HL20: Clayton Christensen—The Innovator's Frustration

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Clayton Christensen.

This profile was published in the December, 2011 issue of HealthLeaders magazine.

 "Over time, we'll need fewer and fewer hospitals. Boards of those institutions need to just remember that the scope of what they need to do is to be responsible for the health of people, not the preservation of the institutions."—Clayton Christiansen

Clay Christensen's writings about disruptive innovation—the concept that new technologies often have the potential to turn industries upside down, yet are exceedingly hard for established companies to recognize and harness—gave the Harvard Business School professor status as a management guru in the late 1990s. Manufacturing and technology executives, in particular, read Christensen's books and sought his advice. Hospitals weren't part of the discussion, for the most part.

But Christensen always saw the U.S. healthcare system as ripe for disruptive innovation. In 2009, he coauthored a book, The Innovator's Prescription, and entered the public debate on how to fix healthcare. Disruptive technology has altered the practice of medicine many times over, yet the structure of healthcare institutions and the healthcare system has resisted change, to its detriment, Christensen says.

Medical technology has complexified healthcare enormously, Christensen observes, but medical education "is structured around a model that was created nearly a century ago that focused around the individual caregiver as the source of solutions. Now, because of the advance of technology, caregiving is a process in which dozens and dozens of people contribute, yet we teach as if medicine is still focused around the doctor," he says.

Disruptive technology in many industries tends to undermine experts in favor of laypeople, according to Christensen's research. What was the province of experts such as doctors—blood testing and interpretation, for instance—can now be done by nurses or even patients at home with inexpensive medical equipment or just a smartphone. In this new structure of healthcare, hospitals are often an impediment to change.

"Over time, we'll need fewer and fewer hospitals. Boards of those institutions need to just remember that the scope of what they need to do is to be responsible for the health of people, not the preservation of the institutions," Christensen says. "The hospital structure was put together at a time when doctors were cheap and travel was expensive. So you had a hospital in every community, and a hospital needed to offer everything, because of the constraint of travel and the abundance of doctors. But now those have flipped: doctors are very expensive, and travel is cheap. And yet we are continuing to behave as if we're bound by the same tradeoffs that existed a generation ago."

During the writing of The Innovator's Prescription, Christensen got an up-close-and-personal view into the healthcare system when he suffered a severe heart attack, followed soon after by a diagnosis of follicular lymphoma and an ischemic stroke, with a detached retina for good measure. These experiences "have intensified my desire to help the healthcare system reform itself," he says.

Christensen began writing about the details of healthcare reform and speaking at events where healthcare leaders gather. He espouses integrated systems of healthcare where the provider and insurer are the same entity, so that efforts to cut costs or improve performance work in tandem. Christensen points to a few integrated health systems as models for the rest: Geisinger Health System in Danville, PA, Intermountain Healthcare in Salt Lake City, and Kaiser Permanente in Oakland, CA.

The national healthcare debate is anything but a model, he says. "I'm frustrated … it's the politicians—it's not that they are inert or that they don't want to do it, but they don't have time to sit down and wrap their arms around the problem or the solution, and their mindset is so fleeting that they want a simple answer." Debate has not yielded to deliberation, in Christensen's view. "Everybody convenes in Washington with self-serving data and self-serving arguments. It's kind of like the people in Washington are sitting around the base of the Tower of Babel, and they can't talk to each other, let alone come up with any answers," he says.

A big part of the political babble, he says, is the false choice between single-payer and multi-payer healthcare systems. "It turns out, as we've studied it subsequent to the writing of [The Innovator's Prescription], that categorizing the world as private multi-payer vs. government single-payer systems is the wrong categorization scheme. At their core, the publicly paid systems in Canada and the Netherlands and Germany are organized very much like most of America, in that the providers are in silos and their inability to stake a systemic view is just the same as in America."

But the integrated health systems that do exist in America "are organized in the same way that Sweden and Finland are organized. Those nations in Europe are way out ahead of those who are organized by silos, in terms of the efficacy and the cost of healthcare, in the same way that the systemic companies in America are way ahead."

To Christensen, who bases his books on research and who speaks in measured, carefully chosen sentences, proper terminology is the key to reforming healthcare. "What I had not realized is how critical a common language and a common way to frame the problem is in trying to make any significant progress in solving the healthcare problems," he says. "It's just really important that we frame the categorization in the right way. When you do that, it becomes clear that the systemic view is critical at this point. I understand that problem more than I did before."

This article appears in the December 2011 issue of HealthLeaders magazine.