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 The management of change has many options. First we have to believe we have to change. In health care, I continue to be astonished by caregivers who ask me why I am so committed to dramatic change, even at the risk of disrupting what we have. I honestly believe we must innovate or die. I’m serious.
The phrase “Innovate or die” comes from Tom Peters, a fantastically interesting man whom I have had the pleasure of knowing well. His “In Search of Excellence” launched him into the business quality guru limelight. Like Jim Collins, he based his advice on what he found by looking at successful companies. Health care systems are at that point: either we innovate or we will die of strangulation at the hands of fee-for-service medicine as piecework payments drop and we burn out and fail as we try to cover our high fixed overhead with declining fees and declining volume.
I am fortunate enough to be enrolled in a leadership course at Massachusetts General Hospital, where I heard recently that health care systems will have to improve efficiency by 2 percent each year over the next decade, or go broke. Why? Because government, employers, insurers, and, most of all, those we serve can no longer afford us. So the “die” road looks like this: hang onto our old ways of provider centric workflows, attempting to see more volume of reduced-payment services, with little attention to what patients really want. Soon the net revenue will not cover the cost, so many start the downhill spiral of cutting staff, service, and materials, and running the flow faster through a broken system.
The innovate/achieve success path looks like: figure out what out the population really needs (it helps to ask them), shed services we don’t need, enhance services patients need and want, and get really good at customer service so we build loyalty. Generally that will mean fewer decentralized inpatient services with regionalization of high tech care, and much more robust and patient-centered outpatient care. That means providers have to get out of their view of the world through the lens of what providers need, and become everything our customers want. The literature suggests the lists of our customers’ wants includes same day access, extended hours, walk-in clinic services, no waits, talking to a person when they call the office, web access to schedule appointments, emailing providers, and highly personable care. All of these are currently being delivered many places; I have seen it.
To get there requires first an ability to see where you’re going. But big companies and complicated industries like health care (or film) often have a hard time seeing the disruption to their industry coming until it is too late. I think we are at that point in health care — especially hospitals. So to innovate we have to let go of stuff we are used to doing while we start new things. Popularity:This record has been viewed 3537 times.
Thursday, February 21, 2013 by Kevin Lake
Thanks Mark
Here is the way that I find myself thinking about the change that is already happening:
Historically, the structure of health care delivery has been driven by the assumption that health care consists of units of clinical service which are exchanged for money. At both the federal and Massachusetts state level, legislative initiatives have been passed and ratified that are changing this. The emerging model is that money is to be exchanged for the achievement and maintenance of health, and health care consists of whatever efforts are effective at producing that health.
In this evolution from a fee-for-service model to a population health model, the definition of our product is changing away from specific clinical intervention (usually by a doctor), and towards a broad array of efforts that produce health and well-being. Such efforts include clinical intervention by other providers, education to help individuals and families avoid disease (or manage or cure or self-care for disease that already exists), initiatives to promote lifestyle change (diet, exercise, smoking, sleep, meditation, etc), primary (pre-disease) interventions of all kinds (immunization, pre-birth and pre-parenting care and training, etc) and any and everything else that produces health and well-being throughout the community. Note that this new reality requires the recognition that all persons and entities engaged in efforts that produce this healthier world, are by definition part of a health care system. This system is not and cannot be hospital-centric, and while it may be physician-led, it cannot be physician-centric.... it has to be community-centric.
An accelerator of the evolution of this new system is technology.....consider the new array of health-related smartphone apps and attachments: Qualcomm's iPhone case that enables it to perform an electrocardiogram, or an (already FDA approved) ultrasonic probe that makes the iPhone into an ultrasound that displays, stores and transmits images, or CellScope's otoscope which goes on sale this year for under $200 and will allow parents or school nurses to send images to pediatricians to diagnose ear infections, or Scanadu's Scout, a tiny $150 device going on sale next year that will take, transmit and store vital signs by touching to a person's temple. In the new world, it is inevitable that most health care will not happen in a health care setting. We can either wait to see what that new world will look like, or we can help create it.
Innovate or die indeed.
Thursday, February 21, 2013 by Paul Norton
It's hard to see the future when so much of the delivery(payment) of health care is not transparent. We see increasing insurance premiums, decreasing reimbursements and we are discussing how we can become more efficient? The insurance industry has us over a barrel. They have us sign contracts that force us to charge out of pocket patients ridiculous charges that no one pays.
Want efficiency and innovation? All one needs to look at is Lasix, cash for treatment from the patient. Costs have not risen like third party payer models. Consumers will spend their money more wisely if they are actually seeing and holding the money
Let HSA's roll over indefinitely. No maximum. Watch as insurance companies die and have to innovate and become efficient to try and come close to efficay and efficiency of the person recieving services paying for the services directly.
Thursday, February 21, 2013 by Mark Novotny
Bharathi
You are correct that change is hard for all humans. On the other hand if we have experienced hanging on too long, can get used to change...
Everyone worries about our jobs. All the more reason to jump in and make ourselves the best we can be. If we focus on improving our customer service and market share we can reduce the chance of job loss. The more attractive we are to patients , the more jobs we will have.
Thursday, February 21, 2013 by Bharathi Janaswamy
I am all for change, I believe that resistance to change takes people nowhere. Unfortunately, lot us are concerned about job security in the process. which I think is a genuine concern. But change is always good. Thanks Dr. Novotny for this encouraging blog.
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