Two decades into our new century and the pieces of the medical puzzle still don’t fit together. Administrators, algorithm developers and funders each form a rigid static piece, promoting standardization of services, while physicians and patients desire developing more customized pieces.

The prospect of any union is poor – unless the pieces can fit organically together.

In England, the NHS processes each patient in exactly the same prescribed way irrespective of individual values and preferences.  As a result, patients are sacrificed on the altar of external performance standards. The catastrophic failings of this approach, though rare, are graphically illustrated by recent NHS hospital scandals.

In contrast, doctors and their professional organizations have always advocated for the supremacy of professional judgement and the acceptance of uncertainty and risk. This is why clinicians are unlikely to follow clinical practice guidelines in the majority of cases, rather preferring ‘mindlines’, that is, locally reinforced and internalised tacit guidelines, formed by brief reading, experience and interactions with colleagues and patients.

Newer pieces in the puzzle, such as the patient journey, are not clearly identified. Still elusive is the framework for ‘co-producing’ care through tailoring services to suit the often divergent beliefs, wishes and needs of patients and their families.

The prospect of any solution is poor unless the pieces can be moulded to fit together. The problem is one of integration at the edges. Standardization is a major piece of the puzzle because it is easily followed and measured. However, on its own, it is problematic because it can promote only uniformity of healthcare; it cannot ensure improved outcomes. Paradoxically, mindlines and patient journeys are less accountable, but more palatable to the community of providers and users and potentially improve effectiveness.

Unfortunately, the current team-based health care system, which is inherently hierarchical, siloed and sometimes even adversarial, does not promote the integration and interlinking of these pieces of 21st Century health care.

Fortunately, there is a way forward: the development of group structures in health care. In groups, members maintain their individual roles, but are collected together. Participants are not forced into a team shape.

In groups, members interact to share information, best practices or perspectives, and make decisions to help each other perform more effectively within each member’s individual area of responsibility. Participants accept their own professional or personal limitations, and contribute from their own role and background to complete the puzzle that is health care. Groups allow a truly healthy system to join together and provide the best health care for the greatest number of people.