Can you spot the different letter? (hint: from top right corner, count 3 rows down, 3 letter to the left)

Out Of 126 Healthcare White Papers We Analyzed, One Stood Out. Part 1

Lack of a sense of community in Healthcare is causing a culture clash between doctors and administrators

Out of the 126 projects we recently analyzed only one addressed the root cause problem in healthcare: the lack-of-community problem.

Lack-of-Community Is The Root Cause Problem of Healthcare

There are many problems in healthcare. For patients it is too expensive, for physicians there is too much bureaucracy, for hospital executives job growth has not brought better patient outcome, for the pharmaceutical industry the future is uncertain and even insurance companies are experiencing reduced gains while legislatures are still fighting over the Affordable Care Act (ACA).

However the root cause for these problems is that Healthcare is not a community that shares a common sense of purpose and therefore it is not a sustainable business ecosystem.

Healthcare is a heterogenous group that includes the most trustworthy professionals (doctors, nurses and pharmacists), working aside those who are the least (lawyers, business executives, lawmakers) (below).


Combined with an uneven growth rate (2% vs. 3200%!) between physicians and administration (below), the healthcare environment has changed to a point that a clash of cultures has developed, seen by many physicians as a moral injury encouraging them to leave.

(By the way, please note that I never use the term “provider”, but insist on “physician or doctor”. This is because the term provider [in German Behandler] was first used by the Nazis, after they revoked the licenses of all Jewish physicians, that were no more entitled to be called Doctor [Arzt]).


Thus, although blockchain-based P2P solutions do have the potential to solve identity, data interoperability and cybersecurity problems (the how problems),

we only found one project addressing the lack-of-community problem (the why problem) in healthcare.

How To Create A Community In Healthcare?

First, create distributed trust

Trust is the glue that holds society together.

Yet the 2018 Edelman Trust report shows institutional trust is at all-time low. The idea that trust can be kept in the hands of a privileged minority operating behind closed doors, is simply unacceptable.

This doesn’t mean this is the age of distrust, but rather trust has shifted into a new form of distributed trust.

Instead of Trust flowing upwards to institutions, experts, authorities and regulators, it now flows horizontally to peers, friends, colleagues and fellow users (Source)
Therefore the first step is to design a sustainable business ecosystem based on distributed trust.

Second, recognize other perspectives

The second step is to acknowledge that others have different concerns than you.

Top concerns for physicians are: burnout and time demand for EHR entries (I posted about this here and here); growing rate of uncompensated tasks; payer interferences with patient care; managing mandatory quality measures; patient non-adherence to care due to high cost; constant changing reimbursements; erosion of patient respect and loss of professional independence (below).


Hospital leaders worry about: data and analytics; consumer health; population health; value-based payments; digital healthcare;
pharmacy costs; external market disrupters (Amazon, Apple, Google);
operational effectiveness; opioid management and cybersecurity.

Industry is mostly paying attention to: the role of AI in clinical decision making; claims processing and supply chain; policy uncertainty around the ACA; the opioid epidemic; disaster preparedness and the role of social determinants of health. (The full PwC report is here).

Since the vantage points of the various stakeholders in Healthcare are so divergent, it is impossible to imagine one, or even a set of solutions that can satisfy everyone.

To Sum It Up:

  • Healthcare is currently a non-sustainable business ecosystem because it lacks a community that shares a common sense of purpose.
  • The first step to overcome the cultural clash between physicians and administrators is to create a community driven by incentives based on distributed trust.

In part 2 we will review the design of decentralized models in healthcare that can encourage collaboration and discourage predatory practices.

(For a detailed review on decentralized models read Vitalik Buterin paper on Radical Liberalism and this commentary here).

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