Sunday, February 25, 2007

Clinical innovation - Disruptive Innovation at Work: One Solo Doc, One Internet, One Room, One Year Later

It's no secret that health care delivery is convoluted, expensive, and often deeply dissatisfying to consumers. But what is less obvious is that a way out of this crisis exists. Just as the PC replaced the mainframe and the telephone replaced the telegraph operator, disruptive innovations are changing the landscape of health care Nurse practitioners, general practitioners, and even patients can do things in less-expensive, decentralized settings that could once be performed only by expensive specialists in centralized, inconvenient locations. If the natural process of disruption is allowed to proceed, the result will be higher quality, lower cost, more convenient health care for everyone.”

Clayton Christensen, Richard Bohmer, John Kenagy, “Will Disruptive Innovations Cure Health Care?” Harvard Business Review, September 1, 2000

Every once in a great while,
thanks to God, Google, Good Friends, and Go-Go Bloggers,
word reaches me through outer, inner, or cyberspace,
that some Wild and Crazy Guy,
has turned the world of health care upside down
by disrupting the way things ought to be,
or are presumed to be by those in the know.
The way things ought to be, of course,
is doctors working in teams in big groups1,2
to get the right things done at the right time,
for the right reason with the right measurable results.
But now my good friend, Doctor Val Jones,
Senior Medical Director at the Revolution Health Group,
owners and developers of,
a comprehensive website designed to empower consumers,
and to turn the cosnumer health care world downside up,
sends me word through her personal blog,
which you can google by typing in ValJonesMD
or going through,
that this Wild and Crazy Guy in Rochester, New York
Gordon Moore, MD, a family doc, working alone,
but on the faculty of the Institute of Health Improvement,
has come up with and implemented,
this Wild and Crazy Idea,
that One Doc Working Alone in One Room,
with no support staff and nothing but a computer
with Internet access to keep him company,
can revolutionize solo practice,
by making it more productive, profitable, and fun.
Sure, I know it sounds crazy,
But he backed and documented
the theory and work of his practice
in a medical journal article,
“Going Solo: One Doc,
One Room, One Year Later.”3
In one year, he did the following:
Maintained open access scheduling,
meaning he saw patients on the day they called;
took his own call, reduced other access barriers,
developed deep and personal relationships
with his patients by spending 30 minutes
with each one of them;
reduced his patient load
from 25 to 30 to 12 patients each day;
operated without support staff,
in one room of 150 square feet,
averaged $65 per patient visit, and
expected to take home $155,000 a year,
thanks to a lean IT system and low overhead.
He did this with high patient satisfaction rates,
and a high percent of quality goals met.
He built his unorthodox practice
on these four basic principles:
1) Access. Patients have unlimited access to the care
and information they need when they need it.
2) Interaction. Interaction between the patient and care team is deep and personal.
3) Reliability. The system exhibits high reliability in that it provides all and only the care known to be effective.
4) Vitality. The practice has vitality: happy employees, a spirit of innovation, and financial viability.
Along the way as he practiced these principles,
he developed and articulated these philosophical axioms.
Interaction is not the price we pay to submit a claim.
It is the essence of what we do.”
“The strategy of exhortation, “Try harder! Read one more article!
Check one more time! Go to one more conference! is bankrupt!”

What do I call this Wild and Crazy Guy’s strategy
of solo practice, lean IT systems, one room, no support staff,
ridiculously low overhead, spending more time with patients,
developing deep and personal relations with happy patients,
meting clinical goals of quality,
and upsetting the multispecialty conceptual applecart,
at least in this isolated instance,
that being in integrated groups the only way to practice?
I call it “Disruptive Innovation!”


1. Halvorson, George, and Isham, George, Epidemic of Care: A Call for Safer, Better, and More Accountable Health Care, Jossey-Bass, 2003.
2. Lawrence, David, From Chaos to Care? The Promise of Team-Based Medicine, Perseus Publishing, 2002.
3. Moore, Gordon, “Going Solo: One Doc, One Room, One Year Later, “ American Academy of Family Medicine, March 2002..

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