On the Science of Healthcare and Healthcare Delivery

The growth and volume of new scientific discoveries over the last century contributed to  many of the greatest advances in the science of healthcare.  With this massive collection of knowledge comes a challenge to those who practice medicine.  The challenge is, how do  we consistently deliver, in a timely manner, what we know works to the people who need it the most.  It has been suggested that the bench to bedside lag is 17 years. (Balas & Boren)  That is, it takes almost two decades from the time we discover what works to the time it becomes an accepted part of clinical practice.  We’ve become very good at the science of healthcare.  Where we are lagging is the science of healthcare delivery.

There is a famous quote from Cecil B. de Mille’s movie , The Ten Commandments, where Yul Brenner playing the Egyptian Pharaoh Ramses II says, “so let it be written, so let it be done.”  In healthcare, it appears we’ve built this assumption into our system.  Unfortunately, just because we write it (science of healthcare) we cannot assume it will be done (science of healthcare delivery).  While they are deeply related to each other, it cannot be assumed that one will always, consistently and quickly follow from the other.  Just over fifty years ago Everett Rogers published Diffusion of Innovations which describes the theory of how innovation is adopted across a social system.  We are still evolving our understanding of how this applies to healthcare.

While it is important for us to continue to advance the knowledge base of the science of healthcare, the next century will need to focus on the science of healthcare delivery.  If we are to seriously undertake the challenge of population health management, then it will need to be built on the foundation of what we already know works.  One of the greatest challenges for the 21st century will be learning how to “let it be done”.


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