To fix health care, accept disruption

Change is hard. And there is no doubt the world is changing around us, particularly for those who work in health.

A massive cohort of our population is aging. People are living longer than they did just 20 years ago, with more chronic conditions that require more time for monitoring and intervention. As this cohort enters retirement, they leave labour shortages behind them — all at a time when more health professionals are needed, access to services is challenging and costs are soaring. What’s more, in the past century since our universal health system was first developed, our approach has not evolved to meet the demands of our time.

The current state of that system is a cause for concern. Ideas like transformation, innovation, and disruption can seem costly or even dangerous. However, we can operate in a state of never-ending reactivity to the challenges, or we can recognize the opportunity that innovations can bring. Many good ideas have been proposed, but why are they challenging to implement and scale?

“Disruptive innovations” coined in the early 1990s by late Harvard Business School professor Clayton Christensen, is a theory that describes the process by which expensive, complicated products and services are transformed into solutions that are more affordable and accessible, thereby making available to a larger population.

Disruptive innovations are not breakthrough technologies that make good products or services better. Instead, Christensen’s research consistently shows that disruptive innovations in health are the result of four enablers:

■ Technology, to simplify complex processes.

■ A funding model, to scale the delivery of the simpler process or solution at a lower cost.

■ A value network, the context in which new partners work together to govern interaction and co-ordination.

■ Regulation and standards, specifically required for disruption in health, to create conditions for successful implementation of new solutions.

These enablers cannot be applied in parts. With aggressive focus on implementing all four, the accessibility and affordability of services will improve.

In other sectors, innovations often precede regulation. Consider what happened when Uber and Airbnb changed the taxi and hotel industry. The business models were developed around a value proposition for simple and convenient access to transportation and out-oftown stays with pleasant alternatives at an acceptable lower cost. The demand for these new approaches was so immediate that opposition from traditional taxi companies, hotel associations and tourism bodies couldn’t fight the swell. Governments were forced to regulate quickly, figuring out how these disrupters could function in parallel with the status quo.

Disruption is already taking place in health care. Think of continuous glucose monitoring for diabetes compared to episodic finger pricking, performing colonoscopies for cancer diagnosis in outpatient clinics compared to high-cost acute care facilities, and developing “stable” vaccinations that can be distributed in mass quantities compared to ones with specific storage requirements that limit distribution capability. Or, expanding the ability of pharmacists to prescribe medications for common ailments.

Improvements in the reliability and performance of these methods and products, and application of new funding models and value networks, have made them more affordable and accessible for patients.

Conversations around change force uncomfortable questions, but the answers we arrive at are important. Further, it’s needed to sustain a high-quality universal health-care system that is a pillar of our Canadian identity. But to do it, we must be open to the new and different.