Adapted from Design for Care (page 253 )
The innovator’s challenge in healthcare is not a technological fix – it is more to understand and preserve core values of human care while changing practices for durable social and economic benefit. Although economic value is often a pivotal driver of innovation adoption, cost management is not itself a core value but a sustainability factor to be evaluated in decision making. The related social innovation challenge is a macro policy problem, not a design issue. An immediate challenge is convincing organizations that accessible patient-centred, value-based care is actually possible with a business model change. (Then new care service models can be designed). It will be the rare organization with the cost buffers and patience that reconfigures care models in advance of a new business model.
Using a simple Business Model Canvas model, a shared value healthcare business model (based on Porter & Lee’s value-based care) is outlined. The model suggests a significant trans-valuation of the “offer” of clinical care, which is not service for fee, but to attain personalized health outcomes that matter to people.
Such a shift may seem impossible in today’s lean, cost-contained, time-sliced organizations. Yet surmounting the impossible is the chief purpose of business model design. Significant social impacts from cost savings could be invested in by transferring the earned value from a high-profit sector of care to a high throughput, low-profitability but essential function. Rather than accommodating the demands of every specialty and department, a core strategic purpose would be formulated – such as to facilitate universal community access to health services and to improve primary care.
Healthcare is a social and public good that can be provided universally, in some form, as in most developed countries. In the United States, this would require a truly disruptive change to public policy and the insurance payer model of the healthcare system. A recent New England Journal of Medicine article declared:
“It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?”*
Was there ever a clearer innovation challenge in any sector or business? Healthcare as an industry faces multiple crises that beg for systemic solutions, not piecemeal fixes. System interventions aim for the root issues most closely related to the perpetuation of critical problems. Sustainable solutions are those that economically scale across institutions and regions.
Systemic redesign requires agreement on a shared vision of the future value state. Any project aiming to satisfy multiple stakeholders (not just users or owners) requires a systemic approach, rather than the mere negotiation of service functions. We might reframe the purposes of “disruptive innovation” in institutional healthcare from economic and technical value to that of co-creating significant service transformations that benefit all stakeholders.
*Murray, C. J., & Frenk, J. (2010). Ranking 37th—measuring the performance of the US health care system. New England Journal of Medicine, 362(2), 98-99.