Cost-effective repairs needed in drive for healthcare reform
Healthcare system could learn a lesson from Advance Pitstop
“Disruptive innovation, which entails radical service reconfiguration and deep cultural reform, will require expertise in managing complex change and courageous leadership by all interested groups. It will not all come down to James Reilly.” Photograph: University Hospital Southampton NHS Foundation Trust /PA Wire
For the sixth year in a row pre-budget political tensions and pubic dismay at the announced “hits”crystalise a central challenge for Irish society: how to provide decent public services in an affordable manner.
Is there a better way to resolve this dilemma than by continuing to cut services and increase the cost? Is there a smarter way?
Five years ago Harvard professor Clayton Christensen presciently remarked: “Healthcare is a terminal illness for America’s governments and businesses. We are in big trouble”.
Just weeks ago this still unresolved healthcare crisis threatened the very capacity of the US to govern itself effectively. He might well have been speaking of Ireland. We too are in big trouble over healthcare.
Christensen famously coined the term “disruptive innovation” to describe a type of innovation that has revolutionised many industries, such as phones, air travel and computers, making products and services more affordable and accessible to everyone, and not just rich people. In The Innovator’s Prescription (2009) he applied his ideas to healthcare systems, distinguishing three types of ailment.
It is impossible to summarise the book here, but a mundane illustration may help: I had a flat tyre recently and instead of leaving it in a high-tech workshop as if I had crashed the car I drove straight into Advance Pitstop and was out in 20 minutes with the tyre fixed for €15. lllnesses for which medical advances can now provide a definitive diagnosis and specify an effective remedy may be routinised and treated in specialised centres, analogous to Advance Pitstop, such as eye surgery clinics or heart centres, instead of being bundled in with more complex cases in a large general hospital, which is ultimately a highly inefficient arrangement that delivers suboptimal care.
An example is the vascular surgery unit in the Galway Clinic. At a conference in Trinity College two years ago, Niamh Hynes of the clinic set out a compelling case for separating out from general hospitals and streamlining procedures that can more or less be routinised.
Her comparison of the cost and quality of the clinic’s services versus similar services provided by University College Hospital, Galway, were truly remarkable. For example, “cost per any procedure” was €22,850 in UCHG and €6,455 in the clinic. More importantly Hynes reported superior outcomes for patients, which generally happens when clinicians work on the same problem repeatedly.
The second category of health problem which Christensen suggests requires the expertise of a “solution shop” in healthcare, meaning a fully equipped hospital or multidisciplinary team. This area includes more complex cases like car crash victims or difficult-to- diagnose illnesses where intuition and trial-and-error by very experienced clinicians and other professionals offer the best prospects.