The Mechanics of Health Care

Picture a clock tower.

There's a small door at the bottom of the tower. Let's say it is green, not because the color of the door is important to the story; but because I really want you to visualize this.

You grasp the handle with both hands and tug the door open. It groans to let you know it would prefer to remain untouched. You step inside. It’s dark. The only light comes from the bright day you left behind, shimmering through the face of the clock, way up there, at the top. It's noisy. You are surrounded by clatter, grating and grinding. You sense, more than see, that chains or cables are moving. You feel like an intruder in this space.

You look around before looking up. The time wheels are on the ground level. There are two of them. The larger one rotates more slowly than the smaller wheel. Turning constantly, never altering its speed. Time is passing.

As the small wheel spins, it slowly raises a frame connected to the wheel-base. The frame is attached to a mechanism that holds a shaft. A gizmo holds the shaft until a full revolution of the smaller wheel is complete. When the frame reaches its height, the shaft is released and it strikes a large bell. You watch, riveted, as it completes several cycles.

Trail the apparatus up with your gaze and climb the narrow spiral staircase that hugs the inside of the moss-covered walls. The treads are old and coated with a dampness that makes them slippery. You just fit on the stairs. Your shoulder rubs the filth caked on the inside of the enormous structure and you brush it off with your hand. It falls to the ground below.

There’s a cylinder overhead. Go up to where you can better see the cables now, each with its own heavy weight, hanging down from the cylinder. The sunlight, filtering through the clock’s face, strikes the weights and they cast creepy shadows. The weights put tension on the lines. Tension keeps the clock running. Without that burden on the line, the clock would need to be reset every day. Gears mesh and engage. The pendulum swings. Each sweep of the pendulum advances the gears. Each advance of the gear creates One Deafening Tick.

You can see the top of the tower. You take a deep breath, resolved to make it all that way. It’ll take so long to climb. At each rung, you must dig to find a foothold before advancing. But inside this tower is where it all happens. This is where the work is done. One tick at a time.

From where you rest today, look down. Hear the continuous noise from the wheels. Listen for each tick. Wait for the distinctive clang of the bell. The repetition is mesmerizing.

Look across the open dial. The light splashes across your face.
You can see why getting results take so long. From this vantage point the face of the clock is backwards.

"You get caught up in forms, in matrixes, in computer programs, and it just draws you in. They were so focused on the mechanics and the process that they never looked at the problem holistically." as quoted in Blink, Malcolm Gladwell, p.125, Little Brown & Co., 2005.

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