This document uses a bicycle metaphor to argue that for successful healthcare reform, both strong clinical services and administrative systems are needed. It states that a bicycle, and a healthcare system, cannot function well with only one wheel working properly. Both the "wheel" of sharp administration and the "wheel" of clinical system redesign must work together simultaneously for a healthcare system to operate efficiently. Health information technology acts as the connecting chain between the two wheels, and it too must be well-designed to synchronize their movement.

1. HealthCare Reform
And the Bicycle
A two wheeler metaphor regarding the essential need for
both clinical excellence and administrative sophistication for
successful future healthcare
Wells Shoemaker MD
January, 2016

3. A Bicycle is Not a Stable Vehicle
Unless:
• Both wheels work
• It’s constantly moving forward

4. Need Both Wheels
• Let’s say one wheel has a titanium alloy rim
with aero-bladed spokes, slick bearings, &
brand new rubber…
• And the other is flat, bent, or corroded…
That bike is going nowhere.

6. A successful healthcare system
also needs two good wheels
1. One is sharp administration…visionary
leadership, intelligently designed processes,
regulatory precision, keen financial strategy,
hunger for efficiency, respect for community
2. The other is clinical system redesign…go beyond
the erratic performance of the past to
consistent, reliable, effective services to all.
That means both coordinated care and
accountability, threaded with a hunger for
improvement, laced with patient responsiveness

7. Both “Wheels” Need to Run True
…Simultaneously
Reforming systems cannot place hierarchical
priorities on one or the other. They need to run
in tandem
• A one wheeled bike is just rusting yard art
• A healthcare system with one slick wheel and
one clunker will operate at the speed of the
clunker

8. An added thought for HIT
• Torturing this metaphor, HIT is really the chain
that allows energy from the driver to be
transformed to intentional, directed forward
motion, synchronizing both wheels. It needs
to be well engineered and well lubricated. It
needs to permit gears to shift smoothly when
demands change for torque versus velocity,
and it needs to consume relatively little
energy for its own maintenance.