Our health system certainly is in transition, and it always will be. And we should ask how we [can] deploy continuous improvement techniques within a mindset of constant change and improvement to make our system better.
A lot of people said, 'You could never do this in the U.S. because it's so big.' People get a bit overwhelmed with our healthcare system. It's big, it's complex, it's layered, and I think that can be an obstacle to making improvements.
The countries I visited are relatively small, and I realized they could do things because they are small. Their systems have some ability to make change at a national level that we perhaps do not, as easily. What I tried to do when I was in those conversations was think about the right level of where we could making something happen. The broad lesson was we may have to start small to make change.
HLM: How does culture influence healthcare?
Gordon: Culture has so much influence on how we implement our healthcare system. In Australia, for example, they call themselves pragmatists. They are not super politically ideological. It was described to me as a fight for the middle in Australian politics, and a general nature or culture of finding solutions. They would talk about health system reform in those terms.
They also couldn't quite understand the controversy over the ACA. I would explain that it's a political dynamic that we have. In Australia, their politics are less extreme, and so what I found was a general confusion about why we couldn't get certain things done in the U.S. And maybe that's part of their success, that they put politics aside.