The Innovator’s Prescription: A Disruptive Solution for Health Care

Authors:  Clayton M. Christensen, Jerome H. Grossman & Jason HwangPublisher:  McGraw-Hill; 1st edition (Dec. 25, 2008)ISBN-13:  978-0071592086

Change and working through challenge has been a constant to anyone working in the health sector in Canada within the past, oh, I don’t know, let’s say the past century to keep it simple. Presently, clinicians, administrators and leaders working in all health care environments have been working through the latest challenge – while continuing to provide excellent client and family centered care, teach the next generation of health professionals, and pursue innovative research addressing the progressively complex health needs of an ageing population, most teams must operate, innovate and execute in a “zero growth funding environment”…. all while the health system itself transforms into a more accountable, transparent and value based system. A tall order for any clinician, team or organization!

Dr. Christensen and his team at the Harvard Business School have been thinking and writing about “disruptive innovation” since the 1990’s. According to Christensen, disruptive innovation theory explains the process by which complicated, expensive products and services are transformed into more simple and affordable ones. A good example in the health care world is cardiac survey. Decades ago the only option for many people was an open procedure fraught with many potential risks and complications. Today, open procedures have largely been replaced by safer and (in theory) more affordable non-invasive procedures – a result of the staggering amount of disruptive innovation that has taken place in cardiac surgery in the recent past.

In his latest book Christensen and two medical doctors – Jerome Grossman and Jason Hwang – discuss how disruptive innovation concepts can be used in health care reform, particularly in the United States (US) health system. While the authors use hospitals in the Unites States as the primary backdrop for their discussion, many of the concepts discussed, particularly in the first 6 chapters of the book, can be applied broadly across many sectors in Canada in addition to the hospital sector, including the not for profit and for profit primary care sectors, and the community care sector.

As in all of Christensen’s work, he starts with his definition of the value proposition for the reader. In this writer’s view it is one of the clearest definitions for a value proposition available: “Helping the customer to more effectively, conveniently, and affordably do a job they’ve been trying to do.” Understanding the “job to be done” (not as easy to determine as one might think!) is a prerequisite to providing value for patients/clients and families, and is critical to successful innovation.

Putting aside the discussion of whether a person participates in health care as a “customer”, the value proposition definition leads us to the crux of all of Christensen’s work and the central questions of the book – What is the “job to be done” for your patients/clients? What business model is the best match for the “job to be done”? How can the concepts of the business model and disruptive innovation come together to improve the client experience and the health system as a whole? Big questions to say the least!

While set in the US using hospitals as the backdrop, and acknowledging that there are detractors to the disruptive innovation theory, “The Innovator’s Prescription” is written and framed in a way that many of the concepts, which have been observed in different industries across over two decades of scholarship, can be used by any clinician, clinic owner, administrator, system planner or health care leader to use as she/he thinks about how to use disruptive innovation to improve the health of Canadians.

Jill Lepore, The Disruption Machine: What the gospel of innovation gets wrong. The New Yorker.  June 23, 2014.

– Submitted by Allan Macdonald

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