Sunday, October 25, 2009

Clinical Innovation - Disruptive Innovation, for the Alliterate

Disruption enables less-skilled people to do more sophisticated things. Disruptive innovation enables a large population of less-skilled population to do things in a more convenient, lower-cost setting, which historically could only be done by specialists in a less convenient setting.

Clayton Christensen, Harvard Business School, Disruptive Innovation in Health Care, January 2008

October 25 – This morning’s news is that health costs will rise 15% for small businesses. Brokers and analysts trace this sharp increase to insurers anticipating Obamacare’s impact on earnings and profits.

This bad news raises the question: can we innovate our way out of this unsustainable rise in costs? Yes, says Clayton Christensen, a professor at Harvard Business School. He introduced the phase “disruptive innovation” into the management lexicon in 2003.

Christensen advances this proposition, “Health care hasn’t become affordable because it hasn’t gone through disruptive decentralization.” By this, he means we haven’t decentralized care down the health care chain from specialized hospitals, to community hospitals, to outpatient facilities, to doctors’ offices, to home care, to self care, nor have we transferred much care from specialists to generalists.

According to Christensen and followers, successful disruptive innovation allows less costly people using less costly approaches in decentralized settings to:

1) do the work of those in more centralized specialized settings;

2) meet the demands of consumers without asking them to change their usual ways of doing things;

3) meet the requirements of organizations and regulations;

4) to do so, by beginning small in seemingly unattractive “trivial” new ways of doing things.

As a writer and sometime poet, I’ve been thinking how I can express the concept of disruptive innovation in a more succinct, yet comprehensive and memorable way to bring it into sharper focus and to give a few examples.

Here is my alliterative definition.

Disruptive innovation is delegating, designating. distributing, and decentralizing doctor duties and devices to decrease dollars and diminish delays in downscale destinations deployed by different deliverers of care.

This is admittedly a contriveed tongue-in-cheek alliterative stretch.

Allitrative wordplay aside, the point is a lot of things in health care can be done well by nurses, nurse practitioners, physician assistants, a new group of people called “medical assistants,” patients themselves using rules-based protocols and, and doctors deploying new approaches in mobile, small, technologies, both IT and non-IT based, and new business models in downscale environments - all while preserving the role of doctors to make complex, clinical judgments their educations prepares them to make.

Some examples, some of which may seem “trivial” or "far-fetched" will suffice.

• Having nurses and physicians assistants take histories, do school physicians, collect history information, give immunizations,

• Hiring laptop bearing “scribes” follow doctors and enter patient information and physician findings.

• Enabling patients to record their own chief complaints, narrative histories of present illness, and personal medical data using clinical algorithms.

• Training a new corps of “medical assistants” to perform duties of RNs, LPNs, and other paraprofessionals.

• Recruiting a new form of hospice nurse, “the end of life nurse, “to go to homes during a patient’s dying days.

• Expanding the array of tests patients can perform themselves – blood lipids, pregnancy tests, home monitoring devices for vital signs and glucose.

• Expanding markets of “convenient clinics”- urgicenters, round-the-clock primary care clinics (staffed by rotating primary care physicians), retail clinics, and worksite clinics.

. Encouraging doctors in offices to use portable ultrasounds to pinpoint needle biopsies and abscesses, check for deep vein thrombosis, peripheral vasccular disease, aneurysms, clogged carotids, and to avoid X-ray and CR-radiation.

. making primary care physicians through medical homesthe center of Amerieca's health system.

I am aware I am oversimplifying, maybe even “trivializing” a subject as broad and complex as dbruptive medical innovation, which includes such things as surgical and anesthesia advances, angioplasty, outpatient surgeries, outpatient imaging, and noninvasive vascular diagnostic – most of which occur in specialized settings.

Nor have I touched upon such disruptive innovations as arthroscopic surgery, artificial intelligence, complementary medicine, electronic medical records, endoscopic surgery, e-prescriptions, gene therapy, health savings accounts, implanted devices, intravascular diagnosis and treatment, joint replacements, laparoscopic and natural orifice surgeries, nanomedicine, noninvasive surgery, personal medical devices, portable ultrasound, data mining, prognosis forecasting, personal therapeutics , stem cells, telemedicine , wearable monitors, web-based information, wellness monitoring.

In other words, seek simplicity, low-cost, and disruptive innovation , but put it all in context.

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