15 Apr Cathedral and the Bazaar in Healthcare
Bazaar (bə-zär’) n.
- A market consisting of a street lined with shops and stalls, especially one in the Middle East.
- A shop or a part of a store in which miscellaneous articles are sold.
Eric Raymond is a famous open source advocate who published a seminal book on the fundamental philosophic basis for the movement. He used the analogy of the Cathedral as contrasted to the Bazaar as the metaphor to compare very top down, overly ornate approaches to software development versus the much more chaotic, decentralized, but ever more vibrant approach of open source.
Having lived that world for several years, I understand the powerful metaphor, and appreciate its appeal to my natural revolutionary streak.
I see the same thing evolving in healthcare – we are beginning to see the big, monolithic systems like Kaiser, Intermountain, Geisinger, Group Health, and even the VA begin to demonstrate impressive outcomes in terms of cost, quality, IT, and patient experience. This might lead one to think that this is the best way to go and we should all begin to worship within the whited walls of a an integrated, fixed fee provider group (“The Cathedral”).
But while the Cathedral has its place and has its appeal, there is much to be found within the ever more vibrant, chaotic, and pleuripotent Bazaar. In fact, I believe that the bottoms up Bazaar holds far more promise to bring me products and services to meet my personalized needs than could be provided by the Cathedral model. Unfortunately, the very nature of the Bazaar makes it difficult to harness, coordinate, and distribute those services in a scalable way.[slideshare id=1292004&doc=whcc-dc2009-21stcenturysystemss-20090414-090415021539-phpapp01]
My contention, however, is that the tools and technology are arriving that will allow the Bazaar to compete head on with the Cathedral. In my “Bazedral” model, there is a layer of software and services that serves as the virtualization layer to abstract out the current challenges of coordination, mixability, and modularity. This integration layer would enable providers to come together in ways to deliver analogous if not superior results (given the enhanced competitive nature of trying to be one of the “care modules” that gets plugged into the overall solution). Thus all the component parts of a right hip repair (pre-op workup, surgeon, anesthesia, recovery, rehab, etc) could be put out to bid but brought together in delivery by the virtual integrator to provide a seamless, integrated service experience This could be huge.
Bottom line for me . . . Cathedral Care is superior (for now). However, I believe there are “virtual integration” companies coming that will allow the Bazaar Care model to self organize in ways that will not only challenge but beat the outcomes results we have seen to date from the Cathedral. This would actually be good for the overall health care system, would challenge Cathedral players to continue to improve and adapt, and ensure competitive market alternatives.
Let us pray for the hastening of this day – Amen!