Health 2.0 and the Big Bang

GlennIt’s hard to believe that last week’s Health 2.0 conference was just the third annual installment of the event. The phrase, “Health 2.0” entered our lexicon at light speed and seems to have been there longer than those few, short years. The conference has become a must-attend for hundreds of people, dozens of companies and a hodge-podge of innovators, consumer activists, and buzz trackers.The Twitter feed from last spring’s Boston event rivaled that produced by the Octomom (well, not quite), and had the wireless carriers supporting last week’s event not sustained a massive H1N1 attack, that feat would have been surpassed easily. Heck, even Aneesh Chopra, our nation’s first-ever CTO, was there to kick it off. Congratulations are in order for the conference organizers, Indu Subaiya and Matthew Holt, but going forward they will have their hands full attempting to manage the wild growth of their event.

In their opening remarks last week, Subaiya and Holt reminisced that their initial conference focused on search, communities and tools. They chose to broaden that focus for the next one, to include bringing together content and transactions in a user-friendly way, and they tipped their hats to a broader concept still: the fabled concept of data liquidity as an enabler for their constituency. This year, they broadened things further by introducing “unplatforms” that could mix data, applications and channels, and in so doing, brought mobile devices, social networks, widgets and more under their tent. Health 2.0, it seems, is exploding like a supernova, and the conference organizers have so far made no visible effort to reign-in the expansion

.Subaiya and Holt are going to have to decide whether they want Health 2.0 to be perceived as All Things to All People, or draw a line around whatever foundational principles they choose to adopt and keep the focus narrow.The easier and more lucrative option, at least in the short term, is to enjoy the ride. Despite the whinging about lousy wireless hook-ups and a spectacularly impersonal venue, most people loved the conference and came away with several good ideas.Few would blame the organizers for taking this path, but before they do, they would be wise to consider similar decisions made by leaders of the Health Care TQM movement, which 20 years ago was every bit as trendy as Health 2.0 is today, but whose influence faded badly after that.

The concept that Total Quality Management principles–originally developed by W. Edwards Deming, Joseph Juran and others to improve performance in manufacturing organizations—could be adopted for use by health care organizations gained widespread acceptance after a pair of articles (here and here), introduced the possibility in 1989.Conferences were formed and grew rapidly, and journals were started to promote the concept. Consultancies claiming to help implement TQM grew like desert flowers after a downpour. Awards were created to honor early adopters and entire careers were built around expertise in the area.But now, most of that is gone. TQM is yesterday’s trend. And sadly, despite a continual stream of success at local levels, quality-related issues that TQM seemed ideally positioned to help solve—things like medication errors, readmission rates and unnecessary test ordering by physicians—remain endemic to our health system.What happened?It had nothing to do with the TQM principles themselves. There is way too much evidence from hundreds if not thousands of successful projects that proves TQM can be implemented by health care organizations, and that in such cases it improves the quality of care and reduces associated costs.The problem was that leaders of the TQM movement chose to be inclusive (an admirable trait in most instances).

Facing the same challenge that the Health 2.0 conference organizers confront today, they chose to open their doors to dozens of new trends and ideas that were at best distant cousins of the foundational principles of TQM. First, there was Systems Thinking. Then came re-engineering. Eventually, self-efficacy theory, organizational change theory, and even techniques to foster individual creativity found their way under the tent.All these movements are based on solid science and have their place in the lexicon of health care improvement strategies. And to be sure, TQM leaders’ decisions to include them under their tent contributed to rapid growth of the movement. But the price those leaders paid was a fatal dilutive impact at a national level regarding adoption of the foundational principles of TQM itself.People began to wonder what TQM actually meant and what it didn’t. There weren’t enough experts around to support and train folks interested in implementing TQM. Supposed TQM advocates espoused different messages about what TQM was. And as is the American way, many of the best and brightest minds chose to pursue tangential interests in search of their
own fame and fortune.

It was inevitable that health care organizations and policy makers would shift to the next best thing.

TQM had become the Old Soldier in Douglas MacArthur’s farewell speech. It never died, it just faded away.

As I watch Subaiya and Holt continue their well-intentioned efforts to expand the Health 2.0 tent, I can’t help but wonder whether the same fate awaits the exciting movement they helped create.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs.  He is a frequent writer for EHR Bloggers, where this post first appeared.