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Scott Shreeve, MD

Hey there!

I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Earlier this week, I was in Philadelphia pitching to a client on a national expansion plan. The markets were in the longest bull run in history, and while observers will always tell you they end, most press was celebrating the achievement and predicting its continuation. Employment was at a high point, interest rates were not budging from historic lows, and everyone seemed pretty optimistic. The good times were rolling! Only a few people were watching the growing outbreak of a viral respiratory illness in some distant inland city in China.

Now, of course, it’s all we’re thinking about.

This past week I presented to the leadership team of my company, Crossover Health, a compilation of articles, writing, illustrations, and concepts that helped provoke an already growing urgency of how we should respond to the covid-19 pandemic. The framework that seemed to fit my perspective most appropriately was the  “Black Swan Theory.” This concept, although it dates back to Roman times, was popularized by Nassim Nicholas Taleb in his 2007 book “The Black Swan”. Taleb used the Black Swan as a metaphor to describe high-profile and rare events that are beyond the realm of normal expectations and predictions in history, science, finance, and technology. 

Black Swan events typically have catastrophic consequences due to structural inflexibility and systemic fragility that gets built up over time and can result in unpredictable and unprecedented failure. Yet, despite the pain these events cause, they also trigger extraordinary societal change that endures well past the event itself. A Black Swan event is the ultimate Disruptive Innovator. 

Negative Robustness

Taleb notes that human behavior tends to retrospectively rationalize Black Swan events, as though we could see the signs of them coming. Some events, like the Crash of 2008, are often classified as Black Swans but truly aren’t, as there were plenty of experts warning (and quite accurately) what was going to happen. However, while the marking of a century since the Spanish Flu pandemic inspired many observers to state it could happen again, guessing timing and impact were just mere conjecture. All just probabilities until they inevitably become the new reality. 

Since you cannot “predict” Black Swan events (only retrospectively can you see clearly), you must instead prepare for them by increasing your general fitness or “robustness” to counteract inherent fragility. In our modern world, with its virtual hyperconnectivity and ever increasing complexity, we inadvertently introduce fragility. Taleb posits the concept of “anti-fragility”—or things that can actually thrive and prosper during times of chaos; the ability to not merely withstand a shock but improve because of it. Effectively, this is learning to live and conduct your life and your work in such a way that no matter the circumstances, you succeed. As such, Taleb has been a big advocate for learning how to make our public and private lives “anti-fragile” rather than just simply less vulnerable to randomness and chaos. 

Anti-Fragility: instigating, absorbing, and thriving with change

Our little corner of the world in healthcare is now, obviously, front and center. And it’s also clear that the current processes and systems are going to struggle to cope, because Taleb’s robustness and ability to pivot have been engineered out of healthcare in the mistaken belief that we have tamed uncertainty.  I firmly believe that our unrelenting focus at Crossover on instigating and absorbing change will stand us in good stead to help those in need—and over time, point the way to a new kind of care delivery and experience.

If (when?) our health centers are closed due to policy or quarantine, we will actually thrive because we immediately fully convert to virtual visits. Similarly, when our clients slow down new construction projects due to financial instability, we expand into other programs that add equivalent value. When travel and conferences are cancelled, we actually divert our time to foundational projects that improve our long-term efficiency and sustainability. When your power goes out you welcome the privilege to read great books by candlelight. You get the idea. 

And most importantly, when we get through this challenging time, healthcare doesn’t revert to the old normal. Hopefully, we’ll all learn to not only cope with but truly embrace uncertainty because we’ve adopted and embraced anti-fragility. In that future, the Black Swan is not a foreboding omen but rather a sign of robust growth and new opportunity. 

2 comments on “The Black Swan – Bad Omen or Bountiful Opportunity?

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