Do “Patients” Still Matter?
Ever since The Innovator’s Dilemma was published more than twenty years ago, everyone has either been busy trying to disrupt, or scrambling to avoid being disrupted by, a pack of ravenous hyenas.
Jill Lepore, writing recently on the gospel of innovation in the New Yorker (from which the above image comes), says “the rhetoric of disruption — a language of panic, fear, asymmetry, and disorder — calls on the rhetoric of another kind of conflict, in which an upstart refuses to play by the established rules of engagement, and blows things up.”
There are disruption consultants, disruption seminars, and disruption conferences, where you can “hear from people who are not only setting the rules but also changing the tech game.” (TechCrunch is hosting “Disrupt SF” in September; you can get your pass here).
To be sure, structural change has occurred. Deep, inevitable forces have re-configured how the world thinks, interacts, creates, communicates…and in what has value.
But “technology” is a commodity input to this story.
IT is best understood as a form of biology, a living organism producing an ever-expanding zoo of micro-applications and opportunities for new services; it is not a stand-alone being with unique powers, and its potential to differentiate declines when it becomes accessible and affordable to all. There is a heavy price to pay confusing strategy with tech vision: look no further than IBM Layoffs at Watson Health for evidence.
Networking capabilities have not only changed the economics of information, they have also changed the way people and organizations relate to one another. So besides a significantly more complex environment, the nature of self is more complex. This means that the boundaries between customer, competitor and collaborator are basically meaningless.
Organizing a healthcare system on outcomes begins with a new taxonomy to frame new ideas, not attaching new technologies to old modes of being. This includes totally re-thinking the concepts of “patient” and “patient-centricity.” Katherine Schneider, M.D., CEO of the Delaware Valley Accountable Care Organization(DVACO) described it this way during the recent Health IT Summit in Philadelphia:
Dr. Schneider told her audience, what really engages her around her health is engagement with her community — the neighborhood she lives in, in Philadelphia, among other things. And her community, of course, is where she lives, 24/7/365. And, as she also noted, apps alone won’t do it. There has to be a human connection — and, though she didn’t say it explicitly, a process connection.
“The goal is to reduce the friction in healthcare. That’s where people get frustrated, and there’s a lot of waste,” Schneider said. “And this word ‘engagement’ is probably the most overused word in healthcare now.”
Said differently, Schneider is not a “patient” in the conventional sense, bounded in a clinical setting and cared for by a doctor, but a human being in the community and increasingly supported by family at home. Which, as it turns out, is the “hospital” of the future. Here’s Bernard Tyson, chief executive of Kaiser Permanente, on the shift:
People matter.
Which brings us to the news today by England’s NHS about its new “digital” solution where, theoretically, every NHS patient will be able to book GP appointments and check their symptoms on a smartphone app. Ministers promise it will make getting treatment as easy as online shopping.
A consumer-grade experience is indeed the new standard for an infrastructural technology (see Apple, Amazon and the New Health Infrastructures.) Jeremy Hunt, the health secretary, said that it would “revolutionise the way we access health services” in the same way that banking and shopping had been transformed by the internet.
Except that the shortage of GPs is at a crisis level in the UK, and the number of docs leaving the profession is at an all-time high. So who are patients scheduling appointments to see?
The allure of the gadgets is hard to resist, but linking to humans is key.
Value innovation flows from a different mindset. This has less to do with using technology to personalize promotion and push the feature-benefit story of a product (or product branding, depending on your perspective), than it does enabling a unique system of health to grow. Outcomes are based on how the new system performs. The center-of-gravity for competition shifts to the system level.
A dinosaur in a fur coat is not a mammal. The healthcare industry, like many other industries and governments throughout the world, is failing because it has not adapted to the breakdown of Industrial Age ideas.
The path to “transformation” in healthcare will happen through a ‘patient-to-consumer loop’ managed over an extended period of time. In other words, there are only two problems to solve in healthcare: fragmentation and continuous health engagement, at scale.
Quoting Martin Amis:
“We’re at war with cliche. Not just cliches of the pen, but cliches of the mind and cliches of the heart.”
/jgs
