Monday, 11 April 2016

The chronic patients’ care needs disruption and no reforms

Clayton Christensen, a professor at Harvard Business School, defines disruptive innovation as a process that, by simplifying a product or service, is expanding the markets until the new products or services manage to get better than the originals that are obviously heavier and more expensive. Disruptive technologies have simplified products, made them cheaper and thus have brought millions of new consumers to the market. Such is the economy of the new millennium.

In The Innovator's Prescription, Christensen says that the health system lacks disruptive innovation, that hospitals concentrate too many specialists, too much investment and too much technology; and according to him, this accumulation is an obstacle to the arrival of more simple services, but perhaps more effective in larger populations.

Te following chart shows, according to Christensen, the bottom-up trajectory of disruptive innovation applied to the health system, where we can see how the least specialised take on the competences of the more specialised (more empowerment): chronic patients who manage their disease more autonomously, nurses who manage demands that so far have been reserved only for physicians, family doctors who become fully responsible for diabetic patients or who are training in techniques such as echocardiography to diagnose heart failure in their own offices; catheterization cardiologists who implant stents avoiding bypass coronary surgery, etc.

With these innovations, described in the chart, the status quo is broken and ensures that the services are more accessible for the population in need. If you have four minutes, you can see, in the video, Clayton Christensen’s explanation of disruptive innovation applied in the health system.

Although in the health system the disruption is rather mild, there’s a group of older people who beg for it. When multiple chronic disease and geriatric frailty appears, patients need community services led by the primary care, they need to benefit from individualized treatment plans, plans that include geriatric methodology and philosophy and they also need access to social services adjusted to a well defined plan. This group of patients, increasingly numerous, require heavy investments in this model of community coordination, with the clear intention to keep them away from fragmented services that too often are offered by hospitals. In short: chronic patients’ care requires disruption and no reform.

Jordi Varela


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