Health care has caught the innovation bug.
An industry famously resistant to change suddenly can’t stop innovating — or at least saying it is. Silicon Valley startups are disrupting health care. Academic medical centers are transforming it. Insurers are revolutionizing medicine and there are any number of conferences devoted to health care innovation. Even the federal government wants in on the action.
Meanwhile, the U.S. health system is unable to safely and consistently provide some of the most basic elements of care. It struggles with massive discrepancies in quality, cost, and outcomes across the country — and performs worse than nearly all its peer nations.
The most glaring deficiencies don’t stem from a lack of technology or creativity or innovation. Many shortcomings could be solved by adopting widely recognized best practices and committing to a handful of mundane, lifesaving processes. Think surgical checklists, timely removal of central venous catheters, and adoption of safe birth practices.
While some health systems have successfully reduced medical errors, improved their use of evidence-based guidelines, and coordinated care across doctors, most continue to struggle — and patients pay the price.
With grossly uneven quality and a body of existing solutions, does health care need more imitation and less innovation? As Anna M. Roth and Thomas H. Lee suggested in the Harvard Business Review, maybe we should be anointing more chief imitation officers — people who scour the literature and the country for effective practices to bring home — and fewer chief innovation officers.
Imitation gets a bad rap. It’s often considered a second-rate behavior for those who can’t think for themselves.
Yet many of the world’s most effective companies have built on existing products and become vastly more successful than the original innovators. The first credit card company wasn’t Visa or Mastercard but the Diners Club. McDonald’s, the world’s largest restaurant chain, followed White Castle — now perhaps best known for its role in the cult comedy “Harold & Kumar.” Facebook borrowed many features from other tech companies.
Health care has a dissemination and implementation problem. We often know what to do and how to do it, but don’t consistently do it. By some estimates, it takes 17 years for a new medical development to become widespread clinical practice.
Take the case of beta blockers. By the early 1980s, a large body of high-quality medical evidence showed that individuals who took beta blockers after having a heart attack were substantially less likely to die prematurely than those who didn’t take beta blockers. But more than decade later, only half of heart attack survivors were taking beta blockers, and in some states less than one-third did. Even in 2010, many patients prescribed beta blockers weren’t getting the right dose.
Or consider pressure ulcers, which can form when elderly or immobilized patients lie in bed for long periods. The risk of pain, infection, and death due to pressure ulcers has been recognized by the medical community for decades, but they continue to affect 2.5 million people a year and account for yearly costs of nearly $12 billion. Donald Berwick, a leader in improving the quality of health care, once described a pair of “innovations” that one hospital used to reduce pressure ulcers by 80 percent: examine patients for signs of debility and turn them every two hours. Neither one of these is patent protected.
If you end up in a hospital, there’s no doubt that it is nice to have a single-occupancy room with remote sensors recording your vital signs and an Alexa to call your nurse. It’s even nicer to know you won’t get a bloodstream infection from the catheter in your neck — a function of humdrum stuff like checklists and antiseptics.
Part of the hashtag innovation trend in health care reflects a broader cultural phenomenon lionizing what’s new and shiny. Too often the question isn’t how do we fix this problem? but rather how can we use this technology?
It wasn’t always that way. Innovation, as a word, has a complex past. For much of American history, it represented not laudable creativity, but disrespect for established tradition bordering on heresy. George Washington is said to have warned against “innovation in politics” while John Adams promised Congress he would never “innovate upon principles which have been so deliberately and uprightly established.”
But innovation has had a renovation. It’s now a universally revered if empty catch-all term that describes anything new or different, whether it’s of value or not. The scientific community has been complicit: The use of “innovative” and other positive words in academic journals has risen dramatically since the 1970s.
This is a problem in health care, where so much can be new and different but so little seems to deliver on the fundamental promise of improving health. The relevant questions for patients and doctors should not be how much money a company has raised, or its valuation, or its growth opportunities. It’s whether whatever it is providing will help people live longer, healthier lives.
A recent analysis found that the majority of highly valued health care startups have few or no peer-reviewed publications supporting their products, and that hardly any have published high-impact papers with human subjects — instead relying on the type of “stealth research” that allowed for the rise of Theranos.
An overemphasis on faux innovation — change for the sake of change — leaves much useful imitation behind. It’s how we end up investing billions in technologies of questionable value, while failing to adopt rudimentary practices that reduce preventable harm and ensure patients reliably receive treatments they need.
The truth, of course, is that it’s not an either-or choice. We need both imitation and innovation. Sometimes, it’s good to look around and adopt things. Sometimes, it’s fine to move fast and break things. Unless they’re people.
Dhruv Khullar, M.D., is an internal medicine physician and a health policy researcher at Weill Cornell Medicine and director of policy dissemination at the Physicians Foundation Center for the Study of Physician Practice and Leadership.
Just a minor bone to pick. Allow me to give you a little helpful historical reference to beta-blocker use in the 80s. Unlike you, I was practicing in the 80s when beta-blocker(s) were limited to two choices, Inderal and Inderal (propranolol), with Corgard (nadolol) a late 80s innovation. For primary prevention, Inderal required dosing three times daily, a virtual impossibility for a working person to comply with (work breaks were not legally mandatory in the 80s). Profound fatigue, erectile dysfunction, exertion dyspnea and orthostatic hypotension was common, making the drug almost intolerable except for a select few. Those were the days when even a previously good employee could be fired for little reason. If an employee’s performance suffered as a result of beta-blocker fatigue, they were gone and their entire family suffered the effects of the breadwinner’s loss of work (most families had a major breadwinner or even a single income-earner during that time). Corgard offered better compliance with single daily dosing but little, if any improvement in side-effects. Rather than lose their jobs and cause their family to suffer economic hardships, many simply decided that the risk of job loss simply wan’t worth the benefit of some nebulous, idealized goal, to them, of prevention. If you will note, neither of those two drugs are currently drugs of choice for primary prevention because we now have much better choices with few, if any, side-effects common to the earlier drugs. Medicine and physicians weren’t slow and lumbering in adopting new recommendations as you so blindly and uninformedly state. We did our best with the tools that we had. The tools simply hadn’t been refined and improved to a level of tolerance that made use practical. Despite being an “expert” you seem to be quite ill-informed. Perhaps you should research those blunt, accusatory assertions that denigrate an entire generation of physicians, colleagues, brothers and compatriots before you let the “gunner” in you bubble to the surface and embarrass yourself with your ignorance.
Well said. Innovation for innovations sake is where we are stuck right now.
I for one think the telephone seems to be greatly underutilized right now. A 2 minute phone call can often clear up considerable confusion aoround a patients medical history and preferences for care, something that reams of electronic transmission fail to do.
This article nails it for me. My family finds US medical care impressive from a building and technology perspective, but if you want sufficient staffing, time with providers, more complete electronic healthcare records, affordability and just a happy, safe human touch—try another westernized country. I once offended a Swiss doctor, because I turned down having a cup of tea with him during my appointment. I explained US providers don’t have time to pee, much less time for tea, as it’s like a fast moving conveyor belt of care type system. I prefer healthcare outside the US.
As well stated by the author, one of the goals of innovation should be to “reduce preventable harm and ensure patients reliably receive treatments they need”. Based upon my research of leadership of health innovation, performed from 2016-2018, that included a leading United States health sector organization identified as a global leader in innovation and 7 health organizations created within the English National Health Service to foster innovation for patient benefit; health innovation was best defined broadly as the implementation of processes and products ‘new’ to a health organization. Too often, leaders think of health innovation only applying to disruptive technological innovations. As discussed by the author, with respect to healthcare providers, informative and how-to knowledge regarding health innovations ‘new’ to an organization may already exist in other organizations.
How about innovating/imitating by supporting primary care rather than expensive hospital systems. Works around the world. Pay for it with the same facility fees big health systems get, or simply share the pot of gold/fees. Stop viewing dinosaur primary care practices as stealing the health systems’ attributed lives.
What do you think, Alexa? Anchor primary care practices in every community, rural or urban? Or more rural closures and impoverishing primary care practices? That’s a real choice for consultants.
Innovation in healthcare is more likely the result of problem solving by its end users and outsiders than its producers. That’s about to change. Radical incrementalism will not solve its problems.
This is a fresh new look into healthcare industry , which no one has thought of earlier.
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