Recently the book, The Innovator’s Prescription – A Disruptive Solution for Health Care, was published. The book’s primary author, Clayton Christensen, is most noted for writing the bestseller, The Innovator’s Dilemma, and is a faculty member at Harvard Business School. With this publication, Christensen applies his economic and business theories of disruptive innovation to provide solutions for improving health care.
Christensen identifies an evolution in how we deliver health care. He states that health care begins as…
…intuitive medicine, where highly trained and expensive professionals solve medical problems through intuitive experimentation and pattern recognition, then as these patterns become clearer, care evolves into a realm of evidence-based medicine — empirical medicine — where data are amassed to show that certain ways of treating patients are, on average, better than others. With the final stage being precision medicine — where diseases are diagnosed precisely — predictably effective therapy for each patient is developed and standardized. The challenges faced with our health care system are symptomatic of this evolution, and as this “disruptive innovation” continues, improvements will naturally result according to Christensen’s theory.
In the clinic, delegating care to professionals other than to the highest trained provider — often the physician — is debated. Often times the assumption is made that the quality of care is decreased when delivered by someone other than the provider with the highest level of training or credentials.
I believe that this is disruptive innovation applied to health care. Triaging care to the health care provider with the most appropriate level of expertise will increase the overall value of care, as the complexity of the problem should most efficiently warrant the care of the provider with the most appropriate expertise.
Do you need a professional with the expertise of medical degree to diagnosis and treat an ear infection? Or is a physician assistant or nurse practitioner a more appropriate match of expertise with medical complexity? Does an ankle sprain warrant the expertise of an orthopedic surgeon, or is an assessment by a physical therapist the most efficient use of expertise? In physical therapy, disruptive innovation would argue that delivering therapeutic ultrasound does not require the expertise of a Doctoral-trained physical therapist, but rather the use of a physical therapist assistant. In applying disruptive innovation to health care, I would suggest that delegation of care to the most appropriate care provider will increase the value of the health care we deliver.
Bridget Morehouse PT, MBA is a consultant with Steffes and Associates, a rehabilitation consulting firm based in Wisconsin.