As we have explored smart libraries, smart farms, smart cities and the like, it's become clear that those next-generation enterprises are really complex adaptive systems, with massive interconnectedness and interdependencies among their various elements. Managing such complexity in a rapidly changing world is perhaps our greatest challenge as we transform our old, static institutions into fast-learning enterprises.
Our current healthcare delivery system is one such example. Having evolved in piecemeal fashion over the past century and a half, it's not really a system at all. Rather, it can best be described as a mishmash of loosely knit cottage industries costing a mind-numbing $3 trillion annually in the United States alone.
As is often the case in self-organizing systems, a core institution tends to coalesce around a particular area of interest, usually to the detriment of others. In the case of healthcare, our current system focuses heavily on acute illnesses, trauma and infections, especially those that are life-threatening, often with astonishing speed and technical marvel. But that has occurred at the expense of preventing and treating chronic diseases that continue to plague our society despite the advancements in technology.
Stitching the pieces together
In previous discussions of smart enterprises, we've stressed the importance of "connecting the dots." The smart hospital needs to do the same. Part I of this series gave a simple example of an emergency room in which the ventilation system was so loud the physicians had trouble using their stethoscopes. There are much bigger dots that, if allowed to remain unconnected, will eventually result in system failure, because the current trajectory is unsustainable.
Consider the following chain of events. An acute condition such as a heart attack or stroke (dot #1) occurs as a result of a prolonged chronic condition, such as steadily increasing high blood pressure and cholesterol (dot #2), which is attributable to behaviors such as poor diet and lack of exercise (dot #3), which are often tied to psychological conditions such as depression or anxiety (dot #4) or socio-economic circumstances (dot #5). Those are some serious dots of which many people are aware, yet our "system" still tends to treat each of them separately and in isolation.
One reason for this disconnect is that performance is often measured by counting the wrong things, such as hospital days per patient. The result has been a steady push toward fast, massive interventions, then sending you on your way with a bill for your portion of the insurance co-payment. The smart hospital must move from an automobile service station model to a patient-centered knowledge delivery and application model.
Expanding our view further, we find a myriad of different types of people and organizations, each looking after their own interests. The human and organizational dots that need connecting include primary care physicians, surgeons, oncologists and other specialists, nurse practitioners, pharmacists, dieticians, psychiatrists and psychologists, exercise/conditioning coaches, family members, financial planners, insurers, government auditors, attorneys and more. Each group speaks a different language and views the world of medicine from a different perspective.
For example, medical doctors receive a steady stream of published research that is often indecipherable and difficult to apply in daily practice. Even in cases in which the research is applied, crossing organizational boundaries and feeding observations from the field back to the research community can be daunting. While all of those players don't necessarily need to speak the same language (although Latin still seems to be hanging on for dear life), they do need to be on the same page.
Medical innovation is also in need of major transformation. There certainly is no lack of innovation in bioscience. Yet much of it is a direct consequence of the "quick-turnaround" model, in which innovators who produce and deliver a quick fix receive the greatest financial reward.
An example is the now common stent used in treating coronary artery disease. At a unit cost of around $4,000, annual worldwide sales have reached the $5 billion mark. Assuming no complications, the entire stent procedure from admission to recovery to discharge is designed to take 23 hours-just within that magic one-hospital-day target-at a cost of about $63,000.
From artificial joints to heart valves to stomach stapling, the list of in-and-out body part interventions is growing. But how long can we artificially kick the can down the road? A stent may be a good temporary fix to a potentially life-threatening condition. But the benefits will be short-lived if the patient remains overweight and in poor aerobic condition, as high-blood pressure and adult onset diabetes eventually take their toll.
The bottom line is that health management, like knowledge management, requires day-to-day commitment. We need to find ways in which we as KM leaders, consultants and practitioners can work with all the players in the medical community to help make the transformation to a new, patient-centered system.
Measuring the right things
One way is to shift the primary target of medical innovation to the source of the problems, such as focusing on healthy lifestyle promotion and disease prevention. But how do you monetize and incentivize behavioral changes such as diet and exercise? Can innovators in those areas be rewarded to the same degree as medical device manufacturing or pharmaceutical production?
That shift is beginning to occur with the emergence of mobile apps such as MyFitnessPal, which make it easy to monitor and track progress and receive guidance, coaching and reinforcement, including rewards and recognition, on a regular basis. That's one dot.