I recently heard Dr. Bob Kustra, president of Boise State University, explain the challenges institutions of higher learning face, and it occurred to me that he could have been giving a talk about the challenges that necessitate reform of health care delivery.
That led me to wonder whether solutions could be found by learning more about education, so I picked up Clayton M. Christensen’s “Disrupting Class: How Disruptive Innovation Will Change the Way the World Learns.”
There are striking parallels, and Christensen makes that clear. He writes, “The U.S. public education system spends more per student than all but a few other countries, and yet, on average, its students often perform at or below the level of those in other economically advanced countries. Over the past three decades, real spending per student has doubled without a commensurate gain in achievement.”
Compare that with this, from The Commonwealth Fund’s “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update:”
“The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance.”
Education experts have discovered that every student learns in a different way, and that schools need to find a way to incorporate a student-centered approach, despite a standardized curriculum. Health care experts have learned the same thing, and that while there is evidence-based medicine, care needs to be patient-centered, including recognition that different patients will have different treatment goals and motivators.
Christensen makes a point true of both industries when he says that “Disruption is a positive force. It is the process by which an innovation transforms a market whose services or products are complicated and expensive into one where simplicity, convenience, accessibility, and affordability characterize the industry.”
It is easy to see why both education and health care would be ripe for disruptive innovation, and we’re seeing it happen in both industries. In education, note the explosion of online programs. There was a time when you would have expected the University of Phoenix to be a college campus in Arizona. Now, most everyone recognizes this as an online degree or certificate program, with a digital library, computer simulations, evening classes, flexible scheduling, continuous enrollment, and a university-wide academic social network. And I’ve written previously here about disruptions in health care such as telemedicine, hospital care at home, and retail clinics.
Christensen describes the role of teachers in a new, student-centered model by saying, “they can be a guide on the side, not a sage on the stage.” There are parallels here as well. I’ve spoken about the need to engage and then activate patients so that they are not recipients of care, but rather are in charge of their care and utilizing health care providers as consultants and advisors.
The author talks about measurement and outcomes in ways that also sound familiar, writing that “Society has asked schools to pursue the new metric of improvement [outcomes] from within the existing organization, which was designed to improve along the old performance metric. In essence, the public schools have been required to do the equivalent of rebuilding an airplane in mid-flight – something almost no private enterprise has been able to do.”
The time is coming when society will expect health care providers to be measured and paid according to outcomes, not just providing services to patients. When pay-for-value becomes the payment methodology, health care providers will be trying to adapt with their current structures, programs, and processes in place, and they will find themselves extremely disadvantaged. That is why St. Luke’s is trying to change now, while we can manage the change and have time to design the new structures, programs, and processes proactively.
For education, “Teachers will always remain in schools … increasingly functioning as one-on-one tutors rather than teaching monolithically – and computer-based and student-centric learning will enable a teacher to oversee the work of more students.”
I have stated that for St. Luke’s to adequately address the primary care physician shortage, especially with the anticipated population growth in the areas we serve and the addition of more than 100,000 newly insured individuals in Idaho after Jan. 1, 2014, when the most significant provisions of the health care reform law kick in, we must evolve to a team-based care model in which physicians work with physician assistants and nurse practitioners to free up physician availability so that the clinic can see ill patients sooner.
This way, the team can improve the health of the populations we serve, the care of patients with chronic illnesses can be monitored proactively, and interventions can be made to prevent deterioration and avoidable high-cost ER visits and hospitalizations.
Christensen notes that “technological improvements (are making) learning more engaging.” So, too, St. Luke’s has been implementing myStLukes, a single electronic medical record that permits patients to see their records online, schedule appointments online, receive a printed summary of their office visit as they are leaving, and email their providers. We are also using myStLukes to create individualized care plans for our patients with chronic illnesses. And we’ve been partnering with Unity Medical to create short-duration, high-definition video content to engage patients better in patient education.
Christensen points out that “research advances (will) enable the design of student-centric software appropriate to each individual learner.” At St. Luke’s, we have created a Center for Health(care) Innovation, led by Chief Transformation Officer Tony Tomazic, to research new ways we can promote our Triple Aim of better health, better care, and lower cost by utilizing design thinking, technology, and social media to make care patient- and family-centric.
Reforming health care and education will be very difficult, especially since both industries are steeped in tradition and a sense of “this is how we have always done this.” Those who get out in front and try to lead the way will take arrows from all those who are embedded in the status quo and who want to ride things out, as if this too shall pass.
It won’t. We are at the breaking point. We have to change. Change will take time, and we haven’t got much left. In the education world, you can see that playing out in Chicago between the city and the teachers, with students paying the price of missing precious school days.
And you can see it in every meeting I have with employers who are trying to provide insurance coverage for their employees, but who question how much longer they can afford to do so. Together with their employers, employees are bearing the brunt of higher premium cost-sharing.
Leaders are emerging to drive reforms in both industries. At St. Luke’s, we’ve made it our work to lead the transformation of health care. Perhaps some of the solutions we are coming up with will have implications for education reforms.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.