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The modern health care paradox

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Paradox -- A statement that is seemingly contradictory or opposed to common sense and yet is apparently true.

The program committee for the Sept. 30 Reshaping Health Care meeting asked me, "The current system seems dysfunctional and unlikely to self-correct. What do you think?"

I think their question is a sign of the times. And I have to compliment them - they are not mincing words, and that makes my job easier. I will tell you what I think on Sept. 30. This is a preview. A more important question: What do you think?

In my experience, today almost everyone agrees the current system is dysfunctional and an increasing number of people believe it will not self-correct. In addition, I see great effort and many resources poured into revolutionary technology, expert management coordination and control systems, more numbers and tighter metrics, new and improved quality improvement programs, better best -practice implementations and big policy and governmental solutions to make the correction.

The mantra seems to be that if health care won't self-correct, someone or something will have to correct health care for us; we just need to try harder.

I have a problem with that thinking. I have been a physician for 34 years, and a health system executive, and a management researcher and teacher, and a patient. In my experience, health care has become increasingly dysfunctional over those 34 years while we have continually tried harder at correcting the system with revolutionary technology, expert management coordination and control systems, new and improved quality improvement programs, more numbers and tighter metrics, better best-practice implementations and big policy and governmental solutions.

My conclusion is that current well-intentioned corrections are part of the problem. But how can that be? On the surface, that seems "opposed to common sense."

Health care is very important. Our industry is filled with smart, highly educated and committed people who have the world's greatest technology and $2.5 trillion per year to spend.

And everyone is dedicated and continually trying harder. And yet, "the current system seems dysfunctional and unlikely to self-correct." How can "the best with the most" fail? It's a paradox.

Harvard Business School Professor Clayton Christensen developed the concept of disruptive innovation to explain another paradox -- the recurring phenomenon whereby the best firms with the most resources fail to develop the simple innovations that transform their industries.

While working with Christensen and others for four years as a visiting scholar at Harvard Business School, we began to develop this concept for health care and have now applied it to our industry for the past six years.

My conclusion: doing what we are doing now with greater devotion and more resources will not enable health care to self-correct. Disruptive innovation makes that conclusion understandable and our current dilemma completely predictable.

So what should we do? The history of innovation in the 20th and 21st centuries shows that successful leaders think and act differently. Start with understanding how disruptive innovation affects you; take the following self-assessment questionnaire.

We will pass this questionnaire out again on Sept. 30, and compile and interpret the results during the meeting.

Reshaping Health Care - What is your organization doing now?

Based on your personal experience, answer the following questions about your organization, Yes or No. If you do not know, do not answer.

Competition

* Is loss of profitable services or products one of your organization's top business issues?

* Is your organization facing competition that gains advantage by "not playing on a level field," for example, cherry-picking simple or the most lucrative business?

* Are some competitors fragmenting previously stable services or products?

* Are previously loyal physician groups and/or former business partners starting to compete against your organization?

* Has your organization used mergers and acquisitions to increase market power or consolidate and/or take capacity out of the market place?

Cost

* Are decreasing your costs one of your organization's top business issues?

* Has your organization engaged in a restructuring or downsizing in the last 24 months or moved business "off-shore?"

* Is it increasingly important to trim or eliminate previously profitable services or product lines that have become low- or no-profit?

Operations

* Is finding and using better operational metrics one of your organization's top business issues?

* Is maintaining employee engagement one of your top business issues?

* Is maintaining customer satisfaction one of your top business issues?

* Is your organization making increasingly large investments in information technology solutions?

* Is your organization focused increasingly on legislative initiatives, regulatory issues and/or new sources of governmental and non-governmental funding?

General

* Does health care need to transform?

* Has your job satisfaction diminished over the last 10 years?

The Sept. 30 Reshaping Health Care meeting will help answer the following questions:

What is disruptive innovation?

How does disruptive innovation affect you and your organization?

How could you use disruptive innovation in your organization?

So, what do you think? I know what one wise person thought: "You cannot solve the problems of the present with the solutions that produced them." - Albert Einstein

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