Health care needs less #innovation

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.