Why the Creative Destruction of Healthcare May Not Be Such a Good Idea

From childhood most of us remember the sage parental advice on how to deal with bullies–“sticks and stones can break my bones, but words can never hurt me”.

Of course, we all know that words do hurt, maybe not physically, but they certainly take a toll on our psyche.

These days in planning meetings at my own company, in articles I read on the web and at various tech industry conferences, I come across words and language that I know feel hurtful, or are at least disrespectful, to the health industry and the people who work there. I hear cavalier talk about the need to disrupt the healthcare industry.

Some thought leaders even say we will creatively destruct the healthcare industry. Consumers armed with technology will rise up, they say, and disrupt everything about the current state of healthcare.

Now imagine for a minute that you are a hospital executive, a doctor, a nurse or other clinician and you hear people who work outside your industry talking about disrupting or destructing it.

Imagine being told that consumers, patients, and tech companies will rise up and destroy your business.

There you are doing the best you can to make it through each day keeping your hospital or practice economically sound, dealing with the barrage of patients at your door, staying one step ahead of ever-increasing rules, regulations and rising costs, while those who’ve never worked a day in your world tell you they are going to disrupt and/or destroy it.

Even if there is a need to disrupt healthcare (and even many who work in the health industry might agree), nobody appreciates being told by some outsider that they know your business better than you do.

I don’t imagine my colleagues who work at Microsoft (or Google, or Apple, or Amazon) would appreciate being told by a hospital administrator or a doctor that they knew better how to run a tech company, or what ails the tech industry.

Nor do I think that most patients and consumers can really appreciate the amazing complexity of our healthcare system or the unbelievable pressures under which it operates these days.

So, instead of casting stones maybe we should all try to work together. Can we not find a common ground—better health, lower costs, more efficient, consumer-centric models of prevention and care?

Can we not mutually work on solving the current ails of our healthcare system?

Can we not show mutual respect and have the humility to say that perhaps the professionals who work in healthcare know more than we do, or at least know a lot of things about their industry that we must know too if any of us hopes to disrupt what’s bad without destroying what’s good about healthcare?

So the next time you hear someone talk about disrupting or destructing healthcare, I hope you’ll have the common sense to remind them that perhaps they could choose better words, and most certainly they should approach the subject with a far greater sense of humility about that which they do not really know or understand.

Bill Crounse, MD is the Senior Director of Worldwide Health at Microsoft. This post originally appeared on the Microsoft HealthBlog.

12 replies »

  1. With regard to the comment ‘hate the ACA’ and fundamental dislodging I think it’s fair to say that there are those with more than “15 years experience” who are well versed on how destructive government authority can be to the practice of medicine. As with the rollout with Obamacare there are lots of government ‘experts’ swinging their weigh around but when things go awry no one seems accountable.

    Additionally, government regulation stifles innovation. I was an early adopter of electronic records (EMR) and instituted an EMR in my practice in 2000 on my own dime. At the time the EMR was close to the state of the art in computer software development but has not progressed much since. The EMR company has gotten bogged down in ‘compliance issues’, HIPPA and the meaningful use incentives. Currently many EMR’s are little more than crude relational databases of the early 90’s. The federal government might have been helpful had it insisted on platform standards and intercommunication of systems–but, as expected, politicians weren’t forward looking or perhaps taking money under the table. Regardless, this mess has been forecast for at least a couple of decades and it would appear Obamacare did nothing to alleviate it (one reason the ACA rollout went so badly).

    Totally destroying the best medical care system in the history of mankind, even if flawed, seems a little drastic–don’tcha think?

  2. I think the healthcare industry requires disruption. I have been in it for 15 years and it is about time for major change. Hate the ACA all you want. However, it has fundamentally dislodged the system in a way that momentum is taking hold with new healthcare delivery models, services etc. That is what we need.

    New technology is changing the industry fast. It always has done so and most MDs cannot keep up. Like other business models, healthcare will continually evolve and some traditional methods of patient care may go away. Still, that does not mean that the fundamentals of patient care will die.

    20%+ of our GDP is dedicated to healthcare, so when we throw words around like “disruption” or “destruction,” it is scary. The industry is too big to be cavalier with change. It is a regulated industry which will require years to morph. The worst thing people can do is fight the changes and hold on to outdated mindsets of how they think things “should be.”

    Ask those in the Music Industry about grasping to outdated business models. The Healthcare industry, like all businesses, must meet disruption head-on and embrace it. That is the only way we can take advantage of the opportunities it brings and use them to positively impact patient care.

  3. Dave Chase,

    What are: “CareMore, Nuka Model of Care, Qliance, Iora Health, MedLion, and Healthcare Partners”?

    – In what way have they improved the quality of health care?
    – In what way have they lowered health care costs?

    I have no doubt that some/all of them have been successful companies and made money for the entrepreneur that started them. And I have some AAA rated (as of 2006) real estate bonds that I am willing to sell you for par too. But aside for making money for their founders, what are they really worth?

  4. There is no doubt there are some obnoxious people throwing around arrogant/naive ideas. However, the “creative destruction” and “disruptive innovation” that has been most impactful has come from physician-entrepreneurs. Often, they are the most provocative and hard-hitting in their language. It seems loosely similar to how the most virulent anti-smokers are former smokers. They want others who they can relate to experience the liberation they’ve experienced.

    I wouldn’t assume ill-intent from these MD-entrepreneurs using direct language. They simply were fed up with what they experienced as “broken” and stepped up with approaches that have out-performed. I’m thinking about the MD-entrepreneurs and innovators who have led CareMore, Nuka Model of Care, Qliance, Iora Health, MedLion, Healthcare Partners, etc. Sometimes to catalyze change, one must use stark, hard-hitting language. That doesn’t seem like a foreign concept to the many excellent MDs I’ve known over the years. I have enormous respect for any entrepreneur, especially one coming from tradition-bound professions who are willing to stick their neck out and endure enormous personal financial risk. Bob Margolis shared how his colleagues referred to him as a “communist” and his team-based model as “communism” yet Bob’s org achieved far better outcomes. He had the last laugh when that “communist” sold his business for $4.4B last year.

    The comments from these MD-entrepreneurs is they feel they aren’t doing their MD friends any favors by candy-coating what is widely recognized as a system that isn’t close to reaching its full potential. In contrast, the orgs those MD-entrepreneurs are running are the reigning “Triple Aim Champs” that we should celebrate — colorful language or not. Often the most impactful entrepreneurs aren’t particularly “polite” in their language — Steve Jobs, Bill Gates, Larry Ellison et al called it like they saw it. What’s wrong with that?

  5. The reason “health care providers” should listen to outside experts is because of the expert’s track record in having their predictions come true:

    “If you like your doctor you can keep him”

    – Except if you change insurance and your doctor doesn’t participate in your new plan
    – Or you are put in an ACO that has a “narrow network”

    “Electronic medical records will save money and improve care”

    – Except they don’t save any money
    – And they don’t improve care

    “ACO will save money and improve care”

    – Except less than half saved money (54 of 114)
    – And they haven’t been proved to improve care

    “Patients who have insurance won’t go to the ER as often and that will save money”

    – Except they go to the ER more often and cost more money

    “When poor people have Medicaid, their health will improve.”

    – Except is doesn’t

    “Prevention saves money”

    – Except it doesn’t

    Yeah, I am pretty impressed by what outside experts have told me about how to; “disrupt”, “improve”, “bring health care into the 21st century”, etc, etc. blah, blah, blah.

    Their predictions and expert advice seems to be almost as good as a coin flip. But of course that doesn’t prevent these experts from collecting their fees and having their their 15 minutes of fame.

    Here is an idea – how about an expert that makes a prediction that is measurable and testable and stands behind it with both reputation and HIS OWN money. Any takers?

  6. I do see your point that it’s not fair to have outsiders come in and know what is best in healthcare but the truth is healthcare is run by lots of people who aren’t healthcare providers which is why it’s not working very well in this country. I believe in creative destruction. I think it needs to come from the inside out. Let’s give docs the tools to do the management side of things so that more practicing physicians can have a voice in how this all runs.

  7. Finally. Someone in tech willing to say what the doctors in the crowd are thinking. Actually, the real doctors who have practiced and didnt just get an MD before becoming a VC or a tech entrepreneur. As with many organizations, the arrogance of the people in power is blinding them to their own deficiencies. But what I want to know is how physicians lost the high ground to such a self righteous, arrogant and self interested group. Is it because we were perceived to be the same and because we couldnt hide behind anonymous technology?

  8. The post by Dr. Crounse is quite true. Unfortunately no one in Washington is listening. The Obama administration has been going out its way to bankrupt the medical profession with his policies of significant reimbursement reductions. As a result, a huge and growing number of practices are being sold to hospitals and other organizations. This migration is goal of Obama as evidenced during his initial presidential campaign and his early years as President when he stated that all physicians should be salaried and not working on a fee for service basis. He is single-handedly marching to that drummer despite no scientific evidence that this model will save money or provide better quality.
    This is a tragedy that I believe will have many unsuspected consequences and will yield poor, uninspired healthcare. For more info see healthcare-financing-myths.blogspot.com

  9. As a practicing Internist I never felt medical providers got much input. Sure the AMA was involved but clearly had conflict of interest and represent only a small fraction of real life doctors. Maybe next time around doctors can overhaul our current Federal Government and political system–makes about as much sense as what happened with the ACA to me.

  10. I think the word disruptive has become Silicon Valley’s equivalent of the word “like” in the 1980s – something you say when you’re trapped and don’t know what to say and are fighting for air

    Most people outside of Silicon Valley get this now EXCEPT some of the younger startup guys (who don’t know any better) some of the “thought leaders” who don’t care (because they were they ones who started using it and think it is a historic word)

    I think they don’t realize people hear this shh*t and tune if out