Speed as a strategy

In competitive healthcare markets, strategic advantage increasingly belongs to organizations that can observe, decide, and act faster than their rivals. This article examines how Col. John Boyd’s OODA Loop framework—developed for aerial combat—applies to healthcare operations, particularly complex patient discharges.

Introduction

Healthcare organizations face intense competition for patients, referrals, and post-acute care partnerships. Market share battles are fought daily, though rarely with the explicit terminology of warfare. Yet the fundamental dynamics of competition remain: organizations that can observe their environment, orient to changing conditions, decide on action, and execute faster than competitors will win.

This reality was formalized by U.S. Air Force Colonel John Boyd, a fighter pilot and military strategist who revolutionized aerial combat theory. Boyd observed that victory in dogfights didn’t primarily depend on aircraft speed or firepower. Instead, it belonged to the pilot who could complete their decision cycle—observe, orient, decide, act—faster than their opponent. Boyd called this the OODA Loop.

The pilot with the faster loop “gets inside” their opponent’s decision cycle. By the time the opponent acts on yesterday’s observations, the situation has already changed. Their actions become irrelevant, mistimed, or counterproductive. The slower combatant falls further behind with each cycle.

This same principle applies to healthcare organizations, though the stakes involve patient outcomes and organizational survival rather than aerial combat. The healthcare system that completes its OODA Loop faster gains sustainable competitive advantage.

The OODA Loop in Healthcare Operations

Let’s examine how the OODA Loop manifests in a specific healthcare challenge: complex patient discharges to post-acute care facilities.

Speed Comparison: Traditional vs. High-Tempo System

Traditional System — Total: 2-4 Days

Phase	Time	Description
Observe	Hours-Days	Manual calls to facilities, waiting for responses, gathering scattered information
Orient	Hours-Days	Interpreting facility capabilities, translating between organizational languages
Decide	1+ Days	Coordinating stakeholders, negotiating preferences, obtaining approvals
Act	1+ Days	Coordinating transfer, arranging transportation, completing paperwork

High-Tempo System — Total: 4-12 Hours

Phase	Time	Description
Observe	Seconds	Real-time data platform shows availability and capabilities instantly
Orient	Instant	Automated matching of patient needs to facility capabilities
Decide	Hours	Pre-aligned stakeholders, clear options, streamlined approvals
Act	Hours	Platform-coordinated execution, pre-arranged logistics

The high-tempo system completes its OODA Loop 6-12x faster than the traditional system. This isn’t just efficiency—it’s a sustainable competitive advantage. While the slow system occupies beds for days at $2,000-$3,000 per day, the fast system maintains throughput, captures more referrals, and builds loyal networks.

The Traditional Discharge Process: A Slow Loop

Consider a large, multi-facility health system competing for market share in a metropolitan region. When a medically complex patient needs discharge to a skilled nursing facility or rehabilitation center, the typical process unfolds over days:

Observe: A case manager begins calling post-acute care facilities from a list. “Do you have an available bed? Can you handle a patient with these specific needs?” Each call takes 10-15 minutes. Some facilities don’t answer. Others require detailed fax submissions before responding. The observation phase stretches across hours or even days.

Orient: When a facility responds positively, the real work begins. The facility faxes a questionnaire requesting detailed clinical information. The hospital team must interpret whether this facility can actually meet the patient’s needs. The orientation phase involves translating between different organizational languages and capability descriptions. More hours pass.

Decide: After collecting information from multiple facilities, the team evaluates options. But the decision isn’t straightforward. The patient’s family has preferences. The insurance company has a preferred network. The medical team has clinical concerns. These stakeholders don’t align automatically. Meetings are scheduled. Emails are exchanged. The decision phase extends across another day or more.

Act: Finally, a facility is selected and the transfer is initiated. But implementation has its own delays. Paperwork must be completed. Transportation must be arranged. The receiving facility needs time to prepare. The patient transfers two or three days after the initial observation phase began.

The High-Tempo Alternative: Speed Through Alignment

Now consider a competing healthcare system that has architectured its operations differently. This system has invested in aligning its discharge process, eliminating the structural conflicts that create delays:

Observe: A shared data platform shows real-time bed availability across a network of aligned post-acute care partners. Each facility’s current census, staffing capabilities, and specialized services are visible instantly. The case manager doesn’t make phone calls—they query a system that already knows the answer. Observation takes seconds, not hours.

Orient: The platform doesn’t just show bed availability—it matches patient needs to facility capabilities automatically. The system has pre-negotiated agreements about what each facility can handle. Clinical requirements are standardized and machine-readable. The orientation phase is instantaneous.

Decide: With clear information and pre-aligned stakeholders, decisions happen rapidly. The patient’s family reviews 2-3 genuinely suitable options rather than a vague list. Insurance approvals are streamlined through network agreements. The medical team trusts the capability matching. Decision cycles that took days now take hours.

Act: Transfer execution is coordinated through the same platform. The receiving facility begins preparation immediately. Transportation is pre-arranged through network agreements. The patient transfers the same afternoon or next morning.

Why Speed Creates Sustainable Advantage

The faster system doesn’t just discharge patients more quickly. It creates a competitive dynamic that the slower competitor cannot overcome through conventional responses.

Getting Inside the Competitor’s Loop

When the aligned system completes its discharge cycle in hours, it captures referrals that the slower system cannot. Primary care physicians and specialists learn that their patients move through the aligned system efficiently. They begin preferring to admit patients there. Emergency departments in the aligned network maintain better throughput, accepting transfers that slower competitors must divert.

The slower competitor observes declining referrals and increased diversions. They orient by analyzing the problem: “We need better discharge planning.” They decide to hire more case managers. They act by adding staff.

But by the time they’ve implemented this response, the aligned system has already moved forward. They’ve added new post-acute partners to their network. They’ve integrated the platform with their EHR system. They’ve trained clinical staff to use the streamlined process reflexively.

The slower competitor’s action—adding case managers—doesn’t address the fundamental issue. More staff making phone calls and sending faxes is still orders of magnitude slower than an aligned network with shared data. This is what Boyd meant by “getting inside” the opponent’s decision cycle. The faster organization makes the slower organization’s actions irrelevant before they’re even implemented.

Network Effects and Lock-In

Speed advantage in healthcare operations creates powerful network effects. Post-acute care facilities prefer working with the aligned system because coordination is easier and faster. They receive patients with complete, standardized information. They experience fewer surprises and readmissions. They become invested in the partnership.

Physicians experience similar lock-in. Once they’ve learned that their patients flow smoothly through the aligned system, they’re reluctant to send patients elsewhere and risk delays. The aligned system captures mindshare and referral patterns that persist even if competitors eventually match capabilities.

The Theory of Constraints Perspective: Conflicts That Kill Speed

Why don’t all healthcare organizations operate at high tempo? Not because they lack intelligence or effort, but because they operate within systems containing unresolved conflicts. These conflicts force repeated delays and rework at every decision point.

1. Thoroughness vs. Speed

Discharge planners must ensure patient safety and appropriate placement (which demands careful evaluation) AND must move patients quickly (to maintain throughput and control costs).

2. Authority vs. Responsibility

Case managers have responsibility for discharge outcomes but lack authority over facility selection, insurance approvals, physician orders, or family decisions.

3. Standardization vs. Customization

Each patient is unique, requiring customized care planning. But customization in every transaction prevents systematic improvement and automation.

4. Competition vs. Collaboration

Healthcare systems must compete aggressively for market share AND must collaborate extensively with post-acute facilities and other market participants.

A practical note: Every system contains numerous conflicts. Theory of Constraints doesn’t suggest resolving all of them—attempting to do so leads to analytical paralysis. Instead, identify the conflicts that most directly constrain your system’s performance. In discharge operations, these four conflicts demonstrably slow the OODA Loop. Resolve these, and cycle time improves dramatically.

Building High Operational Tempo: Practical Implications

Healthcare leaders seeking to build strategic advantage through speed should consider several principles:

1. Map your current OODA Loop

For a critical process like complex discharges, document exactly how long each phase takes. Where does information flow break down? Where do stakeholders wait? Most organizations are shocked to discover how much time their processes actually consume.

2. Identify the conflicts

What competing requirements force your organization to choose between speed and other necessary objectives? These conflicts are often invisible because they’re embedded in organizational structure, policy, and culture.

3. Resolve conflicts architecturally, not procedurally

Adding more staff, creating new committees, or writing more detailed policies typically doesn’t resolve structural conflicts—it adds layers that slow the loop further. Resolution requires changing how information flows, how authority is distributed, and how coordination happens.

4. Build networks, not just capabilities

The competitive advantage of high operational tempo comes not just from internal efficiency, but from aligned external partnerships. Post-acute care networks, physician relationships, and payer agreements all contribute to loop speed.

5. Measure cycle time religiously

If you’re trying to compete on speed, you must know your loop times and track them continuously. What gets measured gets managed. Organizations that don’t measure cycle time cannot improve it systematically.

Conclusion: Speed as Strategic Imperative

In competitive healthcare markets, operational tempo increasingly determines strategic outcomes. The organization that can observe, orient, decide, and act faster than competitors will capture referrals, build loyal networks, and achieve superior throughput and financial performance.

This advantage doesn’t come from working harder or adding more resources. It comes from identifying and resolving the structural conflicts that slow decision cycles. Organizations that invest in systems architecture—aligning authority with responsibility, resolving thoroughness-versus-speed conflicts, building coordinated networks—achieve step-function improvements in cycle time that competitors cannot match through incremental changes.

Col. John Boyd’s insight from aerial combat applies directly to healthcare strategy: the fastest loop wins. Not because speed is inherently valuable, but because speed enables getting inside competitors’ decision cycles, making their actions irrelevant or obsolete. In healthcare, this translates to better patient outcomes, superior operational performance, and sustainable competitive advantage.

The question for healthcare leaders is not whether to compete on speed, but whether to architect their organizations to enable high operational tempo or continue operating within conflicting systems that make speed impossible.

Let’s Talk

If your organization is struggling with slow cycle times in critical processes like patient discharges, or if you’re interested in exploring how systems architecture can resolve conflicts that impede operational tempo, I’d welcome a conversation.

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John Sambrook Common Sense Systems Email: contact@common-sense.com Phone: 425-979-2282 Web: common-sense.com