Innovators Prescription

Clayton Christensen book on HealthCare need for Disruptive Innovation

ISBN:0071592083

http://innovatorsprescription.com/

Intro

• the US HealthCare system is in big trouble; other countries aren't really doing better in terms of productivity, they just have different set of Trade-Off-s (cheaper personal cost, vs waiting times and other rationing of certain types of care)

• there's no Shared Vision for a new system, just lots of micro-suggestions

• HealthCare is still like the Main Frame-era computer industry - there's Sustaining Innovation going on, but it doesn't change the access equation

• need 3 levels of innovation to make real change

  • technological enabler:

    • there are plenty that haven't been leveraged with the other stages

    • there are new things coming along

      • precision diagnostics (he contrasts "precision" to "intuitive" - the latter requiring The Craft of a highly trained (and compensated) Physician, the former allowing Rule Based application by a Para-Professional).

        • many things that seem to be a single disease are really a cluster of similar/different syndromes: there are now 38 types of leukemia and 51 lymphomas identified.

        • genetics

        • imaging system

      • precision therapeutics

      • EHR/PHR

        • Indivo: WalMart and Intel have adopted the "standard" (via Doss Ia)

  • Business Model change

    • from Disrupting Class: Oystein Fjeldstad and Charles Stabell: 3 generic types of Business Model-s: Solution Shop (The Craft), Value Chain, Facilitated User Network

    • right now everything is forced into being deployed by either Hospital or Physician Practice. Both are Solution Shop-s.

    • hospitals need to un-bundle departments that can be treated more like Value Chain

    • Physician practices will be disrupted by Retail Clinic-s like Minute Clinic, and by Para-Professional-s (often working in those clinics), and by Disease Management networks (for chronic care patients)

    • major employers will begin to contract directly with integrated fixed-fee providers (e.g. KaiserPermanente), cutting out Health Insurance companies

      • hmm, does Network Economy model cut against this? BigCo-s are having enough trouble just surviving...

  • creation of Facilitated User Network for P2P value creation: Patients Like Me, etc.

Medical Education

• integrated providers will start training their own doctors

  • example: General Electric Business School at Crotonville Ny

  • Will LCME groups allow certification of these doctors, if this is done instead of traditional Medical School? Answer: start with Para-Professional schools.

• Harvard Medical School has a NewPathways program of integrating basic-science and clinical-education curricula, instead of doing basic-science alone for 2yrs, followed by 2yrs of clinical education.

• applying Learning model from Toyota Production System (Toyota) could shorten Medical School while doing better job