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Upsetting the Apple Cart: Disruptive Innovation Needed to Change Health Care Delivery

June 26, 2012 By Jennifer Thew, RN, MSJ 4 Comments

“The department of redundancy department.” I first heard that phrase while in journalism school. I’m pretty sure one of my professors had written it on an assignment of mine to call attention to the fact that I had crossed the line between proving a point and belaboring one.

At the time, I thought it was a cute way to tell me to stop repeating myself. But during the past four years, as I’ve heard the words health care reform again and again, I’ve started to think the department of redundancy department wasn’t just a joke. Maybe it actually exists and is working behind the scenes to try to change our health care system by doing the same old thing time and time again.

Probably the most notorious part of the recent attempt at health care reform (which itself is nothing new, Hillary Clinton took a stab at it in 1993) was the health insurance mandate. People became fixated on it. It was trampling our constitutional rights. The government was telling us what to do. It would just line the pockets of insurance companies. But no one seemed to stop and question if it, or any part of health care reform, was going to truly change and improve our system. Wouldn’t there still be huge deductibles, co-pays that were too high and plans with 80/20 coverage that would still leave an average person with medical bill debt? And how would we keep health care costs down while increasing access to care?

To truly change the health care system, disruptive innovation is needed. I first heard the term disruptive innovation while attending an Illinois Organization of Nurse Leaders conference in 2009. Jason Hwang , MD, MBA,  Executive Director of Healthcare at Innosight Institute, gave a speech on how disruptive innovation could be applied to our health care delivery system to create change.

Just what is disruptive innovation? A theory developed by Harvard Business School Associate Professor Clayton M. Christensen, disruptive innovation:

  • Meets the needs of new customers overlooked by existing products or services in the marketplace
  • Slowly improves the performance of the product or service to which it has been applied
  • Has a value that becomes appreciated by the mainstream market
  • Because of its improved perception, replaces and disrupts the existing products and services in the market.

One simple example of disruptive innovation is Toyota. When it entered the U.S. marketplace, Toyotas were cheap but not the most reliable vehicles. Still, people who couldn’t afford cars before were able to buy Toyotas. The company began to refine and improve the quality of its cars, and eventually, Toyota earned a reputation of having cars that were more economical and better quality than American-made autos.

In health care, retail clinics, telemedicine and mobile personal health records all have the potential to cause disruption in the health care delivery system. One innovation I think has huge potential to change health care delivery is the Hospital at Home care model developed by the Johns Hopkins Schools of Medicine and Public Health.

Patients who need hospital-level care, but are at a low risk of clinical deterioration and who are less likely to require highly technical hospital-based procedures, can be admitted to Hospital at Home if they meet medical eligibility criteria. Patients with illnesses like heart failure, chronic obstructive pulmonary disease, cellulitis or urinary tract infections are good candidates for Hospital at Home. This care model has been found to lower costs by nearly one-third and to reduce complications.

Technology often helps drive disruptive innovations. There is no doubt in my mind that HIT could help shift the way we deliver health care. Perhaps it could improve nurse triage lines, prevent readmissions or allow specialists to perform virtual visits with patients who are not in their geographic area. The possibilities are endless. How do you think HIT can disrupt our health care system and provide lower-cost, higher-quality care?

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Jennifer Thew, RN, MSJ

Jennifer Thew, RN, MSJ, is a registered nurse and journalist who has covered healthcare issues and how they relate to the nursing profession. She began her nursing career as a neuroscience nurse at Rush University Medical Center in Chicago and then transitioned to journalism after receiving a degree from Roosevelt University in Chicago. She has edited and written numerous articles on a wide range of nursing and healthcare topics like Accountable Care Organizations, evidence-based practice and telehealth.
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Latest posts by Jennifer Thew, RN, MSJ (see all)

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Filed Under: Health care, Healthcare IT, mHealth Tagged With: Clayton M. Christensen, Disruptive Innovation, EMR, health IT, Innovative Instititue

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  • Hospital Management Software

    Nice description. Technology is trying a lot to change the healthcare system. EMR, EHR, Telemedicine, PACS,DICOM, these are the example of advanced technology in healthcar system.

  • thinkdisruptive

    You are thinking too conventionally. None of the things you mention — retail clinics, telemedicine or mobile personal health records — have any chance at all of disrupting the health care delivery system. These are all tweaks to the way things operate now.

    That doesn’t mean that these things don’t have potential to disrupt small pieces of the system. For example, retail clinics could take a serious bite out of emergency services. Long run, they might even disrupt hospitals for that piece of the market and become the primary place people look to for triage. But the whole health system? Please.

    To disrupt the health care system, you have to start with what doesn’t work about it. Health records are a mosquito on an elephants hind end. Telemedicine is a tiny incremental process change, and not necessarily more convenient, faster or better solution than online self-diagnosis, after which most would seek real care if they believe they have a problem.

    Disruption would require tackling the biggest and most intractable issues: cost, access, service levels, control, bureaucracy with less complex, inexpensive and more personal solutions that are systemic. It would require disintermediating insurers and employers as the deciders and controllers of routine healthcare. All these middlemen do is increase cost, deny services, tell me who I can and can’t see, hide the real cost of services by insulating consumers from providers while simultaneously making health services like a buffet where the consumer is incented to “eat” as much as possible (thereby increasing costs across the board), and make services less convenient and less personal. Insurance should only be available for catastrophic, unpredictable and expensive needs, and they and employers should be regulated out of the provision of healthcare (and not replaced with an even worse government system).

    Another big factor is lawsuits. Capping medical malpractice suits to rational levels (orders of magnitude lower than is routinely granted today), using alternatives to the court system (requiring arbitration for all but the most serious cases), and banning legal payment by contingency would eliminate 90% of the unnecessary cost of insuring doctors, which is necessarily passed on to the consumer.

    To attack systemic causes of cost, complex and poor care issues like these need to be directly confronted or bypassed. It requires solutions that upend the way the whole system works, not things that enable it to keep hobbling along by applying bandaids and tourniquets to the most egregious pain points.

  • Murphy

    This is an interesting comment from @thinkdisruptive and seems to be one
    anonymous person’s thoughts about what would revolutionize or
    recreate the entire health care system. Problem is that this article
    didn’t intended to tackle the all-encompassing problem of healthcare in
    America. Hell, since @thinkdisruptive is so ambitious, maybe he should
    quit toying around with healthcare delivery and use his Genius on world
    peace, poverty, global warming, the corrupt political system, or how
    they get the cream filling inside a Twinkie.

    This type of comment is what is truly disruptive: Disruptive to
    dialogue. Disruptive of inviting outside opinion. Disruptive of personal
    knowledge growth. Thanks!

  • Quanta-His Kim

    Very informative article you shared here.

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