More primary care, a disruptive innovation

Jordi Varela
Editor

 

One of the bad news that 2020 brought has been Clayton Christensen's death, a Harvard Business School professor who developed the theory of disruptive innovation and who already deserved the care of our blog with the commentary on the book The Innovator's Prescription, where the author analyzes the reasons why healthcare systems are so refractory to innovation. As I believe that the effort that Christensen has made to adapt his theory of innovation to healthcare is worth it, as a tribute, I have recovered a video of a lecture he gave at King's Fund in 2013.

Disruptive innovation, says Christensen in the video, is a process that, by simplifying a product or service, expands markets, until new products or services manage to surpass the original ones, which are heavier and more expensive. Disruptive technologies have simplified products; they have made them cheaper and, with it, they have incorporated millions of new consumers into the market. The example that Christensen liked was the appearance of the first personal computers, because, he remarks, the great computer builders despised the new devices. They simply saw them as a matter of games and leisure. The story is that the computer companies that did not gamble, or did it late, were wiped off the map. In short, the recipe for disruptive innovation is clear: simplify, cheapen, and spread everywhere.

At the King's Fund conference, Christensen said that all health service delivery systems tend to concentrate large investments in technology, innovation and research in hospitals, especially teaching ones, which is reminiscent of the error of the builders of computers that did not know how to intuit the disruptive innovation of personal computers. Thus Christensen says that we see that despite the excellence that large hospitals proclaim, due to the difficulties in accessing their services and the lack of competitiveness, innovations are being very costly and have not achieved the desired impact.

To address the crisis generated by hospitalism, the disruptive innovation that Christensen proposed at the conference was very clear: decentralize the provision of healthcare services in two directions: that of empowering primary, community and home care to expand their portfolio of services and making technology and services cheaper thanks to telemedicine, eHealth and the popularization of certain diagnostic tests, such as ultrasound and self-monitoring in wearables.

The theory of disruptive innovation (simplify, cheapen and spread), which has worked so well in the corporate world, should now be the conceptual support to empty hospitals of all the activities they are offering inappropriately, especially to chronic patients and, with this, to finally be able to provide primary care (including community and home care) with more services and greater resolution capacity.

Thank you Professor Clayton Christensen for reminding us that healthcare should not go the opposite way to disruptive innovation. In Memoriam.