sense -- looking from the outside -- of history departments that decide, okay, these five fields will be our longterm research and publication priorities, and everyone we hire will pitch in, applying their specialized skills to help our teams pursue these predetermined common goals.
It seems the same in university teaching. Students, even those that focus on a major, mostly get a smorgasbord of classes to take, with each class largely determined by what the individual professor wants to teach. Students become as cowboy-like as their professors, and often the good ones come away largely self-taught.
Freedom of inquiry is a wonderful thing. Historians in universities are probably no more eager than doctors to lose their heroic self-sufficiency But individualism has its costs. Are any university thinkers thinking like Atul Gawande -- that there are gains as well as losses to be had from systematization?
I say this as a freelance writer, vividly aware that I have taken my career about as far out on the cowboy end of the spectrum as one can go, and hardly been part of the education system at all. But maybe Willie Nelson is the philosopher the university system, as well as the health-care system, needs. Mommas, don't let your
