Paper 02 · Outside banking
Bridging Fragmented Health Systems in the Age of Subscription, Orchestration, and Ambient Care
Most health systems are now funding two incompatible operating models at the same time.
What this paper argues
Health systems are running two operating models in parallel: one built for episodic, encounter-based care, and one emerging around subscription, orchestration and ambient monitoring. Both are funded. Neither is fully governed.
The paper tests the institutional decision chain outside banking. The same pattern appears: the components are governed, the joins between them are not, and the patient meets the consequence of a decision no single part of the system can reconstruct.
Healthcare matters to this body of work because it demonstrates that decision drift is not a financial-services phenomenon. It is a property of institutions that execute decisions through people and systems at scale.
Terms used here are defined once in the glossary: Decision drift · Decision Engineering™
Start with one decision
Name an important decision made in the last ninety days that your institution could not fully replay today — the rule that applied, the data that was live, the authority that permitted it.