Some Thoughts on Christensen’s Disruptive Innovation in heathcare

I’m going over the HBR piece by Clayton Christensen et al. on “How to Revive Health-Care Innovation”. The basic idea of the piece is that disruptive innovation is typically not driven by a new technology alone, new business model innovations are necessary and regulators must be careful to not stifle disruptive business models and work to facilitate them. Second, stand-alone disruptions are rare–you need new value networks that disrupt old and to do this you need greater integration than the health industry is accustomed to. Therefore employers can become a catalyst in creating these networks. Finally, leaders in an industry providing high end services and products almost always disparage and discourage disruptive innovation. These are important insights that I’d like to build upon by bringing these ideas into relationship or conversation with some other threads around public health, social innovation and citizenship.

I think Christensen et al. could be on to something important if we expand the vision. Furthermore, disrupting the many policy “wonks” who have dominated the debates in health policy in the US might be a good thing as well. There is growing frustration with the general lack of imagination, self-referential networks or epistemic community whose ability to constrain the discourse is equal to the much talked about problem of “special interests”. But enough of that. Public health is also in dire need of new thinking as well and there is a growing movement in the global health arena to rethink health system transformation, learning from the successes and failures of social entrepreneurship (which might be quite useful in the US health context but really hasn’t been given the attention it deserves, and this includes some of the debates on the limits of market-led approaches), but public health’s focus on health as a public good and notions of citizenship rather than the consumer can be a productive asset for the health business community as well. My feeling is that the concept of the consumer in healthcare is growing increasingly problematic–it carries with it a great deal of baggage around behaviors and markets that have fallen rather dramatically since October 2008. But one problem that both market-led and public health folks share is a concern and organizing framework around diseases rather than people. People as individuals, communities and networks. Some in the entrepreneurial sector get this and we need to open up room for conversations around this in rethinking social innovations. At some level most people in public health get it as well but we still work within an epidemiological paradigm with some important exceptions.

I’ve written in several posts here about open health, collaboratories, etc. One of the reasons for this is the need to develop form(s) of health and healthcare organizations that can focus on a prevention economy rather than the current system where all incentives are focused on disease after the effect. We need to begin mapping out what a prevention economy would look like, the key stakeholders that could drive disruptive innovation, the metrics for keeping people well, the processes of co-management/co-creation of pre-symptomatic and post-symptomatic services, the connections between mental health (perhaps the most neglected disease and possibly playing a major role in obesity and other chronic conditions, particularly in a “traumatic economy”). One of the reasons why I don’t like the ‘consumer’ is that we’re seeing quite a bit of activity in social movements in health and public health that has been growing since the 1960s. In anthropology there is a growing literature on bio-citizenship. Health business folks rarely pay attention to this, public health may have another language to talk about it. But these are growing networks of folks who just don’t behave as consumers and they’re getting a lot of new tools in their hands to find one another, from mobile phones to cheap diagnostics to social networking platforms. This provides a ‘platform’ to build other social innovations for health around this emerging prevention economy. Employers are going to be a big player here. Genetic testing and social networking are gradually coming together, the green movement has become mainstream, more attention is being paid to local economic development and the built environment (if only stimulus plans would give greater attention to the environmental impact of big infrastructural projects that may only reinforce the problems that got us here), health 2.0/architectures of participation are creating new ways of thinking about knowledge production in health, the current financial crisis will mean that we have to find more creative ways to finance health and ways to reduce costs. It will be incredibly difficult for a single company or business model to address these concerns and they probably shouldn’t. But new possibilities for innovative social networks, partnerships (ie. collaboratories/cooperative networks of players pushing towards moving an eco-system of prevention into the mainstream) to keep people well within their environments are going to be needed. Innovation that straddles both the public and private sectors will help us to get there. This means a different way of thinking about what we mean when we say “innovation”. What are the pathways to wellness? In many ways there is nothing new here, what is new is taking it seriously.

The Sudanese scholar of urbanism and social movements in Africa Abdul Maliq Simone has written on the informal sector and the modes of survival of the urban poor in Africa. One of the expressions he has used is “people as infrastructure”. Can we use this term in the prevention economy with the tools and network institutions at hand and create the social innovation platforms that keep people well? This is another piece of the “assemblage” called health that this blog is exploring.

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