How Healthcare System Complexity Harms and Heals People
Complexity did not simply arrive in healthcare; it was
curated. Layer upon layer of administration, technology, specialty services,
and regulatory processes have transformed a system designed to heal into one
that often delays, distorts, and exhausts. The result is a paradox: a system
that spends more than ever yet leaves many people without timely access to the
care they need most. This essay argues that healthcare complexity has first
harmed the system itself and, in doing so, has harmed patients. It further
contends that while technological advances hold promise, their current
deployment often undermines human care, inflates costs, and diverts resources
from primary and public health—the very foundations of population health and
economic productivity.
The architecture of complexity: primary, secondary, and
tertiary care
Healthcare is commonly described in three levels. Primary
care is the first point of contact for individuals and families, focused on
prevention, early diagnosis, and ongoing management of common conditions.
Public health complements this by addressing community and environmental
determinants of health—vaccination programs, health promotion, and policies
that shape the social conditions in which people live. Evidence consistently
shows that strong primary and public health systems yield better outcomes for most
people at lower cost.
Secondary care involves specialist services accessed via
referral from primary care—cardiology consultations, appendectomies, diagnostic
imaging, and acute hospital care. Tertiary care is highly specialized, complex
care for rare or severe conditions, typically delivered in large academic or
regional hospitals: organ transplants, neurosurgery, advanced oncology, and
complex cardiac procedures.
These distinctions matter because they map onto need. Most
people, most of the time, require primary and public health services. Secondary
care is necessary for a smaller subset of the population at any given time.
Tertiary care, while lifesaving for specific patients, serves a tiny fraction
of the population but consumes a disproportionate share of resources. Yet in
many jurisdictions, including Ontario, funding and administrative attention
flow first to hospitals and specialty programs, even though primary and public
health interventions prevent more illness across the life course.
Where the money goes: administration, executives, and the
mid-layer
A central driver of complexity is the growth of healthcare
administration. In Ontario, the annual Sunshine List reveals the scale of
executive compensation in publicly funded institutions. In 2025, the top
hospital CEO earned nearly $940,000, with several others above $700,000; the
average hospital CEO salary was over $350,000—nearly three times the average
hospital-sector salary. At Ontario Health, the provincial agency overseeing
system coordination, the CEO’s total compensation exceeded $830,000, while the
agency employed over 1,500 staff with an average salary around $129,000. Some
association and agency executives earn double what many hospital CEOs make,
raising questions about how these roles are valued relative to frontline
impact.
This “mid-layer” of managers, consultants, and
administrators is not inherently bad; coordination and policy work are
necessary. But when this layer expands without clear accountability for
frontline implementation, it becomes a sink for public funds. Policies are
written, committees meet, and reports are published, yet there is rarely
mandatory evaluation of whether these initiatives change practice at the
bedside or in clinics. The result is a system that appears busy but moves
slowly where it matters most: access to timely, human-centered care.
Technology’s double edge: promise, dependency, and
workaround culture
Technology in healthcare was supposed to simplify.
Electronic medical records (EMRs), decision support tools, telehealth
platforms, and now artificial intelligence were marketed as solutions to
fragmentation, error, and inefficiency. Yet after my two decades in health
informatics, many frontline clinicians report the opposite: more clicks, more
alerts, more time spent documenting than caring. Nurses and physicians rarely
say, “I love this tech solution.” Instead, they adapt—building workarounds to
keep patients moving through the system.
Workarounds are often stigmatized as deviations from
evidence-based practice, yet they are essential survival strategies in a
complex system. They allow staff to bypass clunky EMR workflows, expedite wound
care, or ensure documentation is completed despite poor interface design. These
adaptations are not acts of rebellion; they are acts of care. However, because
they occur outside formal protocols, they are invisible to quality metrics and
research. No one measures how many hours of nursing time are saved by a
workaround, or how many patients benefit from a process that bends the rules to
prioritize healing.
The cost of this complexity is not only human; it is
economic. Health technology vendors—EMR companies, device manufacturers, and
now AI firms—extract significant public funds with limited scrutiny.
Interoperability across provinces and facilities remains poor, and
outcome-based research on the benefits of these systems during routine
operations or pandemics is sparse. Meanwhile, the promise of AI looms large,
with companies positioning themselves as saviors of an overburdened system. Yet
without addressing the root causes of complexity—fragmented workflows,
administrative bloat, and misaligned incentives—AI risks automating
inefficiency rather than eliminating it.
The economic case for simplicity: health as a driver of
growth
The argument for rebalancing toward primary and public
health is not only moral; it is economic. Research by Bloom and Canning
demonstrates that health is a core input to economic growth, not merely a
humanitarian concern (see Well, 2007 and Harvard article link below).
Improvements in adult survival, vaccination coverage, and maternal health raise
productivity in measurable ways, with effects comparable to traditional drivers
like education or infrastructure. Their work reconciles microeconomic and
macroeconomic evidence, showing that health interventions yield returns that
justify prioritization in national budgets.
If health drives growth, then a system that delays access to
primary care undermines its own economic foundation. When people wait weeks or
months for appointments, when chronic conditions go unmanaged, and when
preventive services are underfunded, productivity suffers. Absenteeism rises,
disability claims increase, and the burden on acute and tertiary care
grows—precisely the expensive end of the system that consumes disproportionate
resources.
In Canada, where healthcare is publicly funded through
taxation, this misallocation is particularly striking. Taxpayers contribute
significant portions of their income to a system that, by design, should
prioritize population health. Yet access to same-day or even same-week primary
care appointments has become rare in many regions. People host illnesses for
days, years, or decades without treatment—not because of staff shortages, but
because the system’s complexity creates bottlenecks.
A personal lens: from frontline to policy and back again
Having worked across the spectrum—from public health nursing
to clinical policy and practice consulting, to health informatics—I have seen
how complexity erodes both care and caregiver. Early in my career, I followed
manuals and medical directives faithfully, only to witness leaders grant
special treatment that bypassed the same rules. Later, in policy roles, I was
overwhelmed by the volume of research and directives on my desk, wondering how
many would ever reach the frontline. The implementation lag is not a bug; it is
a feature of a system that rewards activity over impact.
I have also been harmed by regulatory processes—both through
my own missteps and through reports by others. These experiences left scars on
my professional identity and reinforced a troubling truth: the system punishes
deviation even when that deviation serves patients. Workarounds get people back
on their feet, yet no one formally acknowledges their value. Instead, staff are
expected to twist themselves into pretzels to fit the system, rather than the
system being redesigned to fit human needs.
This tension is personal. As a refugee and immigrant to
Canada, I cherished the opportunity to study nursing and kinesiology as
undergraduate degrees here, and to pursue a master’s in international public
health in Australia. I entered healthcare hoping to help people at the
frontline and in policy. Instead, I lost my path—along with many colleagues who
share this disillusionment. The system does not need this much complexity, and
tech giants do not need this much leverage.
Reimagining care: human-to-human, cradle to grave
What would a simpler, more humane system look like? It would
prioritize access to primary and public health services across the life course,
from cradle to grave. It would offer a no-screen option for those who want to
speak to a person rather than navigate a portal. It would hire more frontline
staff and deflate the mid-layer administration that consumes public funds
without clear frontline impact.
Technology would still play a role, but it would be
subordinate to human care. EMRs would be designed with clinicians, not just
administrators, in mind. AI would augment—not replace—clinical judgment, and
its deployment would be tied to outcome-based evaluations. Interoperability
would be mandatory, not optional, ensuring that patient information flows
seamlessly across provinces and facilities.
Most importantly, the system would acknowledge the value of
workarounds—not as deviations, but as signals of design failure. When staff
consistently bend rules to get work done, it is not a sign of noncompliance; it
is a sign that the system is broken. Listening to these signals, and
redesigning workflows accordingly, would be a first step toward simplicity.
Conclusion: curiosity, complexity, and the cat
The title of this essay borrows from the proverb “curiosity
killed the cat,” but with a twist: it is not curiosity itself that is
dangerous, but the curiosity of complexity—the belief that more layers, more
technology, and more specialization will solve problems that often require
less. Healthcare used to be simpler. A doctor or nurse listened, examined, and
acted. Referrals were made when needed, and surgery was scheduled when pain or
limitation demanded it.
Today, in 2026, getting an appointment can feel impossible.
Humans can host illness for years without treatment, not because we lack
trained staff or tax revenue, but because the system’s complexity creates
barriers. The mid-layer of administration absorbs funds, executives earn
salaries that dwarf those of frontline workers, and tech vendors extract public
dollars with limited accountability. Meanwhile, primary and public health—the
foundations of population health and economic growth—remain underfunded.
The path forward requires courage: to admit that workarounds
are essential, to measure what matters (access, outcomes, human experience),
and to rebalance funding toward prevention and primary care. It requires
skepticism toward the next technological promise, especially AI, until it
proves it can enhance—not replace—human connection. And it requires a
commitment to a system that serves people, not processes.
By 2030, the goal should be clear: more access to primary
and public health services, fewer preventable illnesses, and a frontline
workforce that is supported, not stifled, by the system around them.
Screens should not replace humans; they should enable them.
And the mid-layer should shrink, not grow, as public funds
are redirected to where they do the most good: keeping people healthy,
together, across the life course.
About the Author
Renata was born in 1984 in Oradea, Romania, a region marked
by Hungarian legacies and Romanian cultural tensions since the 1920s (Treaty of
Trianon), as she became a refugee at age four when her family fled the
communist regime in 1988. She grew up in post-communist Budapest, Hungary
(schooling) and Oradea, Romania (summer vacations), experiences that shaped her
social justice and ethical compass, and led her to challenge oppressive and
racist health and social service systems throughout her nursing career. Her
father and brother spend fiver years (1990-95) in Rochester, New York in hopes
for her mother and herself to follow but at that time families could not easily
join. Her family immigrated to Guelph, Ontario, Canada in 1996 and has called
this lovely and safe place home even across her decades of travel and nursing
career. Since completing nursing school in Canada (2003–2008) and continuing
through diverse roles in ortho-trauma, med-surg, rehabilitation, mental health,
long-term care, public health, outbreak management, policy consulting,
education, and global humanitarian work (2009–2019), she has consistently
challenged the status quo, even when it meant alienating friends, colleagues,
and family.
Today, she firmly believes nursing and healthcare remains the most
human-centered profession, uniquely positioned to challenge profiteering
practices, build regulatory and safety guardrails through healthy public
policy, and resist automation of human-care work. Grateful to other nursing and
public health authors for helping her articulate the political nature of her
own choices, she writes in hopes that reflection, awareness, and philosophy
will offer others the same healing she has found through two decades of authentic
practice in nursing and across the health system.
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