A collaborative initiative: pipe dream or possibility?

Students of social sciences and economics are familiar with and have had lengthy discussions about the game theory known as the “prisoner’s dilemma.” The “prisoner’s dilemma” was created by Merrill Flood and Melvin Dresher in the 1950s and later formalized by Albert W. Tucker. The theory behind this game reveals why two people may not cooperate even if it is in the best interest of both parties to do so. The classic prisoner’s dilemma is represented in Table 1. Today, the label “prisoner’s dilemma” is often applied in the business world when two independent corporations would gain substantial benefit from a collaborative venture, but fail to do so because of real or perceived difficulties or financial constraints. Even though the collaboration is possible, no attempt is made. Most HEMS providers are living this modern version of the “prisoner’s dilemma.” Many agree that working collaboratively with neighboring HEMS programs will mitigate overall risk and increase safety for those programs. Still, many do not or cannot collaborate together. Clearly when individual HEMS providers work collectively to overcome common challenges, the results are impressive (and there are number of regional examples). There is a general consensus by all HEMS stakeholders that collaboration is welcomed and encouraged. However, there are many regions within the country where one can observe a seemingly universal and often self-imposed lack of collaboration. Occasionally this is the mindset of individuals or entire HEMS providers, but more often it is caused by lack of the skills to “reach across the competitive divide.” Open collaborations demonstrate to the general public (our customers), and government regulators that neighboring “competitors” can work together to improve clinical medicine while reducing overall risk and improving safety for themselves and the community at large. The permissive culture of competitive isolationism must be combated with a paradigm shift, sense of urgency, and a set of practical educational tools to accomplish this goal; the goal being a collaboration of neighboring HEMS programs that identify commonalities and work together to create solutions.