A recent PlexusCall featured the recent controversy between Dr.
Jill LePore and Clay Christensen on the topic of disruptive innovation. Three panelists shared their experience
with, and perspective on, Christensen's theory: Peter Jones, David Hurst,
and Dr. John Kenagy.
Dr. Kenagy said that successful organizations are designed to
keep doing what they are good at doing.
This prevents them from seeing, or fostering, innovations that may be
disruptive (game-changing). In
healthcare this is important because existing organizations, especially those
that are well-known and established, may miss or suppress a "game
changing" innovation that could provide a breakthrough on Kenagy's
area of focus, generating "more care at lower cost."* In order to support disruptive
innovations in healthcare, we need to create "safe places" in
which to experiment toward better and even disruptive solutions to healthcare's
problems. Kenagy went on to
elaborate on his methods for creating this kind of "learning line," or "safe to fail" lab in healthcare organizations.
However, healthcare also seems to be a special case of
disruptive innovation. As Kenagy
and other speakers noted, the notion of "disruptive" innovation
suggests the advent of a new product or service that disrupts the status
quo. But what is the "product" of
healthcare? Kenagy posits that we
have one product in healthcare: the health of the patient in front of us. This is a complex challenge, one that
suggests a different set of variables than those confronted by Apple or Google.
David Hurst and Peter Jones noted additional dimensions of the
healthcare challenge which differentiate it from other industries. Jones suggested that the popularity of
the "disruptive" idea may lead us down the wrong path,
especially when it comes to healthcare.
Do we want medical device startups competing for funding on the idea
that they have a disruptive innovation, when a better solution may be that a
consolation of companies all have parts of an overall solution that would be
better than any of them can produce on their own? The current funding model may suboptimize in terms of
overall problem-solving and advancing the health and well-being of individuals
and the wider society. For these
and other reasons, Kenagy asserted that "adaptive" innovation
may be a more appropriate term than "disruptive" innovation
How does a complexity view help us develop an optimal US
healthcare system? Let’s
assume that healthcare is a complex adaptive system. How do we represent our theory of the system itself? What are the metaphors of change that
can help us navigate the journey of disruptive innovation in healthcare? The panelists agreed that organic metaphors,
such as the butterfly effect or the self-organizing capacity of flocks of
birds, work better than mechanistic metaphors or system dynamics diagrams. If we want to mimic nature, the
panelists agreed, we need to promote conditions for trial-and-error
experimentation, such that the actors in the system can use a trial-and-error
pathway toward innovations that may become "disruptive."
Are there current efforts in healthcare to mimic nature’s
process of self-organization and evolution? What can we say about the conditions which foster this kind
of process in human organizations?
Viewing the situation through a complexity lens may help.
When we think about nature as a metaphor for self-organizing and
evolution, we need to think about the conditions in human organizations that
promote self-organization. We
would like to highlight three:
agreement among stakeholders; and
language and common framework for complex problem-solving.
Following the Stacey Matrix (below), "optimal uncertainty” refers
to a middle zone between chaos and simple problem solving. There is uncertainty but not so much as
to paralyze the organization; there is familiarity but not so much as to make the problem seem
routine. Optimal agreement is a
similar concept, in which we find a diversity of views but also enough commonality
to bind, or hold, the group together.
Finally, we believe the capacity for self-organization is fostered by a
common language and framework for complex problem-solving, such as the ability
to differentiate between simple, complicated, and complex problems and the
capacity to match appropriate methods to each.
How does all of this apply to healthcare? We will take up this question in our
Tom Bidga-Peyton is a Senior Consultant with Plexus Institute. Tom's work focuses on widening and accelerating the pace of improvement in individual, organizational, and large-system change initiatives.