What if we had to care for twice as many people at half the cost?
Scarcity-driven thinking may be what is needed to unlock needed innovation.
In March 2020, I watched our hospital transform overnight.
I remember sitting in a conference room listening to one of our ICU physicians describe a patient who had just been transferred: a middle age, otherwise healthy man with respiratory failure, intubated, with a positive COVID PCR test and classic findings on chest imaging consistent with COVID pneumonia. He was the first known case of severe COVID-19 infection at our hospital.
Those of us in the room — a group of clinicians and administrators — shared uneasy glances at each other, but continued the meeting with the level of equipoise healthcare professionals strive to maintain despite facing life or death crises. However, beneath the calm exterior, we all knew this was just the beginning.
Over the subsequent months as the COVID pandemic unfolded, our hospital transformed and innovated in an all hands on deck manner that was equally stressful and inspiring. Traditional boundaries dissolved as we mobilized every resource and idea we had, knowing there was no playbook for what we were facing. The constraints and sense of scarcity we encountered - limited PPE, hospital beds, staff shortages - didn’t paralyze us, but rather forced us to innovate that resulted in lasting transformations. For example, telehealth adoption increased from less than 10% to 90%; while this number has since equilibrated, telehealth and virtual care have evolved from being regarded as novelties to necessary tools for care delivery.
Looking back, the scarcity we faced didn’t just challenge us; it gave us a mandate to freely innovate, driven by an unprecedented sense of urgency that bound us together around a common mission.
The case for scarcity-driven innovation
The American healthcare system is fortunate to have survived through the worst parts of the COVID pandemic, but is slowly inching towards a crisis of greater magnitude. Ballooning healthcare costs are indebting households as well as our nation. Providers are burning out and as a population, we are not healthier.
Unlike COVID, this crisis is manifesting over years and decades rather than weeks and months, but shares the same accelerating, existential feel. And just as with COVID, addressing this crisis will require us to operate under hard constraints: our healthcare system needs to deliver better care for more people at a significantly lower cost.
Also unlike COVID, we have the benefit of time that should enable us to be more intentional and thoughtful at innovating without being forced to constantly react to immediate threats. The scarcity we face may not be as obvious or immediate, but are very real. We will need to decide whether to embrace this burning platform now, or wait until we have no choice.
How would we deliver high quality care to twice as many people at half the cost?
This is not just a thought experiment - it is a lens that forces us to fundamentally rethink care delivery and challenge assumptions and perceived barriers that systems of abundance often afford.
Scarcity forces us to challenge core assumptions about care delivery
When resources feel abundant, we rarely question basic assumptions about care delivery, especially if we have more to lose than to gain from changing the status quo. During the early days of the COVID pandemic, we initially continued the practice of having the entire medical team enter every patient’s room each morning for rounds, consuming precious N95 masks and gowns to maintain a ritual that added questionable clinical value on top of what could otherwise be monitored virtually. The looming PPE shortage forced us to reconsider when a physician truly needs to evaluate a patient at the bedside, and what instead could be substituted by a virtual interaction and asynchronous monitoring.
We eventually created a virtual rounding system where the team would evaluate patients via video while reviewing vital trends and other clinical data. The physician would enter the room when physical examination was truly necessary. COVID specific clinical teams were then developed that leveraged virtual interactions, asynchronous monitoring, and standardized care protocols which enabled a single physician to efficiently care for large numbers of COVID patients. The ICU proactively identified patients in the hospital who may require care escalation to avoid unanticipated transfers and intubations, which were risky for both the patient and providers involved. We did explore using AI to perform these predictions, although it turned out that simply following the rate of increase in the amount of oxygen needed provided an immediately effective solution at no additional cost.
This shift, born from necessity, revealed how many of our 'essential' practices were more ritual than requirement. The quality of care didn't suffer; in fact, many aspects improved. Teams spent more time discussing care plans and teaching. Patients weren't awakened repeatedly by large groups trooping through their rooms. What started as a response to PPE scarcity evolved into a more thoughtful approach to patient care.
Now on the other side of the pandemic, this experience has taught us to more broadly question fundamental assumptions about care delivery: does a given patient encounter need to be in-person with a physician versus delivered virtually? Does it require synchronous communication, or could it be handled asynchronously? Does this level of care truly require a hospital setting, or could it be safely delivered at home with the right monitoring and support? When we strip away historical assumptions and focus on what creates real therapeutic value, we often find that traditional care models are built more on convention than necessity, creating opportunities for transformation.
Shifting from a mindset of technology deployment to technology enabled care model design
Achieving this type of transformation, however, requires a shift in mindset. The current discourse around technology in healthcare suffers from a sense of abundance: we layer expensive new tools onto existing expensive care models. The net result is more cost, more complexity, attention grabbing headlines, and ritzy conferences, but not necessarily fundamentally better care.
Scarcity-driven thinking would force us to flip this approach. For example, instead of asking “How can we deploy AI into cardiovascular disease care,” we would ask “what would we need to do if we had to treat twice as many patients with congestive heart failure with half as much clinic space and staffing?”
Consider how these different mindsets play out in practice. The abundance approach might result in the addition of a fancy (and likely expensive) AI monitoring tool to existing heart failure clinic visits that may generate additional clinical encounters and interventions: all adding to cost while preserving the incumbent care model. The scarcity approach would force us to reimagine the entire care model since there simply would not be enough staff and space for the number patients we need to treat. We may design a system of using AI to continuously monitor patients at home, automatically adjusting medications within safe protocols or with asynchronous input from the clinical team, and reserving precious clinic time only for complex decisions that truly require in-person physician expertise. Same technology, but fundamentally different impact on care delivery and cost.
Embracing scarcity is more often a reality at the local level than for the healthcare system at large
Change is difficult when the scarcity is hidden. Healthcare can feel like the proverbial frog in slowly boiling water; despite mounting evidence of crisis — rising costs, debt, workforce shortages, burnout — our system continues to operate as if resources are infinite. Current incentives reinforce this mindset: fee-for-service revenue models, technology vendors promising additive solutions, and headlines celebrating the latest expensive innovations all suggest the pie will keep growing. It's hard to embrace scarcity thinking when the water feels comfortably warm.
Yet at the local level, scarcity is already a daily reality. Individual clinics struggle with staff shortages. Hospitals face space constraints. Primary care practices buckle under growing patient panels. These frontline challenges, while less glamorous than the latest AI breakthrough, are where real innovation often happens out of necessity.
This is why frontline teams need to be empowered to lead innovation at the local level. They intimately understand both the constraints and opportunities in their local systems, and are more likely to be driven by the problems they face rather than grand visions of technology transformation. Yet, there are challenges - we all naturally want to preserve or expand our resources, and the case for change is difficult when there isn’t a pressing crisis. But when given a clear mandate and permission to redesign care delivery, those who are closest to the work and experience the scarcity first hand often generate the most practical and impactful innovations.
We are in an all hands on deck moment
When working in the hospital, memories from Covid sometimes trigger me to wonder, what if we suddenly have to care for twice as many patients in our medical ward? What fundamental changes would need to occur in our workflows and care models that would make me confident our system would hold? What if one day in the future, we are faced with the real challenge of needing to care for twice as many patients at half the cost?
The tools and talent exist to tackle this question; what we need is the will to act before crisis forces our hand. My bet is that in doing so, we will also generate the best, most innovative ideas to improve healthcare.