The future of adaptive innovation in health care may be surprising

Issue: April 2012

ByJohn W. Kenagy, MD

Introduction

Intuitively, we know changing times bring opportunities, but few relish the idea of change. This article outlines why current conditions make this a time of opportunity, how normal human neurophysiology makes it difficult to realize that opportunity and what we can do about it. The solution is probably not what you think — and that is good.

Anthony M. DiGioia III, MD
Emerging Technology & Innovation Editor

Now is the time of greatest opportunity in orthopedics since the emergence of total joint replacement. It may not be what you think. Let us explore why and how we, and our patients, have a new opportunity.

For starters, I am a vascular surgeon who believes that bones are important. For me, one bone made a big difference — C2. In 1992, in the midst of a busy, growing surgery practice, I fell out of a tree and broke my neck. Fortunately, I sustained a non-displaced odontoid fracture. I did not pith myself and, although disabled for 6 months, made a full recovery.

That experience changed my thinking. Surgical expertise and technology were important — but, as a surgeon, I already knew that. I discovered my recovery depended on something more: the efforts of hundreds of people, from housekeepers to senior executives, who used their knowledge and creativity to problem, solve “the system” to get me what I needed. “The system” often did not help and even got in the way.

Great outcomes despite the system? That changed my thinking and started me on a path to unexpected places, like 4 years as a visiting scholar at Harvard Business School. Here is some of what I learned along the way.

Anthony M. DiGioia III

John W. Kenagy

Let us start with how “the system” works. In successful 20th century health care systems, managers analyzed data in meetings, while the frontline just got the work done.

The result: Successful 20th century health care systems increased quality in silos and increased the cost of care. But now, we cannot afford increased costs. That is the opportunity.

Just like total joint replacement in the 1970s, the factors that will drive success in the future have changed.

20th century success = increase quality and increase cost.
21st century success = more and better care and decrease cost.

Those who deliver more care for less cost will be uncommonly successful. It is a new basis of competition and that is why it is a time of opportunity for all of us.

But, that is only part of the story. I am a surgeon. I needed to know how to do it.

I focused my Harvard research on the few companies who gained competitive advantage by innovating to provide more for less in ways others could not duplicate. Apple is a good example.

Studying their success, I discovered that Albert Einstein was right: “You cannot solve the problems of the present with the solutions that produced them.”

In my research, the leaders who changed the basis of competition all asked, “Will what got us here get us there?” and answered, “No!”

Therefore, following the path of Steve Jobs and Einstein (pretty good company), we ask, “Will sending more data up to people in meetings while the frontline just does the work get us more care at less cost?” The rational answer is, “No!”

Think differently

Now, it gets interesting. There are many alternatives to current management and frontline methods; that is not the problem. More care/less cost means both management and the frontline have to think differently. That is the problem!

Thinking differently is the problem because, as John Kenneth Galbraith said, “When faced with the choice between changing one’s mind and proving that there is no need to do so, almost everyone gets busy on the proof.”

Recent advances in neurophysiology explain why. Human brains become physiologically hard-wired to repeat what they have done successfully and are non-consciously threatened by what they do not know how to do. The drive to automatically repeat past success and view the unknown as a threat is a non-conscious, neurophysiologic norm for every human.

When the world changes, the greater the past success, the harder it is to think differently. In his book Collapse, Jared Diamond documents: “The values that people cling to most stubbornly under inappropriate conditions are those that were previously the source of their greatest triumphs.”

That is our successful management and physician brains, naturally, “clingingly stubbornly.” Data is necessary, but insufficient to change mindsets and behavior. You cannot think your way to a new way of acting; you have to act your way to a new way of thinking. Management and physicians experiencing success together — that is the only way to learn to think differently. Our brains say it is so.

How to experience success together is not rocket science, just different thinking. It starts when management and physicians decide together, “What got us here will not get us there.” That opens the door. No one is at fault. There is nothing to blame. The world has just changed. The slate is clean.

Out of the silos

Secondly, the solutions are never big, complicated contracts designed in meetings — that is 20th century thinking. Successfully coordinating care across the silos in the new world of bundled payments means both management and physicians first need to move out of our mental silos by experiencing success together centered on the patient. You do that by starting small, proving it works, and building trust and optimism with success.

Linking management to frontline success is the new opportunity. An orthopedic service line is a perfect learning site for everyone to discover that opportunity. It is the chance to get out of our silos.

Managers become leaders when they discover they can get out of the meeting room, set direction, take down barriers and coordinate rapid, real-time decision-making.

The frontline leads when they discover they can leverage their knowledge and creativity to make improvement and innovation part of everyone’s daily work.

Then, it is a matter of working together to:

align innovations with a simple, clear, meaningful purpose;
link information to action to rapid results for patients, in real-time; and
use the mutual experience of success to realign, inspire and replicate what works.

The results, documented in multiple environments, speak for themselves. There is no ceiling to our potential. Our ceiling is our current thinking, both for management and at the frontline.

The future is not what we currently think — and that is good for all of us — staff, physicians, management and patients. When we align with a meaningful purpose and experience success together in achieving it, we change our thinking and commit — no ambiguity, no assumptions, no workarounds and no tradeoffs. It is developing people to deliver ideal patient care at a continually lower cost.

It is not the way we currently think — and that is a great opportunity.

References:

Kahneman D. Thinking, fast and slow. Farrar, Straus and Giroux. 2011.

Kenagy JW. Designed to adapt: Leading healthcare in challenging times. Second River Healthcare Press. 2009.

Kenagy JW. Leadership versus the brain. White paper available at http://johnkenagy.com/resources.writing.php.

For more information:

John W. Kenagy, MD, is Director of Kenagy & Associates LLC. He can be reached at 3434 Columbia Heights Road, Longview, WA 98632; 617 515-7209; email: john@johnkenagy.com.

Disclosure: Kenagy has no relevant financial disclosures.