To Fix Healthcare, Let's Not Just Rearrange the Deck Chairs on the Titanic

As physician, healthcare executive, academic scholar, author, advisor and, most importantly, a patient, I propose the answer to our current healthcare dilemma starts with a laser-like focus on getting patients exactly what they need at continually lower cost. But current healthcare proposals are offering more of the same.

Over the last 40 years, I have heard that we shall transform healthcare by the exact same solutions proffered to Congress by health care industry leaders this week: simplifying administrative costs, making hospitals more efficient, reducing hospitalizations, managing chronic illnesses more effectively and improving health-care information technology.

Yogi Berra said it best: "It's déjà vu all over again."

We are not going to transform healthcare by trying harder at 1978 ideas. Trying harder will instead deliver exactly what it has already delivered -- less care at higher cost

Trying harder is simply rearranging a few more deck chairs on the Titanic -- it might improve the appearance of the healthcare ship, but it will continue to leak and it will inevitably sink. The recent announcement of the eminent insolvency of Medicare Part B suggests our Titanic is taking on water a lot faster than we anticipated and we have a limited number of very antiquated lifeboats with which to save ourselves. We better start building a few more lifeboats fast.

Fortunately, there is a simple set of principles for building more lifeboats and eventually constructing a much better healthcare ship.

To begin, we must recognize that healthcare transformation is not dependent on what we have done in the past or are doing now, but rather on how we adapt what we are doing to a constantly changing environment.

We also must recognize that the structures and systems of current organizations and the habits, behaviors and values of the people embedded within them will usually slow, stall and stop adaptive change. This is an organizational fact of life developed by Harvard Business School Professor Clayton Christensen in his concept of disruptive innovation, and most of us have experienced it.

Therefore, healthcare transformation begins with those few organizations strategically and operationally "designed to adapt." These organizations have incredible competitive advantage in a rapidly changing world. They represent the opportunity. They are where we will make the new lifeboats for our sinking ship.

Christensen says it is almost impossible for an established organization to lead disruptive change. But, if it's "almost impossible," that means it's possible. It means that we can expand the adaptive potential of established organizations, and in doing so, expand the possible solutions for healthcare.

How do we build adaptive organizations? We follow the methods that create great innovations. In healthcare, these methods have been proven to work in many organizations. Here's what the process looks like:

1. Find a place to start close to the patient.
2. Focus exclusively on getting patients exactly what they need at continually lower cost.
3. When that fails to happen, understand why and then rapidly problem-solve the system.
4. Use discipline and structure to rigorously test and validate the solutions.
5. Develop the knowledge and creativity to replicate what works as rapidly as possible.

Working adaptively means developing, leading and challenging the knowledge, creativity and problem solving ability at the point of care, not by sending more data up and implementing more big solutions down, as we have been doing for 40 years.

This time, rather than rearranging the deck chairs on the Titanic, let's develop, coordinate and control problem solving and improvement where the information already is -- in the workplace, at the point of care.

This isn't to say government has no role in transforming health care. Becoming more adaptive requires organizations to work differently and that requires strong leadership. Government can help by creating the safe harbors that encourage adaptive work. It can build the places where management, caregivers, unions, insurance, industry, employers and patients can come together to learn to work differently. But government must be willing to adapt its role. If it does more of the same, we'll all drown.

Dr. John Kenagy MD, MPA is a former Visiting Scholar at Harvard Business School and the author of the forthcoming book Designed to Adapt: Leading Healthcare in Challenging Times (Second River Healthcare Press, 2009).