Unlocking peak performance: a perspective on what health care delivery can learn from Formula One racing

I have been an avid aficionado of Formula One (F1) for over 25 years. I've followed the sport closely — analyzing each new innovation, obsessing over its growth and evolution, and enjoying countless races in person or on any screen I could find. 

A few years ago, I went to the British Grand Prix in Silverstone, and I had a seat right above the pits. I recorded a pit stop on my phone, and when I went back to look at it, the entire video was less than 2 seconds long. The engineering, attention to detail, collaboration and preparation that went into that one interaction is mind-blowing. Four tires changed in less than 2 seconds. 

That is excellence in efficiency, precision and teamwork. 

Several leading health institutions in the U.S. and across the globe have recognized this and embraced the many innovations and best practices developed by F1. 

So, what more can we, the U.S. healthcare industry, learn from a sport that has innovated almost as fast as its race cars can accelerate? I believe reaching our full potential as an industry includes a commitment to adopt these innovations more broadly and holistically.   


Bold, audacious and precise goals

F1 is no stranger to ambition. Recently, the organization committed to reducing its carbon footprint to net zero by 2030. For a sport that is, by definition, a gas-guzzling spectacle, this is a truly audacious goal. But F1 isn't daunted by these grand visions, and in fact has made its ambitions public to hold itself accountable.

In addition, F1 has a “Vision Zero” safety approach, which aims to reduce motor-sport related fatalities to zero. F1 has done exceptionally well in this area: Of the 32 total deaths during a F1 race weekend since 1950, only three have occurred in the past 30 years. Despite these significant strides, F1 has taken on a bolder goal of bringing fatalities to zero across all racing formats, and it is prioritizing this goal through innovations, processes and systems. 

F1 has a specific overarching vision: "to unleash the greatest racing spectacle on the planet." This statement is bold and crisp, and it serves as a driving force in every decision made by the organization. Examples include the 2022 design guidelines that make overtaking easier; new formats such as sprint racing, introduced in 2021; audience expansion efforts such as esports; and the widely popular Netflix show "Formula 1: Drive to Survive."

The vision statements of several leading healthcare institutions include common themes around enhancing access to care and improving health and overall quality of life. While healthcare delivery has many fundamental dissimilarities from F1, I see an opportunity for our entire industry — not just individual health organizations — to develop a bold vision statement or statements with precise goals. This could help align all health systems and their partners on priority focus areas and ultimately, success. For example, could the industry strive for 100 percent early diagnosis for certain diseases? Can we strive to cure certain disease types, or reduce total cost of care for standard procedures by 50 percent? This kind of specificity in a vision or goal statement can further enable the industry to achieve the level of excellence for which we are striving. 


Speed of innovation 

Constantly searching for performance advantages has led individual F1 teams to introduce dramatic innovations in order to outsmart the competition. The history of F1 is rich with examples of notable innovations that have improved team performance in their quest to win. These innovations have spanned the gamut of engine design (such as the Mercedes turbo-hybrid engine from 2014 onward), aerodynamic improvements (such as the double diffuser from Brawn F1 in 2009), and other notable innovations introduced on chassis, suspension, gearbox, etc. (for example, the stronger and lighter carbon-fiber monocoque, first introduced by McLaren in MP4/1 in 1981). 

A constant focus on winning has created a culture of innovation. Foundational to this culture has been hiring top talent, including superstars like Ross Brawn, Adrian Newey, Rory Byrne and Patrick Head, and creating strategic partnerships that bring complementary capabilities. Prominent examples include the legendary McLaren-Honda partnership (1988-1991) that paired McLaren’s car design with Honda's engines, and the longstanding Ferrari-Shell partnership, tracing its roots to the 1930s, with Shell's fuel and lubricants extracting maximum performance from Ferrari's engines. By working together and drawing on another organization's strengths, F1 has been able to achieve excellence through accelerated innovation. 

The healthcare industry proved its ability to be agile and innovative when it came together to respond to the COVID-19 pandemic. Health systems were driven to collaborate and innovate by the industry's mission-driven focus to save lives. At the same time, several indicators point toward significant opportunities to bolster innovation and its adoption in U.S. healthcare:

  1. Unsustainable trajectory of costs. At approximately $4.5 trillion, U.S. healthcare spending represents nearly 20 percent of the nation's overall gross domestic product, having almost quadrupled in share of GDP from 1960.

  2. Labor productivity growth in healthcare lags that of the overall U.S. economy. Between 2001 and 2016, healthcare delivery contributed 9 percent of the overall growth of the economy but only 29 percent of net new jobs.

  3. The U.S. has generally worse population health outcomes than other high-income countries, including lower life expectancy, higher infant and maternal mortality rate, etc. 

Several barriers have led to a slower adoption of innovation in healthcare, including misaligned payment and reimbursement economics, regulatory complexity and fragmented industry structure in healthcare delivery. And while several health systems have individually focused on addressing the triple aim of healthcare, can the key stakeholders of the healthcare industry, like F1, accelerate these efforts by working together and drawing on each other’s strengths and resources? Harnessing that spirit of agility, innovation and speed can be the formula that helps the industry as a whole achieve its ambitious goals of improving health outcomes, accelerating productivity (especially as healthcare worker shortages loom), reducing total cost of care as systems move to value-based economics, and improving the overall consumer experience.  

Data-driven decision-making

F1 is truly a data-driven organization. The volume of data collected through more than 300 sensors on each F1 car generates 1.1 million data points per second. This, combined with the fidelity and granularity of analytics, puts F1 at the forefront of data analytics and high-performance computing at a scale spanning the entirety of use-cases: car design, race setup (tweaking design to create the optimal horse for the course), race simulations and strategy, safety and crash simulations, driver performance analysis, etc.

While healthcare has expanded the use of big data to help unlock significant potential for better clinical outcomes, improvements in quality and safety, as well as total cost of care, these efforts are at early stages and the full potential of big data and analytics has not been broadly realized across the industry. Each delivery system can prioritize data analytics as a critical capability to deliver on its mission and augment the provider team with information and insights that will help with more precise decision-making. Further, industrywide collaboration between health systems, payers, life sciences, academia and technology firms can help accelerate the path to a more data-driven care delivery ecosystem that would create value to all stakeholders.

Teamwork for peak performance

The sub-2-second pit stop I witnessed was made possible only due to exceptional teamwork, which involves extensive practice, coordination and deep understanding by every person on the crew. Approximately 20 people on the pit crew need to work in a well-choreographed orchestration to make this possible.

The pit crew represents a small slice of the whole F1 team structure. There are hundreds of employees involved in the complex F1 team organization. As an example, the Mercedes AMG F1 team, the eight-time constructors’ champions from 2014-2021, have more than 1,500 employees that collectively design and develop the car, engines and powertrains and traveling race team. All these individuals work in unison to deliver the peak performance needed to win races. What enables this extraordinary teamwork is the clarity of roles, transparent communication, a culture of continuous learning and a focus on winning.

Furthermore, there are unique roles, such as the race engineer who integrates input from the driver, car and a slew of engineers to communicate bidirectionally with the driver in preparation for the race, in real time during the race and during the post-race debrief. 

How can teamwork reach the pinnacle of performance in healthcare, as it is in F1? An example, which has been well documented, includes Ferrari's collaboration with the National Health Service in the U.K., focusing on handoffs during a procedure being orchestrated in a similar manner to a F1 pit stop. This type of high-performance teamwork is core to reducing care variation and improving quality and outcomes. Further, teamwork at levels of F1 orchestration and precision help bridge the productivity imperative in health care that is much needed at a time of significant staff shortage. What if health systems could create and embed new roles in healthcare, be it in the emergency room or a primary care setting, where clinical teams had a dedicated equivalent of a "race engineer," providing real-time feedback to further personalize care, guide optimal outcomes and design improvement opportunities? 

Pay for performance 

F1 went through a sustained period of increased costs incurred by teams, creating significant advantages for well-funded teams. To address this challenge, F1 recently introduced cost caps, and no team can exceed their cap without incurring penalties. In addition, a significant portion of revenues are determined by performance. F1 revenue from ticket sales, TV and digital broadcasting is allocated back to teams based on points a team receives. In other words: performance-driven payments. 

Healthcare is also faced with unsustainable growth in costs on the back of reimbursement pressures that will stretch health system margins thin. While health-care is moving in the direction of pay-for-performance or value-based care, it is doing so slowly, and a large portion of payments today are still fee-for-service. With growing margin pressures, how can healthcare systems adequately fund innovation and progress to help accelerate the move to new reimbursement models? Focusing our efforts on aligning all stakeholders — payers, employers, providers and government officials — to focus on delivering real value to patients is critical to our industry's ability to effectively and consistently deliver improved outcomes and safety, a better consumer experience, and reduced total cost of care.

Experience and engagement

In the past few years, F1 has dramatically expanded its reach, with current estimates placing its fan base at over 1 billion in 2022. This growth can be attributed to a targeted focus on growth markets, including the U.S. and Asia; digital engagement, including the Netflix series; growth in esports; and the ongoing expansion driven by the #WeRaceAsOne initiative, which prioritizes diversity, inclusion and community. The F1 organization has committed significant resources to creating more engagement, expanding the market and improving fan experience. 

How can we collectively accelerate patient and provider experience in healthcare, leveraging digital and omni-channel experiences, to improve engagement? And how can we ultimately channel this engagement to drive better health consumer decisions (for example, harnessing Nudge Theory to increase the likelihood that individuals will make healthy choices)? 

Relentless commitment to safety  

If there is one similarity between F1 and the healthcare industry, it is our shared commitment to safety. 

In F1, a major crash in 1994 resulted in the death of the legendary Ayton Senna, but in the 28 years since, there has been only one more fatality, thanks to the accelerated innovation that ultimately placed the safety of the drivers — as well as the crew, marshals and spectators — above all else. When it comes to safety, efforts are entirely collaborative across all F1 teams. Although they compete on the track, this is one area in which a governing body (the FIA) dictates consistency and adherence across the entire sport. In 2015, Jules Bianchi, a driver, died from head injuries sustained during a race. In the past two years, I have seen several races where similar outcomes were prevented, the most recent being the crash by Zhou Guanyu at the 2022 British Grand Prix, where the car essentially flipped. The drivers were protected in these recent crashes by an invention called a halo, which consists of a curved bar that protects the head of the driver, an invention that resulted from knowledge gained from the Bianchi crash.

Overall, the healthcare industry has also had its share of defining moments related to safety that have helped accelerate innovation in this area. One notable example is the landmark 1999 report issued by the Institute of Medicine, "To Err is Human," which helped propel patient safety efforts. 

While there has been considerable debate on statistics that point to medical errors being the third largest cause of death in the U.S., due to challenging assumptions used for extrapolation and a lack of high-quality data, one thing we can all agree on is that even the most conservative estimates still place deaths and adverse events from medical errors at a high value. In health care, as in all industries, zero safety events are the only desired outcome. The healthcare industry could benefit from a few core tenets from F1 to achieve this goal. For example, could healthcare organizations expand the mandate of existing noncompetitive collaboratives, something equivalent to the FIA’s safety commission, to analyze all safety data across U.S. health systems in a single, centralized fashion, which would result in the development of best practices and the funding of innovations that would address some of the common safety challenges faced by health systems? As part of this effort, the innovative solutions developed could be more quickly adopted to address some of the common safety challenges across all health systems. 

Summary

It is true that F1 and the healthcare industry are vastly different organizations. Sports, including F1, are inherently based on high-frequency feedback, such as lap times or winning or losing. Healthcare, on the other hand, is a mission-oriented field focused on saving lives and helping communities improve their health and overall quality of life. The infrastructure in F1 allows for more collaboration and the fragmented health care system in the U.S. serves as one of our industry's most significant barriers. 

And while I marvel at the 2-second video of four tires being changed, I have also witnessed extraordinary moments of ingenuity and innovation in healthcare — groundbreaking innovations that have saved lives and contributed to a continuous increase in life expectancy for Americans.  

Nevertheless, for decades, F1 has been the pinnacle of performance, innovation, engagement and safety. Given how our industry came together to respond to COVID-19, can we extend that collaboration and spirit of innovation to solve our industry’s most complex issues? I believe that by working on our issues together and adopting solutions across our industry, we can transform the healthcare delivery ecosystem and take our mission-driven industry to even greater heights. 

About the author

Feby Abraham, PhD, grew up in India and completed his doctorate in mechanical engineering at Rice University in Houston. When he was younger, his ultimate dream was to work as an aerodynamicist, including potentially for a F1 team. Life can take sharp turns, however, and early in his career, he became immersed in fluid flow modeling and other engineering challenges in healthcare. 

Dr. Abraham has more than 20 years of experience in the healthcare sector. Before joining Memorial Hermann, he served as a partner at McKinsey & Co., where he worked for nearly 12 years advising private equity funds across sectors, including healthcare. Before joining McKinsey in early 2008, Dr. Abraham worked as a research investigator with a focus on data analytics and mathematical modeling at GlaxoSmithKline.  

Today, he works to transform how healthcare is delivered to the Greater Houston community as chief strategy officer for Houston-based Memorial Hermann Health System, one of the largest nonprofit health systems in Texas. He is responsible for imagining the future of healthcare, focusing on the ways in which the system serves the community while optimizing care delivery. As he pursues excellence within Memorial Hermann, he continues to refer to the lessons of Formula One. 

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