Home Industries Health Services The process, not people, is hurting state’s health care system

The process, not people, is hurting state’s health care system

By

Karl Wadensten

-

12/26/2025

QSfLyvol-Trending_2 — Karl Wadensten

The story didn’t begin in a hospital. It began hours earlier on a Zoom screen during my very first board meeting as a member of the R.I. Business Group on Health. I was sitting with well-tenured leaders who have spent decades inside health care, policy and public service. These were thoughtful professionals focused on outcomes – not optics. Our guest that day was R.I. Health Insurance Commissioner Cory

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The story didn’t begin in a hospital. It began hours earlier on a Zoom screen during my very first board meeting as a member of the R.I. Business Group on Health. I was sitting with well-tenured leaders who have spent decades inside health care, policy and public service. These were thoughtful professionals focused on outcomes - not optics. Our guest that day was R.I. Health Insurance Commissioner Cory King. We were discussing data – premium drivers, trends, policy constraints and cost pressures. It was the kind of conversation that feels analytical and manageable when you are upright, healthy and outside the system you are trying to improve. What I didn’t know was that within a few hours, I would be inside that same system. As the meeting went on, my body started to fail with a sharp pain. Still, I stayed on the call, absorbing charts and constraints while my physical reality was quietly collapsing. The pain remained when the meeting ended. Soon after, I was doubled over and headed to the hospital for what eventually was emergency hernia surgery. Health care was no longer a policy discussion or a data point. It was my lived experience. The system at the door I started watching the moment I arrived in the emergency room. Spanish, Portuguese, English filled the air, layered proof of how this place serves everyone. The ambulance drivers arrived knowing they were handling lives, not just bodies. They remembered the stories and knew the urgency of those they carried. Some patients were moved gently. Others urgently. Some were handed off knowing the emergency room was their primary care doctor and only access point. For many people, the ER is not part of the health care system, it is their health care system. People with language barriers, poverty, mental health struggles, confusion and exhaustion, arrived with real medical needs. The ER doesn’t get to choose; instead, it absorbs everything. From the outside, it’s easy to talk about “appropriate utilization.” From the inside, you see reality. People aren’t abusing the system; they’re surviving it. The ambulance drivers, nurses, techs and doctors carry that weight every day because they refuse to let a poorly designed process fail. People vs. process Lying in a hospital bed strips away titles and distance. I watched nurses that were stretched thin still make eye contact. Doctors make decisions that didn’t stop at the end of their shifts. Teams coordinated under pressure with professionalism that never shows up in spreadsheets or rate filings. Each small act mattered whether it was a blanket that needed to be adjusted, repeating an explanation, or preserving a moment of dignity. These people are working inside a process that is the problem. Lean teaches a simple truth: People are not broken, processes are. A process has no feelings, no kids and is not your neighbor. However, a broken process pushes good people into impossible tradeoffs. It creates human waste of waiting, overburden, rework, burnout and moral injury along with financial waste. When we fight each other, hospitals versus insurers, employers versus providers, regulators versus businesses, we shut down the conditions required for improvement. Trust erodes, curiosity disappears and humility is replaced with defense. When infrastructure shows its age That same day, the backup generators at a Rhode Island hospital did not perform as expected during a power outage. Care continued not because the system was resilient, but because people compensated. Nurses adapted, doctors recalculated and teams rerouted care in real time. That is not resilience - that is risk. When aging infrastructure fails, the burden silently transfers to people. A Day of Convergence While Rhode Island was processing the Brown University shooting, a major windstorm rolled through the state, testing power and infrastructure. Though the events were different, the lesson was the same. When systems are under stress - health care, public safety and community - standing apart only increases the risk of failure. Systems break when their parts pull against each other instead of reinforcing one another. Health care is no different. If we continue to fight each other politically, institutionally, and financially, there will not be that place which knows how to console, heal and put broken pieces back together. People can only compensate for broken processes for so long. The fight that matters This is not a complaint. and it is not theoretical. It's about urgency. Hospitals are not villains; insurers are not cartoons; employers are not just checkbooks and patients are not statistics. We are all inside the same system. We must stop fighting each other and start fixing the process together if we want better outcomes for businesses, workers, and communities. Kindness is not soft, dignity is not optional and humility is not weakness. They are prerequisites for fixing complex systems. I confirmed something that day in the ER I already believed but now feel it more deeply. We are fighting a process, not people. Unless we stand together, the system will keep bending until it breaks. The people inside it deserve better, and so do we. Karl Wadensten is a member of the R.I. Commerce Corp. board and president of VIBCO Inc., a manufacturing company based in Richmond. He has spent more than 25 years helping build and retain jobs in Rhode Island’s small and mid-sized business sector.