Physician as Choreographer

As entities like ACO's emerge to offer healthcare for populations as well as individuals, one of the rumbles in the background is that they should be physician-led. What might doctors learn about this from architects? With this in mind I attended a continuing education workshop entitled "Directed Build: The Architect as Choreographer."

Traditionally, architectural practice as well as its academy has considered design and construction as separate activities in a strict sequence. Proposed at this workshop was the idea that builders should be working along with designers, both on the drawing board and in the field. How does that work?

First, everyone is engaged. There is across the board communication, professionals leave their silos, and it's all hands-on and brains-on. Good solutions emerge.

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Next, design and construction are no longer sequenced as before, but instead are more like concurrent activities, featuring more design than construction on the front end, and vice-versa. The hand-off from designer to builder, with its negotiations and denials, is replaced by continuous improvement.

Work flow is non-linear. It's not constrained by scale, and it's not just project management. Instead, it's about building the feedback loops that permit the freedom to think differently and to change the risk factors.

There is inertia to overcome. This audience of architects quickly focused on how this open approach would not play well in state government, among other apparent obstacles. Everyone will need to learn to see the spaces between the pickets.

There was quite a bit of discussion about the phrase "architect-led," and whether it was really accurate. In the end, "architecture-led" seemed to be a better descriptor because it makes quality the goal as opposed to individual achievement.

What might this offer to the physician-led care of population health? Engage everyone, build the plane as you're flying it, focus on what to accomplish rather than what to avoid. Just as architects learn to share the proverbial sketchbook, we will all gain when physician leaders let everyone put an ear to the stethoscope.