Organizations default to complexity. Simplicity requires more work, not less.
The Bias Toward Complexity
Adding a step to a process is almost always easier than removing one. Adding a committee is easier than dissolving one. Adding a metric to a dashboard is easier than deciding which existing metric to retire. Organizations accumulate complexity the way houses accumulate objects: gradually, through many small decisions that each seem reasonable at the time.
Eric Cecava came from a manufacturing background where eliminating waste is the core discipline. Lean production is built on the idea that most of what a process does is not value-adding, and the work of operational improvement is removing the non-value-adding steps. That discipline is harder to apply in healthcare than in manufacturing, because the waste is less visible and the stakes of getting it wrong are higher.
But the principle holds. Most healthcare processes are more complex than they need to be. Most of that complexity was added in response to a real problem at some point. Some of it was never removed after the problem was solved. Some of it was never the right solution to begin with.
What Simplification Actually Costs
Simplifying a process or structure requires decisions that adding complexity doesn’t. You have to decide what to stop doing, and stopping things has costs. People lose work. Systems become unnecessary. Processes that were familiar have to be relearned.
There’s also the political cost. Complexity tends to be distributed across teams and individuals who each have a stake in their piece of it. Removing complexity means removing pieces that belong to someone. That’s a harder conversation than adding something new.
Eric Cecava has proposed simplifications in organizations that were technically correct and operationally sound and still took two years to implement, because the political work of getting agreement on what to remove took longer than the operational work of removing it. The simple solution was the hard one.
The Lean Insight That Applies
The insight from Lean that comes up most often in this context is the idea of standard work: a defined, documented, minimal process for doing a task correctly every time. Standard work is not a constraint on how people do their jobs. It’s a baseline that makes it possible to see when something is going wrong.
Without standard work, process variation is invisible. You can’t tell whether someone is doing something differently because they found a better way or because they misunderstood the process. With standard work, variation is visible, which means it can be investigated and addressed.
Building standard work in a healthcare context is difficult, because clinicians often experience it as a reduction in autonomy. The work of making it stick is explaining what it’s for: not to constrain clinical judgment, but to make operational problems visible. That explanation requires patience and repetition, and it requires that the people building the standard work involve the people who will use it.
How to Think About It
Eric Cecava’s default assumption when he encounters a complex process is that the complexity is hiding a problem. Either the underlying logic of the process is sound but was never simplified after it was designed, or the process was built to accommodate a constraint that no longer exists, or the complexity is doing political work — distributing ownership so broadly that no one person is responsible for whether it works.
The test he applies is: can he explain why each step exists? If he can’t, or if the people doing the work can’t, that’s a signal that the step should be examined. Sometimes it has a good reason. Sometimes it doesn’t.
Simple is not the same as easy. But simple processes are more reliable, more teachable, and more fixable than complex ones. Building them is harder. Running them is not.