The final word: Resisting the status quo

Monday, July 01, 2013 12:54 PM

Today’s health care system must embrace change to move forward

Jason Hwang, MD, MBA
Co-author of “The Innovator’s Prescription: A Disruptive Solution for Health Care”

In business school, I read a memorable case study about a company that brought in an innovative piece of equipment that promised to transform its factories. This technology made it possible to utilize new types of workers to build an entirely different set of parts, attract new customers and ultimately grow the business. However, this potential was never realized.

Instead, the new equipment was used sparingly, mainly by employees who had figured out ways the technology could be adapted to help them make the same parts they had always made, and even then only as a backup solution to traditional methods. Most people in the company viewed the new technology as inferior because it couldn’t match or elevate the production that was already in place – though of course preserving the status quo was not what the innovative technology was meant to do.

In the world of health care, we often fall victim to this same mentality. When physicians talk about how to reform the health care system, too often we favor proposals that only preserve or reinforce the existing model of care delivery: tort reform, new and more generous payment codes, increasing the number of medical education slots, greater bargaining power through consolidation, and so on. Moreover, we routinely fight proposals that threaten to change the status quo and affect our historical roles in the system, perhaps most vehemently when faced with the increasing scope of practice of nurses, pharmacists and other health professionals.

However, we must recognize that preserving the status quo is not the only, nor likely the best, way forward. Certainly, with ever-increasing costs and unreliable quality despite our best efforts to date, we already have much evidence to confirm this. What we are putting into practice and routinely advocating does not amount to innovation – it is stagnation.

Yet just like the company above with its many factories, our health care system has numerous opportunities to bring in innovative technologies and care models throughout its many components. Unlike the factories, however, we can ensure they are implemented successfully by actively promoting new delivery models that deliberately challenge our existing practices, rather than just the ones that sustain them.

With this frame of mind, the medical home, for example, is much more than payment reform that protects primary care; it is a radical transformation in caregiving – empowering other members of the clinical staff (and engaging patients themselves), leveraging information technology and data analytics to manage population health, emphasizing and incentivizing patient wellness, and promoting communication across all stakeholders in the medical neighborhood.

Similarly, ambulatory surgical centers and specialty hospitals are not cherry-picking competitors that undermine the system; they are opportunities to rethink how some elements of care could be performed by more efficient entities. Retail clinics that use nurses to provide care are not threats to patient safety, but offer affordability and convenience that the current model lacks. Telehealth providers are not inferior substitutes deserving of low reimbursement; they reach patients that the traditional brick-and-mortar facilities cannot. Smartphone-based apps and consumer-oriented health devices are not toys to be scoffed at; they hold the potential to put an “always-on” health care system in
the hands of everyone.

The pace of innovation in health-related technologies, and in the novel delivery models that accompany them, will only increase. Furthermore, business history informs us that those who suppress, resist or simply fail to recognize the inevitable changes that follow typically end up on the losing side. Physicians must not just become comfortable with this rapid and constant change; we should promote and be a part of it. We must move beyond managing patients as we have always done; we must also lead the people and shape the organizations that care for those patients. That is how physicians can promote innovation, and it is how we can ensure the health care system reaches its full potential.