HealthAchieve 2010: Opening Session (Day 1 – morning)

Welcome from HealthAchieve 2010! I was able to attend this year and am looking forward to some interesting presentations, inspiring stories (most likely from the Canadian Olympians), and warm reconnections with colleagues. I’ll try to post some photos to include with the posts (if I remember to take them).

As usual, the opening session was kicked off with a playing of the Canadian national anthem. I’ve always enjoyed hearing (and singing) the anthem to start the conference. The good thing was that the old 1970s style video montage was replaced by a newer version (from the 2010 Vancouver Olympics). Kudos for that, but is it too much to ask for a *simple*, unadorned, unaltered version of the anthem so people can actually sing-a-long? Sorry for the rant, but I’m a big believer is that national anthems should be simple and unmodified. Okay, back to the write-up of the opening session.

Welcoming Remarks: Paul Collins

Paul Collins started the session by highlighting “Movember” a fund-raising event occurring during the month of November. He also hlgh-lighted some other future sessions like eHealthAchieve track, the Olympian panel session, and a few others as well as acknowledging the students in the audience. He also highlighted some of the innovation exhibits on display.

McKessen (Canada) sponsored the opening session again and a representative made some remarks and challenged the audience to “focus, engage, recharge, and connect” while at the conference.

Some awards were presented by Longwoods Publishing for leading practices:

  • Health Information Practice: SIMS
  • Leading practice for patient safety and quality: Wiliam Osler Health System
  • Education: Erie-St. Clair & Windsor regional hospital
  • Leadership: Windsor Regional Hospital
  • Family & Patient-Centered Care: St. Joseph’s Hamilton
  • Access to Care: Oakville-Trafalgar and Halton Health Services

Out of over 370 submissions, the “Best of the best award” goes to St. Joseph’s Health Care (Hamilton).

The Ted Friendman Award (sponsored by Accenture) was awarded to UBC & UNBC for the work in addressing underserved communities to give access to medical services.

Congratulations to the award winners!

The theme of this year’s conference seems to be “shaping health care for the future”. If so, then Clayton Christensen is a very good choice for an opening keynote speaker.

Speaker: Professor Clayton Christensen

Started off with how he became an academic and focused on innovation. Here are some tidbits from his presentation:

  • Has been looking at health care for about 12 years based on some prodding from colleagues and students;
  • Three months ago, he had a stroke. (Wow). Now he’s re-learning how to speak.
  • Can describe most industries as a series of concentric circles.
  • Middle is the most expertise and the most money. Outermost circles is where most of the rest of the people live. Computers is a great example.
  • Outer edge circles is usually the most simple solutions. Centralization is followed by decentralization.
  • Christensen then walked through the evolution of the computer industry: mainframe to mini-computer to PC to today
  • The main thrust is that solutions increasingly bring power and expertise to the rest of the users rather than centralizing expertise with a few elite
  • Christensen then explains the theory of disruptive innovation using the classic example of DEC and the PC
  • Decentralization and centralization is only beginning in health care
  • @ Brigham-Young Hospital – ~70% of patients today would be in ICU 10 years ago, about 30% of patients would be dead 10 years ago. Example of increasing expertise and ability within the hospital system
  • What needs to happen to make care more affordable is to drive decentralization.
  • Technologies that enable clinics to do more and more is required and keep driving more and more technology away from hospitals eventually into patient homes
  • Ultimately, we don’t need as many hospitals
  • Unreasonable to expect specialists to accept pay cuts. Need to bring more expertise to primary care physicians and keep making expertise available to other, less specialized (and less costly) people and venues
  • Conclusion #1: probably will be fewer general hospitals in the future than today; need to drive this with new mechanisms to enable this
  • Enablers of disruption: #1 simplifying technologies (makes expert knowledge accessible); #2 business model innovation (#1 needs to be embedded in a model that is accessible to customers); #3 new value networks (extract value from #1 and #2)
    • #1 Simplifying technologies commoditize expertise and make it easier for non-experts to access the information; what does that mean for health care? Need to start commoditizing expertise of specialists, using evidence-based medicine, and finally precision/personalized medicine
    • #2 Business model innovation: Elements of a business model include: value proposition, resources, processes, and profit formula. More pathways and complexity leads to higher costs for overhead. Hospitals use a high-cost value proposition business model
    • Hospitals are expensive conflations of three types of business models: #1 solution shops (identifies problems and recommends solutions – makes money base don fee for service); #2 value-adding process business (make money by fee for outcome); #3 facilitated networks (need to interact with others – make money by fee for membership)
    • #3
  • Disruption of the hospital model might look like #1 coherent solution shops (whole focus is to diagnose the problem and recommend solutions) and #2 value-adding process clinics (e.g., Shouldice hospital for hernia repair in Toronto)

Final summary remarks by Christensen:

  • Health care will not become cheap as long as we use centralized models. Need to drive decentralized models facilitated by new innovations to do more sophisticated things
  • The value proposition of hospitals is a problem that no-one can resolve because of the business models within the organization
  • Cost is in the overhead. By focusing, overhead hosts can be reduced (Hans’s note: see Hertzlinger’s focused factory idea)
  • Quality comes from tightly coupled integration. Focus on a job enables appropriate integration
  • Costs will fall and outcomes will greatly improve when focused colution shops emerge for major categories of disease

Christensen answered a question about the notion of focused factory in health care and how people may not want to travel to different organizations and used the integrated vs. modular analogy. Health care is in the modular model and doesn’t have an integrated/system perspective. In an integrated system, where the payer is a part of the system, then there might be an incentive for prevention rather than being disease treatment focused.

Regarding IT in health care, Christensen used the “jobs to be done” model in that we “hire” products or services to get a job done. Therefore, IT will only play a role as long as it is useful in solving the issues that we are trying to solve. IT is only useful for people when they aren’t well. So, simply giving more information to the healthy folks doesn’t really have an impact because people don’t think about medical issues when they are healthy.

Some other interesting tidbits about HealthAchieve:

  • You should check out HealthAchieve’s new mobile app. I downloaded the iPhone app. It seems to have all of the content, but some of the information isn’t quite formatted right. Nevertheless, it’s a great start.
  • None of the afternoon sessions seem to “jump-out” at me, but someone suggested the cancer track as the Ontario 2012-2015 strategy is being presented. We’ll see if it’s cancer only or whether some of the other activities will also be included.
  • eHealthAchieve looks to have some interesting sessions, especially with Greg Reed, head of eHealth Ontario, to present some of the