ealth is not a fixed concept—the goal posts are constantly moving. How we help our patients achieve health constantly changes, too. Simon Sinek’s recent book, The Infinite Game, reminded me that while we don’t get to make the rules in health care, we do get to decide how to play the game. It gave me a framework that makes complexity feel empowering.
Finite vs. infinite
Finite games have clear winners and losers. There are clear goals and clear results. The Super Bowl is an example of a finite game. (This year especially was a really great game.) The goal is to score the most points, and whoever does that is the winner. End of game.
An infinite game is more complex. The goals are many and they constantly change. Winning and losing are not fixed categories. Health care is an infinite game. While individual encounters may have finite goals (diagnose this, prescribe that) the aim of health is infinite, and it changes based on where patients are in their own life journeys.
Five principles for thriving in complexity
#1 Advance a just cause. Infinite organizations need a just cause. For Sinek, a just cause is something that people are willing to sacrifice for; it is an ideal that we look up to. Our just cause is an obvious one: helping people live healthier lives. In pharmacy, January and February are crazy months—often more than triple our regular workload. We don’t force people to come in early, or stay late, or come in on Sunday—but people choose to do it because they believe in our just cause.
#2 Build trusting teams. You cannot build trust overnight; instead, you change a culture, and create trust, by working at it over time. The goal of building trust is to make your staff feel safe. The way we do this in pharmacy is by focusing on the problem, not the person. With medication errors, we try to figure out what went wrong, and then we figure out what processes we need to change so that it doesn’t keep happening. People can report issues to management without fear of retribution, which makes it easier to address errors so patients are safer.
#3 Study worthy rivals. Find another player that is worthy of comparison. While that could be another health system, I think about it in terms of internal rivals—people in the organization who I admire and strive to be like. The rival is someone you compare yourself to, not out of hostility or hate, but for the opportunity to have them reveal your own weakness so that you can improve your own game. There is no winning in an infinite game—so the point is not to best your rival, but to respect your rival.
"A rival is someone you compare yourself to, not out of hostility or hate, but for the opportunity to have them reveal your own weakness so that you can improve your own game."
#4 Prepare for existential flexibility. No one drives to a Blockbuster video on a Friday night to pick up a movie. Instead, we sit on our couch and watch streaming videos. Blockbuster couldn’t change the way it existed, and now it no longer exists. Implementing electronic refills, or prior authorization, is one example of existential flexibility in pharmacy. Instead of faxing forms—which requires a huge amount of labor—we are adapting to an electronic workplace. Being flexible has increased our value, rather than threatened our jobs. It has given pharmacists more time with patients and providers.
#5 Demonstrate the courage to lead. You will have to make unpopular choices in the infinite game if you want to maintain your just cause. Courageous leaders think beyond their yearly performance review and merit goals. They think about the long term future of the organization, even if they don’t immediately see positive results. Leaders with a finite mindset tend to think only about their own gains.
We are all trying to improve the health of our patients and the populations we serve. While there are a lot of metrics that allow us to measure ourselves against other organizations (and we are right to care about those) they often are a finite game. The infinite mindset allows us to take the long view—a view that is in the best interests of our patients.