Shaun Mehta is an Emergency Medicine Resident (R4) at the University of Toronto
In elementary school, I always dreaded bringing my report card home. My grades were good, but the teachers’ comments that followed could go either way — and were unfortunately of much more interest to my parents. I was often described as “disruptive,” and it seemed that relinquishing this quality was the key to making something of myself.
Two decades later, I’m finding out that being disruptive is one of my most valuable assets.
To clarify, we probably shouldn’t praise students for being disruptive in the classroom. But outside of the classroom... now, that’s an entirely different story. The health care industry is ripe for disruption; strapped for cash and bursting at the seams, we need better ways to manage today’s volume and complexity of patients. Forward-looking individuals and organizations have heeded the call and are making huge strides in health care innovation, yet patients continue to suffer as a result of systems-level issues.
By shifting our paradigm of innovation, creating an environment to foster disruption, and educating future leaders to drive change, we stand a chance at driving maleficent creatures (like hallway medicine and eternal wait times) to extinction.
Changing our mindset: When most people think of innovation, the quintessential examples that come to mind are almost always technology-based and revolutionary. If we adopt this view, the task of innovating health care seems overwhelming, expensive, and — frankly — impossible. To shift the power back to us, I invoke the wisdom of Harvard business professor Clayton Christensen. In describing both incremental and disruptive innovations, he teaches us that even small changes can be profoundly innovative. I urge people courageous enough to innovate health care not to merely ask for more money, bigger teams, and better technology, but instead to focus on reallocating your current resources to drive change (no matter how small that change may seem).
Challenging the status quo: Definitions of innovation are innumerable, yet underlying them all is one message: challenge the status quo. Our current health care system is struggling to care for patients optimally, so the status quo clearly has dysfunctional elements. Moreover, in considering data trends forecasting increasing patient volumes and complexity, tomorrow’s system looks even more doomed than today’s. Challenging the status quo requires us to think outside of the box and be critical of why things are the way that they are. In the medical community, we are hard-wired to be scientific and favour our left brain over our right, but creativity plays a key role here. I commend current examples of innovative thinking in medicine: shifting trends in data ownership and access, peripheralizing medical services into the pre-hospital realm to relieve hospital burdens, and using technology to augment human capabilities. We need to foster more ideas like these to improve the delivery, efficiency, and safety of health care.
Getting organizational buy-in: Some of the best innovators work at large organizations where they face bureaucratic challenges in being disruptive. This is not the fault of these organizations — Christensen’s resources-processes-values (RPV) framework posits that successful organizations have created a system that works in acquiring significant market share. Accordingly, disruptive efforts often lie in conflict with a company’s RPV schema and can lead to their downfall. In the corporate world, dramatic consequences ensue as new companies have the RPV wiggle room to be innovative and replace incumbent firms. Thankfully, Christensen offers a solution: large organizations can develop subsidiary units that have the opportunity to create a new RPV culture and thus be innovative. In medicine, it’s less about shifting market share, but we need to be cognizant of RPV forces so as not to stifle innovation. Two great examples are University Health Network’s OpenLab and Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), both of which function as interdisciplinary spin-offs tasked to find innovative solutions to health care. I encourage other organizations to follow suit, either by developing their own subsidiaries or partnering with third parties.
Teaching disruption: As a group of successful professionals, physicians often believe they are good at everything. It can be tough to convince an intelligent group of people with Type A personalities that they are not innately excellent at something. Albeit a hard to swallow pill, the truth is that we are not all good innovators — though we certainly have the capacity to be. I liken this idea to the evolution of medical teaching: groups of health care professionals figured out that we were not all inherently good educators, and perhaps learning the science and philosophy of education would make us better. Fast forward a few decades, and many clinicians now possess graduate-level certifications in education studies and enrich the atmosphere of learning for trainees. I propose a similar philosophy for innovation; curriculum development centred on learning how to be disruptive combined with forums that provide an avenue to present innovative work will be instrumental in creating a brighter future for medicine.
I’ve listed a number of recommendations here — take two and call me in the morning.