Good Ideas From Unexpected Places

How about this: in Harvard Business Review, two leaders at Johns Hopkins suggested that hospitals could learn something about buying equipment from -- drum roll, please -- the airline industry.

You don't often find many people defending airlines these days, much less holding them up as good examples of anything (except, perhaps, about what not to do, what with overbooking, cramped leg space, plenty of add-on fees, and, of course, dragging paying passengers off planes).  That their recommendations make sense probably says more, though, about how poorly health care often does things than how well airlines do.

The point that Peter Pronovost and Sezin Palmer make is that "hospitals purchase technologies without requiring that they communicate with each other."  They have lots of high tech equipment, each with lots of important data, but the equipment is generally not interoperable (of course, even the same types of equipment often aren't interoperable -- EHRs being the prime example).

As they say, "health care is woefully underengineered."  This leads to all sorts of workarounds and double-entry, which at best make patient care more difficult and at worse threaten patient safety.  They urge that heath care take advantage of system engineering to truly integrate technology, workflow, and clinical practices.

Hard to argue.

Their great quote:

We don’t expect airlines to build their own planes. They buy them from experienced system integrators such as Boeing or Airbus. There’s no reason that hospitals shouldn’t have a similar model. 

For example, they suggest that, instead of building hospital rooms and then filling them with equipment that don't communicate, hospitals could buy hospital room modules that come with fully integrated devices.  It could be not just rooms, but clinical units, whole floors, even a "hospital in a box," each coming already integrated.

The approach goes beyond hospitals, of course.  For example, aircraft engines increasingly tap into the Internet of Things (IoT), so that they can be continuously monitored and problems addressed before they become serious.  That is something that health care talks about a lot, in terms of monitoring our heath, but so far has failed miserably at.

Of course, the airline industry still uses air traffic control systems that are decades old, their baggage tracking systems still manage to lose your bags, and it seems to take a suspiciously large number of keystrokes to rebook you if your plane gets cancelled.  So the airline industry could use some systems engineering of its own.

Upon reflection, the two industries are not as dissimilar as they might seem on first glance.  In both cases, we literally put our lives in their hands, hoping that the people and equipment all function correctly.  Both are very capital-intensive.  Both use some technology that is decades old as well as some cutting edge technologies.  Both have seen rapid consolidation of service providers, leading to less competition.

And neither has a great track record about doing exactly what they promise to do exactly when they say they're going to do it.

Health care or airport waiting room?

On the other hand, you can easily shop for flight choices and prices (although airline pricing may just rival health care pricing for its inexplicable variations), can book your airline ticket and pick your seat using your smartphone, and on-board entertainment options are becoming fairly sophisticated.

The equivalents in health care pale by comparison.

Health care can do better.  John Nosta writes in Psychology Today that healthcare innovation is "in the ICU."  In other words, in serious trouble, but not dead yet.  He believes the underlying technologies are there to spur innovation, and that "an inflection point is at hand."  He cites in particular a survey done by Klick Health, which found that consumers don't think that health care is very innovative, but they wish it was.

Specifically, health care was at bottom of 18 industries in terms of which respondents felt was the most innovative (17%), but top of the list of ones that they thought should be (40%).  Ninety-one percent believed innovation will positively impact healthcare over the next five years.  Ninety percent also felt technology would have a positive impact on their health, with 70% believing technology will help them personally manage their health.

Contrary to oft-mentioned concerns about technology interfering or even replacing the physician-patient relationship, the Klick respondents felt that it would benefit from innovation, such as in better diagnosis and treatment.

Health care all-too-often sees itself as unique, and tries to solve problems using health care people applying health care solutions.  That may be necessary in many cases, but it can't be the only approach.  There are too many other industries, using too many interesting business models, process improvements, and technologies, to limit problem solving to "traditional" health care models.

Suzanne Fox, the former CTO for HHS, recently told Washingtonian: 

The most successful groups I’ve seen in terms of the innovation work I oversaw at HHS or discussions I’ve been a part of in other settings, the more diverse groups, the better the innovation becomes.  You’re going to want to hear from people who haven’t yet developed the muscles for a certain way of thinking about health care, who are going to maybe have that outside idea that’s creative.

So, if we're going to innovate in health care, we need to flex those non-health care muscles.  We need to break down barriers.  We need to listen to diverse voices and ideas.  We need to apply ideas that we might not normally think would apply to health care.  We need to beg, steal, and borrow good ideas from wherever they come.

Even if that means learning from the airlines.