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Disruptive Innovation and Transformation
in Healthcare
Paul Plsek Consultant on Innovation and Change in Complex Systems, Atlanta Mark Hutcheson Chair of Innovation, Virginia Mason Medical Center, Seattle
Outline The call for transformation in healthcare Definitions of terms Understanding disruptive innovation and
transformation in healthcare Challenges
The growing demand… Improved access… less waiting… faster
diagnosis and paths to treatment… more convenience… less anxiety … even better outcomes… more involvement in care… greater sensitivity to cultural differences…
Around the world, the talk is about the need for reforms US Europe (e.g., UK, Germany, Scandinavia)
Australia
“Healthcare systems around the world are engaged in striving to make radical and sustainable changes through various programmatic approaches to improvement... The words…leave no doubt that what is being envisaged is big, bold, transformational change…Internationally there is a parallel realization and understanding that the design of the existing healthcare system will not deliver what is required for the future.”
Bate, P., Robert, G. & Bevan, H. (2004). The next phase of healthcare improvement: what can we learn from social movements? Quality and Safety in Health Care, 13 (1), 62-66.
“The challenge is to bring the full potential benefit of effective health care to all… this challenge demands a readiness to think in radically new ways about how to deliver health care services.”
US Institute of Medicine “ Crossing the Quality Chasm”
“You cannot solve a problem using the thinking that got you there”
Albert Einstein
Innovation…
The purposeful production of creative ideas in a given topic area, followed up by deliberate efforts to
implement some of those ideas.
Creativity... The connecting and rearranging of
knowledge — in the minds of people who will allow themselves to think
flexibly — to generate new, often surprising ideas
that others judge to be useful.
Plsek PE. Creativity, Innovation and Quality. ASQ Press, 1997.
Edward deBono’s Mental Valleys Model for Thinking
Streams of thinking Valleys
Existing Mental Models Block Innovative Thinking Our mental models become natural way of
seeing and explaining things Difficult to see (“like water to a fish”) Hard to imagine any other way Filters our perception of reality and keeps
us in our mental valleys Reinforces the status quo and locks us into
incremental thinking Innovation = Breaking the ‘rules’
“Creative thinking involves breaking out of established patterns (valleys) in order to look at things in a different way.” de Bono
Purposeful channel Random jump
Creative addition…
+
The drive-thru flu shot at Virginia Mason Medical Center in Seattle…
Creative addition…
+
Creative addition…
+
Creative addition…
Read more: http://channel.nationalgeographic.com/series/explorer/4828/luke#ixzz1JEZibfmB
Luke Massella
Directed Creativity via 4Ws Tool Usual primary care Alternatives???
Who Doctor is main care giver. Doctor manages disease, patient is expected to be compliant.
What (or
How)
Some pro-active and preventative care, but mostly care and information-giving in reaction to symptoms, delivered primarily face-to-face in office visits.
When On doctor’s schedule.
Where Primarily in doctor’s office.
Incremental Improvement to Radical Innovation Continuum
© 2003 Paul E. Plsek & Associates, Inc.
Doing what we do better
Doing what we do in a
more clever way
Doing something that has
never been done before, challenging
many paradigms
Doing something different by challenging
1-2 paradigms
Incremental Improvement
Radical Innovation
Defining Service Innovation
“A step change in the who, what, when and where (4Ws) of health service delivery —relative to the usual approach in a comparison context—that produces a step change in performance when implemented.”
Source: Maher LM and Plsek PE. Making a Bigger Difference: A Guide for NHS Front-Line Staff and Leaders on Assessing and Stimulating Service Innovation. NHS Institute for Innovation and Improvement, 2008.
Tool: Seven Dimensions of Performance (IOM+1)
Source: Maher LM and Plsek PE. Making a Bigger Difference: A Guide for NHS Front-Line Staff and Leaders on Assessing and Stimulating Service Innovation. NHS Institute for Innovation and Improvement, 2008.
Safety Timeliness Effectiveness Efficiency Equity Coordination *
(across the whole system)
Patient-centeredness
Tool: 4Ws Table
Current thinking…
Potentially innovative alternatives…
Who?
Does What? (or How?)
When?
Where?
Incremental Improvement to Radical Innovation Continuum
© 2003 Paul E. Plsek & Associates, Inc.
Doing what we do better
Doing what we do in a
more clever way
Doing something that has
never been done before, challenging
many paradigms
Doing something different by challenging
1-2 paradigms
Incremental Improvement
Radical Innovation
AHRQ’s Health Care Innovations Exchange Web-based Repository of Service Innovations
National electronic learning hub for sharing health care service innovations, bringing innovators and adopters together
Searchable database featuring innovation successes and failures, expert commentaries, lessons learned, etc.,
Designed to help health care “Agents of Change” improve quality
innovations.ahrq.gov
What is Disruptive Innovation? Coined by Clayton Christensen, Harvard
“Cheaper, simpler, more convenient technologies, products or services that ultimately let less expensive professionals provide sophisticated services in affordable settings, or that enable customers (patients) to service themselves.”
Requires fundamental shifts in thinking about the who, what, when, and where of service delivery value streams
Tertiary hospital
General hospital
Outpatient clinic
Office
Home
Patient AHP Nurse Family MD Specialist Disruption
Disruptive Innovation in Health Care
“…typically driven by scientific understanding that shifts the method used to diagnose and treat disorders from an unstructured, experimental, problem-solving process that demands a high level of professional expertise towards a rules-based regime that is less demanding.” Christensen CM and Anthony SD. Cheaper, faster, easier: disruptive innovation in the service sector. Strategy & Innovation. January-February 2004. (Harvard Business School reprint number S0401A)
Disruptive Innovation Examples The PC displacing mainframes ATMs and Internet banking On-line/distance/franchise education (e.g., Univ of Phoenix) Paralegals and websites (e.g., LegalZoom.com) providing ‘good
enough’ legal advice on some topics Retail primary care clinics staffed by RNs and NPs Angioplasty as an alternative to thoracic surgery for substantially
more patients Home blood glucose monitors and mail-in clinical tests for
people with diabetes Note changes in who, what, when, or where at
various points in overall system
Outline The call for transformation in healthcare Definitions of terms Understanding disruptive innovation and
transformation in healthcare Challenges
Are we training the next generation of clinicians to lead disruptive innovation and transformation of health care?
Some Challenges for Leaders of Transformational Innovation
Deep knowledge in specialized topics, with curiosity, inquisitiveness and openness to new ways of thinking
Generative relationship skills Systems thinking Multi-lingual (in sense of professions/disciplines)
Team leadership Optimism, hopefulness and inspiration
Four Venues of Leadership for Transformational Change
Political process
Bureaucratic process Adaptive action
process
Community process
Adapted from: Westley F. The devil in the dynamics: Adaptive management on the front lines. In Gunderson LH, Holling CS. Panarchy: Understanding Transformations in Human and Natural Systems. Island Press, 2002.
Outline The call for transformation in healthcare Definitions of terms Understanding disruptive innovation and
transformation in healthcare Challenges
Be of strong heart, innovation is nearly always opposed initially…
“That it will ever come into general use, not withstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble; both to the patient and practitioner. Its hue and character are foreign and opposed to all our habits and associations.”
A physician writing to the editor of The Times of London, in 1834
The stethoscope!…
Disruptive Innovation and Transformation
in Healthcare
Paul Plsek Consultant on Innovation and Change in Complex Systems, Atlanta Mark Hutcheson Chair of Innovation, Virginia Mason Medical Center, Seattle
