Following on from my earlier article “Getting serious about making changes in health care?” I want to highlight the importance of understanding the difference between the two types of innovations – sustaining and disruptive.
To meet the complex challenges of First World countries’ health systems, both types of innovations are needed. Each type of innovation provides solutions to two common types of complex challenges which are:
Some innovative solutions provide answers to (1) while others provide answers to (2). Getting the right type of innovative solutions for the two different type of challenge is fundamental.
It is also important to note that any improvement or innovation agenda needs a portfolio that has the right mix of sustaining and disruptive innovations.
Innovation involves making products, services or processes better. There are different ways to look at innovations. For the purpose of this article we will stick with how Professor Clayton Christensen classifies innovation.
Sustaining innovations (sometimes referred to as sustaining and efficiency innovations) largely impacts on people who can access existing health services by improving the quality, safety, timeliness, patient experience, efficiency, and efficacy of health services. Exemplars of this type of innovation include well-known health system quality initiative like
the SURGICAL CHECKLIST and CHOOSING WISELY.
These initiatives aim to reduce variations, save lives, improve efficiency; reduce waste as well as cost. These in turn provides better care and experience for patients.
The significance of these innovations and improvements is made clear by Dr Atul Gawande in his 2017 interview with Malcolm Gladwell. He observes that lack of proper execution of existing treatments is responsible for over 30% of deaths of people over 75 that can be avoided. This observation is significant given that in most First World countries’ over 65s make up on average 15% of the total population and account for 40% to 50% of these countries’ total health expenditure.
The Economist March 2nd, 2017 article “A digital revolution in health care is speeding up” points out that in rich countries about one-fifth of spending on health care goes to waste, for example on wrong or unnecessary treatments.
Some health leaders argue that there is no more room for “savings” through reducing waste and improving efficiency. However, both Dr Gawande’s observation and the Economist article clearly indicate that there is still room for achieving these savings through sustaining innovation improvements.
Disruptive Innovations and improvements open up access to health services in a timely manner for a significant number of people unable to access existing services by making them more affordable.
Disruptive innovation can do this by changing health service delivery that involves the use of new technologies supported by new business model that make services more accessible and more affordable. For clarity, service delivery, new technologies and business model are defined as:
It is important to invest time to understand the above four elements of a business model. Often in meetings and discussions the term business model is used without a good understanding of what it means.
Some examples of disruptive innovations in health care include:
Sustaining innovations improve existing services that benefit people already accessing current services. Disruptive innovation opens up affordable access for significant numbers of people missing out on current health services. Both are needed and the challenge is to get the right mix. The two different types of innovations provide solution to two very different problems. That is why it is important to know their differences.
It is important to remember that disruptive innovations involve making changes to both service delivery and all four elements of its business model (value to the user, resources, key processes and sustainable financial formula).
There has always been and most likely always will be resistance to innovations. Some innovations survive while others don’t. Professor Calestous Juma in his 2016 book, provides examples of innovations (which we take for granted today) going back 600 years that met significant resistance and survived. He concludes that the underlying reason for this resistance is the disjuncture between rapid technological innovation and the slow pace of institutional adjustment due to a fear of loss. New innovations whether sustaining or disruptive will face the challenge of this disjuncture.
Think through the different innovations and improvements in your organisations. Is your organisation getting the right innovations for the right problem? I welcome your feedback and comments on this article.
Here are some useful books if you would like to go into greater details some of the material covers in this article.
Likewise, here are some YouTube clips referred to in the article:
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