Michael Porter has published another anthology document, in this case for the industry; and the question raised is paramount, the one regarding the interconnectivity of products. According to the authors, the main value that industries of the last century conveyed to consumers was the quality, or the durability, or the performance of their products; but with the advent of computers, the value of adjustment to the circumstances took hold. Hybrid cars and robotics are examples of this. But Porter and Heppelmann explain that now the products, besides being smart, should come embedded with interconnectivity of origin, and argue that in the future this will be the differential value for competitiveness.
"Smart and interconnected products -the authors say- will change the consumers’ perception, but so will the rules of the competition game, so the industry will be affected by this new setting. The new wave of information technology improvements will result in disruptive improvements in the capabilities of products and services, which will result in radical changes in the world economy and human relations".
And what all this has to do with the clinical management?
When I read the document, I found it of little use for health care, but a sixth sense told me to give it some thought. Porter is Porter, I thought. And when I read it again and I noticed the three successive stages of the concept of industrial product: a) the product is good in itself, b) the product is intelligent and adapts, and c) the product gets better when interconnected, I thought that this evolution is what has guided clinical management to date it will also mark the natural development from now on, and to illustrate what I mean, I have chosen a few examples:
a) The product is good in itself: a surgeon satisfied with the success of an intervention; a family physician proud to have gained control of glycaemia haemoglobin for a complex diabetic patient or a nurse who successfully applied the prevention of pressure ulcer in a bedbound frail patient.
b) The product is intelligent and adapts: a surgeon who shares with the patient the pros and cons of an intervention; a family doctor who pays attention to the emotional impact of the death of a spouse in adherence to treatment of a diabetic patient or a nurse who knows how to apply the palliative techniques proportionately to the degree of suffering of a patient in the final stage of life.
c) The more interconnected, the better the product gets: a multidisciplinary team that not only has the ability to jointly develop an individualized treatment plan for a patient with complex health and social needs, but also knows how to raise alarms when decompensations are detected and reunites as many times as necessary to rethink the coordination strategies.
In my view, the industrial Porterian recipe applied to clinical management would be: firstly to get it right; secondly to adapt it to real needs; and thirdly, to be able to align care objectives and knowing to revise them whenever necessary. Porter shows us again, albeit indirectly, the path to excellence in clinical management.