Making health care feel like buying a latte or catching an Uber ride is our new obsession. This week Forbes asked why health care cannot be more like Starbucks. In a world buzzing with health precision, it’s a reasonable question.
When I think about why my clinic can’t run like a Starbuck’s drive through, I look to Clayton Christiansen and Jason Hwang. Their book, The Innovator’s Prescription, discusses three key business models in health care. Two of their models beautifully reflect a field caught between empiric and precision medicine.
Solution shop model. Solution shops take open-ended, complicated problems and try to solve them. Care for a child with growth failure and anemia, for example, makes my Texas Children’s clinic a solution shop.
These “shops” are businesses that are structured to diagnose and solve unstructured problems. Consulting firms, advertising agencies, research and development organizations, and certain law firms fall into this category. Solution shops deliver value primarily through the people they employ—experts who draw upon their intuition and analytical and problem-solving skills to diagnose the cause of complicated problems. After diagnosis, these experts recommend solutions. … Highly trained experts amass information from imaging and other monitoring equipment, analysis of blood and tissue samples, and personal physical examinations. They’ll then intuitively develop hypotheses of the causes of patients’ symptoms. When the diagnosis is only an uncertain hypothesis, these experts typically test the hypothesis by applying the best available therapy. If the patient responds, it verifies the hypothesis. If not, the experts iterate through cycles of hypothesis testing in an attempt to diagnose and resolve the problem. | The Innovator’s Prescription.
Value-adding process model. This is where measurable things get done. This is where businesses offer solutions for defined problems. Example might be a clinic that repairs hernias. I frequently see children with elevated TTGs in need of small bowel biopsy to confirm celiac disease. The problem the outcomes in the VAP model are tightly defined.
Organizations with value-adding process business models take in incomplete or broken things and then transform them into more complete outputs of higher value. Retailing, restaurants, automobile manufacturing, petroleum refining, and the work of many educational institutions are examples of VAP businesses. Some VAP organizations are highly efficient and consistent, while others are less so. Many medical procedures that occur after a definitive diagnosis has been made are value-adding process activities. … Institutions such as the Minute-Clinic, Shouldice Hospital, eye surgery centers, and certain focused heart health and orthopedic hospitals are examples of value-adding process businesses. | The Innovator’s Prescription.
We’re slowly approaching the practical application of precision medicine where care can be delivered more in a VAP model. I will add Christianson’s model doesn’t fully envision the role of patient/consumer-driven care. Either way, we can expect the transactional magic of medicine to look more like buying a mocha chip frappuccino as medicine evolves slowly away from clinics fashioned as solution shops.
If you haven’t read The Innovator’s Prescription, you’re behind. With The Creative Destruction of Medicine, it represents one of the most important books of our generation.
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