The question for healthcare is whether disruptive innovations are required to radically improve value and outcomes? Alternatively can tinkering with the system, (QIPP, ACO, Medical Homes, pay for performance, increase measurement and accountability) drive sufficient performance and improvement. To truly understand the significance of this question, one has to understand both the power of disruptive innovation and the failure of those agencies being disrupted to challenge the disruption.
Disruptive innovations essentially create a market for a product or service that the incumbents fail to recognize. They do so, often by offering a cheaper, slimmed down product; think Ryanair. One may not like them but they not only offer a cheaper reliable service, but developed a market for services that no-one could have imagined, (London Lodz anyone?).
Existing airlines had no incentive to develop such innovations; they were happy with their quasi-monopolies. Ryanair had to develop such markets in order to grow. if existing companies were to chase these market opportunities, they would cut into their existing markets and reduce their profit margins. In a sense they are helpless to do anything, apart from resisting and fighting back, (think lobbyists, negative advertising campaigns)
Jump to healthcare, the structures are identical. Seemingly strong vested interests, institutional, professional, academic, who will do their best to fight any interloper promising a better cheaper service. And they are helped immensely by the emotional arguments that if the service they offer is undercut, people will die.
Are there examples of such disruption in health? They are likely to appear when the current model no longer makes financial sense, or where Western models are not applicable. It is likely that if this economic downturn persists that we will begin to see disruptors emerge in both the West, and emerge from the developing world into the West. For example, “Aravind the world’s biggest eye-hospital chain, performs some 200,000 eye operations a year. It takes the assembly-line principle literally: four operating tables are laid side by side and two doctors operate on adjacent tables. When the first operation is done, the second patient is already in place.” (Economist April 2010)
A paper by Robert Brook of the RAND corporation outlined one vision of potential disruptors. These include:
- Considering the entire cost of care, to include not just the cost to the individual but the energy cost, (carbon cost)
- Unifying the two great silos of medicine and education so that educators play a central role in improving children’s health and healthcare providers are judged partly on their success at improving educational attainment in their patients
- A shift to non-physican care, e.g. nurse practitioners
- Reduce the training required for repetitive technical task; for example why go to medical school, residency and fellowship to train how to remove cataracts. Pretty radical.
- Routine healthcare delivered 24/7. So no more 9-5 operating rooms or clinics.
- Outsourcing or off-shoring of many tasks, including diagnostics, elective surgery which is already happening.
