Where would you start?

In this reflection on Part 2 of the Haven Healthcare series, Dr. Bruce Spurlock looks at the choices Haven made once it moved from ambition to implementation. In Ohio, the organization experimented with benefit design and easier navigation. In Seattle, it explored technology-enabled access to primary care. Different populations, different approaches, and—most importantly—something that could finally be measured.

Bruce explores a fundamental challenge of healthcare innovation: eventually, leaders have to stop designing the perfect strategy and put a foot down somewhere. That first decision creates consequences, produces information, and gives an organization the opportunity to learn.

The question isn’t whether your first decision will be perfect. It’s whether you have built a process that allows you to recognize what is working and adopt, adapt, or abandon as you learn.

Show Notes

In this reflection:

• Why unlimited resources don't eliminate implementation risk
• Haven's experiments in Ohio and Seattle
• Simplifying benefit design and healthcare navigation
• Using technology to improve access to primary care
• Why changing physicians can become a major adoption barrier
• The value of segmenting populations before scaling
• Why a pre-mortem can reveal problems before implementation begins
• Turning implementation into something measurable
• Knowing when to adopt, adapt, or abandon
• Making decisions without the benefit of hindsight
• Why every implementation decision creates consequences
• The question every healthcare leader eventually faces: Where do we start?

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What happens if Haven Healthcare actually succeeds?

Employees get healthier. Prescription drug spending falls. Primary care becomes easier to access. Unnecessary emergency department visits and hospital stays decline. Amazon, Berkshire Hathaway, and JPMorgan Chase spend less on healthcare.

It sounds like success. But in healthcare, lower spending for one organization often means lost revenue for another.

In Part 2 of the four-part Haven Healthcare series, Bruce Spurlock moves beyond Haven's ambitious launch and into the realities of implementation. Haven wasn't entering a blank healthcare system. It was entering an enormous network of hospitals, physicians, insurers, pharmacy benefit managers, pharmaceutical companies, brokers, technology companies, employers, and patients, all operating with different incentives and definitions of value.

Bruce explores the uncomfortable economics behind healthcare transformation and then follows Haven as its broad mission begins turning into actual experiments. New health plan designs are tested. Primary care models are explored. Technology becomes part of the strategy. Employees begin interacting with these ideas in the real world, sometimes differently than expected.

And another challenge begins to emerge.

While Haven was developing new approaches, its founding companies remained capable of pursuing their own healthcare strategies. Amazon Care, for example, was developing alongside Haven's work, raising a much larger question about alignment, independence, governance, and who ultimately controlled the strategy.

None of these developments meant Haven was failing. But together, they were beginning to form a pattern.

In Part 3, Bruce asks: When does a setback become a warning?

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Imagine being given more resources than you could reasonably expect, a long-term time horizon, access to more than a million employees, and a mandate to rethink healthcare.

Would you take the job?

In this reflection on Part 1 of the Haven Healthcare series, Bruce Spurlock goes back to 2018 and deliberately removes what we know today. Amazon, Berkshire Hathaway, and JPMorgan Chase had come together around an enormous ambition: find a better way to deliver and pay for healthcare.

Atul Gawande was brought in to lead the effort, giving Haven an accomplished physician, writer, and healthcare thinker who had spent years examining how healthcare systems work and why they fail.

From where the leaders stood at the time, the opportunity was extraordinary.

But once you accept the opportunity, a much harder question appears: Where do you start?

Do you redesign the entire system? Focus on one population? Choose one healthcare problem? Start small and learn? Or use the unusual scale and resources you've been given to attempt something much bigger?

Bruce reflects on the decisions facing Haven's leaders without using the benefit of hindsight and sets up Part 2 of the series, where the story moves from ambition to implementation.

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On January 4, 2021, one of the most closely watched experiments in American healthcare came to an end. Haven Healthcare, created by Amazon, Berkshire Hathaway, and JPMorgan Chase, was shutting down less than three years after its launch.

Its CEO had already stepped down. Its COO had left before him. The remaining employees would be absorbed back into the companies that created it.

So what happened?

In Part 1 of this four-part Viral Healthcare series, Bruce Spurlock deliberately avoids starting with that question. Once we know how a story ends, hindsight makes it easy to identify all the reasons failure seems inevitable. Instead, Bruce takes us back to January 2018 and asks what Haven looked like to the people making decisions at the time.

Three enormously successful companies. More than a million employees. Extraordinary access to capital, technology, data, purchasing power, and talent. A healthcare system almost everyone agreed needed improvement. Then, six months later, the venture selected physician, researcher, author, and healthcare thinker Dr. Atul Gawande as its leader.

On paper, it was difficult not to believe Haven had a real chance.

But underneath the excitement was a much harder question: What exactly were they trying to fix?

Bruce explores the difference between a compelling purpose and an implementable aim, the complexity of trying to disrupt an interconnected healthcare system, the challenge of governing an independent organization with three powerful owners, and the decisions Haven's leaders faced before anyone knew how the story would end.

And he leaves us with the decision Haven itself had to make: Do you use extraordinary resources to rethink healthcare broadly, or narrow the problem to one population, one market, and one measurable outcome, prove it works, and then spread?

In Part 2: Who loses if Haven Healthcare wins?

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If you're committed to improving health outcomes, how far beyond the traditional healthcare system should you be willing to look? 

In this Episode 25 Reflection, Bruce Spurlock builds on his conversation with Rich Rasmussen, President and CEO of the Oklahoma Hospital Association, and explores what healthcare leaders can learn from the development of the Oklahoma Healthy Oklahoma Profile, or OK HOP. 

Transportation, food access, broadband, preventive services, virtual care, and other factors outside the hospital can have an enormous impact on health. The challenge is that healthcare organizations cannot address every need at once. 

Bruce discusses why leaders need to identify the highest-leverage opportunities in individual communities, prioritize limited resources, and collaborate across the public and private sectors rather than treating healthcare as a collection of separate "swim lanes." 

The larger lesson is about thinking differently. Improving health requires understanding the entire system surrounding the people and communities we serve, then determining where focused action can have the greatest impact. 

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Hospitals collect enormous amounts of data. But how much of that data actually helps improve the health of the communities they serve? 

In Episode 25 of Viral Healthcare, Bruce Spurlock sits down with Rich Rasmussen, President and CEO of the Oklahoma Hospital Association, to explore OK HOP and a different approach to improving health across Oklahoma. 

OK HOP brings together data from hospitals and sources outside the traditional healthcare system to identify gaps affecting health at the community level. Transportation, broadband access, food availability, healthcare access, chronic disease, and other factors can all influence whether patients ultimately achieve better outcomes. 

Bruce and Rich discuss why hospitals, particularly in rural communities, often serve as much more than places to receive medical care. They are anchor organizations, employers, public health resources, and essential parts of the local safety net. 

The conversation also explores how Oklahoma is bringing hospitals, health plans, government agencies, transportation leaders, chambers of commerce, philanthropy, and other stakeholders together around shared priorities and measurable outcomes. 

The lesson extends well beyond Oklahoma. We already collect much of the data needed to understand where communities are struggling. The opportunity is to connect it, prioritize it, and use it to decide where action can make the greatest difference. 

In this episode: 

• How OK HOP turns healthcare and community data into actionable priorities  
• Why rural hospitals are critical anchors in their communities  
• How transportation and broadband access affect health outcomes  
• Why better healthcare requires looking beyond the walls of the hospital  
• How hospitals, payers, government, and community organizations can collaborate  
• Why local proof of concept can help successful interventions spread  
• How other states could replicate Oklahoma's approach  

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When a healthcare innovation has already produced strong results somewhere else, do you need to implement it exactly the same way?

Not necessarily.

In this Episode 24 Reflection, Bruce Spurlock takes a deeper look at fidelity versus adaptation using the ABCDEF, or ICU Liberation, Bundle. The bundle demonstrates why healthcare organizations often have flexibility in how an intervention is implemented, but much less flexibility in what the intervention must accomplish.

Bruce explores how components such as early mobility, spontaneous awakening and breathing trials, pain management, sedation, delirium prevention, and family engagement work together. He also explains why measuring individual components can be just as important as measuring the final outcome.

Before changing an evidence-based practice to fit your organization, the better question may not be, "How can we simplify this?" Instead ask, "What is the purpose of this component, and how will we know we're doing it effectively?"

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A healthcare innovation works somewhere else. The evidence is strong, your organization decides to implement it, and then the questions begin.

Can we simplify this step? Can someone else do it? Can we combine these responsibilities? Do we really need every part of the original model?

Those are reasonable questions, but they are also consequential leadership decisions.

In this episode of Viral Healthcare, Bruce Spurlock explores the tension between fidelity and adaptation in healthcare implementation. Using Project RED and the ABCDEF, or ICU Liberation, Bundle, Bruce examines why some elements of an innovation can be adapted to fit local staffing, workflows, resources, and patient populations, while changing other elements can undermine the mechanism that made the intervention effective in the first place.

Bruce also introduces the idea of "intelligent adaptation" versus "rationalized violation," where individually reasonable shortcuts accumulate until an organization is no longer implementing the intervention it intended to adopt.

The goal is not perfect fidelity or unlimited adaptation. It is understanding what actually makes an innovation work so leaders can adopt, adapt, or abandon thoughtfully.

In this episode:

Why healthcare innovations cannot always be copied exactly

How organizational context affects implementation

Fidelity versus adaptation in quality improvement

Lessons from Project RED and the ICU Liberation Bundle

Why seemingly reasonable shortcuts can undermine outcomes

How to identify the essential mechanism behind an intervention

Why sustainability begins during implementation, not afterward

Questions leaders should ask before modifying a proven innovation

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Healthcare leaders have access to more data and information than ever, but having more knowledge does not necessarily make an organization wiser.

In this Viral Healthcare Reflection, Bruce Spurlock looks at the Serenity Prayer through the lens of healthcare leadership and asks an important question: How do we know what we can change, what we cannot control, and when we need to adapt?

Bruce explores the progression from data to information to knowledge to wisdom, why learning requires humility, and how leaders can remain decisive while still acknowledging uncertainty. Because even a well-informed decision can produce an unexpected outcome, and sometimes an imperfect decision can succeed because an organization knows how to adapt.

This reflection is about becoming a learning organization, not by simply collecting more information, but by getting better at applying what we know.

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Healthcare has never had more information.

We have research, dashboards, conferences, podcasts, webinars, certifications, and endless data. Yet better information does not automatically lead to better decisions.

In this episode of Viral Healthcare, Bruce Spurlock explores the difference between collecting information and genuinely learning. Using the renewed public debate surrounding Dr. Anthony Fauci as a starting point, he examines why so many people search for evidence that confirms what they already believe instead of asking what they can learn.

Bruce discusses confirmation bias, learning organizations, quality improvement, and why the strongest healthcare leaders are willing to change their thinking when new evidence emerges.

If we want better healthcare systems, we have to stop trying to prove we were right and start focusing on making tomorrow's decisions better.

In this episode you'll learn:

• Why information alone does not improve organizations

• How confirmation bias shapes healthcare decisions

• The difference between learning organizations and information organizations

• Why curiosity is one of the most valuable leadership skills

• Practical questions every healthcare leader should ask before making major decisions

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