AHIP: Gawande, Gladwell on Healthcare's Chauffeur Problem
Gladwell presented the chauffeur analogy as an example of what happens when new technology is introduced. At first everyone is unfamiliar with the technology and needs a guide. When automobiles were first introduced they were embraced by the wealthy, but because they didn't know how to drive they hired chauffeurs.
Families needed the chauffeur to bridge the technology. Chauffeurs had power; families couldn't travel in the car without them. But, over time as more people became familiar with cars and learned to drive, chauffeurs lost their power.
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Gladwell pointed to phototcopying as an industry that let go of its chauffeur and grew by leaps and bounds. He explained that when Xerox first introduced its machines in the 1960s a Xerox rep would be on site to take care of the machine. Offices paid a royalty for the number of copies used. "Xerox was the chauffeur." As other companies entered the business and competition increased, the industry changed. The chauffeur became less important.
He noted that two processes that have happened quickly in other industries, commodification and customer control or consumerization, have been slow in coming to healthcare. The reason, said Gladwell, is the healthcare industry has been unable to compromise on the quality continuum.
"A key step in any kind of technological transition is the acceptance of a temporary deficit in performance at the beginning in exchange for something else," said Gladwell. That something else can eventually include increased convenience and lower cost. He offered a number of examples, including the shift to digital cameras where early pictures were not as good as film and the advent of the digital compression of music, which he contends has made the quality of music worse.
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