Soapbox Round 2: ‘disruptive innovation’ debate disrupts ‘the chattering classes’

click to enlargeIt’s a Blackboard Jungle out there. Clayton Christensen rebuts Jill Lepore on most–but not all–of her views on his theory of disruptive innovation [TTA 24 June] aired in a New Yorker cover story. The forum is a follow up interview (20 June) with BusinessWeek. (Hat tip to Tom Boyle commenting on the original Soapbox. Also see a just-released HBR video interview, link below.)

Your Editor agrees with his point that his theories have been developed and updated far beyond his first (1997) book, ‘The Innovator’s Dilemma’, the only one she refers to.  (Similarly, I am most familiar with ‘The Innovator’s Prescription’ of 2008, but we’ve commented on his more recent relevant work, readily searchable here.) This is, unfortunately, her argument’s major flaw. It is akin to ceasing your review of WWII history with A.J.P. Taylor and Cornelius Ryan; as fine foundationally as they are, the scholarship and strategic debates will extend far beyond our lifetimes.

Mr Christensen in his rebuttal is appealingly modest in bringing up where he got it wrong (the iPhone), where his model has gone off (in 2002, a mathematician from Tuck demonstrating the causal mechanism as incorrect to that point) and that he still sees problems with the theory. Moreover, her strongest point is one he agrees with: (more…)

Soapbox: Is ‘disruptive innovation’ a theory gone off the tracks?

click to enlargeHaving publicly stood as a huge fan of Clayton Christensen’s theories of disruptive innovation, particularly the ‘broken circle of innovation’ as an explanation of our current economic stagnation (if not ‘stagflation’ which was a hallmark of my early adulthood and yes, now) and disruption in healthcare (even if it hasn’t started yet because it’s been sidetracked), this Editor was prepared to savage, demolish and otherwise lay waste to a New Yorker article by Jill Lepore (a Harvard professor of American History, for Pete’s sake).

Having read and digested the article, I am surprised in largely agreeing with Prof. Lepore. She brings forth certain weaknesses and concerns I had about the entire Weltanschauung of disruptive innovation, first as an overarching theory equivalent to Darwin’s theory of evolution. There is a veritable industry around disruptive innovation which she outlines, reminding me that hype of this type around any theory I find profoundly irritating because theories are just that–to be reality checked early and often, just like voting in the 1930s in Jersey City, New Jersey. Prof. Lepore then points out where fellow Harvard Prof. Christensen didn’t paint the complete picture (e.g. Bucyrus, US Steel) and–to me quite importantly–discounts external events and even aggressive, defensive business strategy (as Ron Hammerle’s Soapbox on sidetracked innovation pointed out). Many of Prof. Christensen’s acolytes ignore history (and business strategy) altogether in a near-religious form of Determinism-by-Innovation.

There is also another circle–a circular logic prevalent in Mr Christensen’s theories summarized aptly by Ms Lepore: (more…)

Soapbox: How healthcare disruption can be sidetracked

click to enlargeRon Hammerle’s comment on Disruptive innovation in healthcare hasn’t begun yet: Christensen (TTA 31 Mar), posted on LinkedIn’s Healthcare Innovation by Design group, made the excellent point that a potentially disruptive and decentralizing healthcare service–retail clinics–has been sidetracked, at least in the US, leaving an open question on their reason for being. This Editor thought it was worthy of a Soapbox. Mr. Hammerle knows of what he speaks because his Tampa, Florida-based company, Health Resources Ltd., works with retail and employer-based clinics to connect them via telemedicine/telehealth systems with medical centers.

When Clayton Christensen first anticipated that retail clinics would be disruptive to the established healthcare industry, their business model was potentially disruptive. What has subsequently happened, however, is a prime example of how potentially disruptive movements can be sidetracked.

After acquiring MinuteClinic and laying the foundation for taking retail clinics national, CVS Caremark chose to make deals with hospitals, which could easily afford to rent, open and operate such clinics without making money on the front end or facing real disruption. Retail clinics were a loss leader to hospitals in exchange for large, downstream revenues, and slightly-enhanced market share for the retailer’s pharmacy.

After CVS shocked Walgreens with one-two punches involving MinuteClinic and Caremark acquisitions, Walgreens came back with three counter-punches of its own:

1. They doubled the number of their clinics (to 700) in less than two years, thwarted AMA opposition, leapfrogged ahead of CVS in clinic count and totally changed the retail clinic model by setting up politically-invisible, broader service, make-your-profit-up-front, employer-based clinics. (more…)

Disruptive innovation in healthcare hasn’t begun yet: Christensen

Clayton Christensen, as many of our readers know, pioneered a theory of disruption in business models and a three-step cycle of innovation (empowering, sustaining and efficiency, now quite broken indeed). With two other writers, he applied these theories to healthcare in the 2009 book ‘The Innovator’s Prescription’ which this Editor heard co-author Jason Hwang, MD present in 2009 at the Connected Health Symposium and at a private meeting in 2011. One would think that we’d be well into disruption, which is part of the empowering innovation cycle and which the authors championed in the book as underway.

The surprise at the end of this Mobihealthnews article on his recent presentation at “Better Health” in Boston, a McKesson-sponsored meeting series, was not what constitutes disruption, but that it has not really started yet, four years later. This will be much to the surprise of many successful and unsuccessful companies (Misfit ShineZocDoc, Zeo, 23andMe) and health plans which have stoutly touted their products and services as The True Disruptors. Sorry, you may be only a part of the Big Shift: decentralization. Decentralization will push out parts of healthcare off the hospital (more…)

The CES of Health: post-scripts

It’s Everywhere, Everyday, Disruptive, Not Impressive and Still ‘Bicycles for Fish’.

Neil Versel’s first major article recaps the Digital Health Summit ‘Point of Care Everywhere’ panel with Dr. Joseph Kvedar of Partners HealthCare/Center for Connected Health, Walter De Brouwer, founder and CEO of Scanadu (the tri-corder everyone’s waiting for) and Laura Mitchell, VP of business development at ‘grizzled pioneer’ in telecare and telehealth GrandCare Systems. The key is integration–for Dr. Kvedar, making it ‘about life, personal and social’; for Mr. DeBrower, bringing digital health into the home; for Ms. Mitchell, persuading long-term-care providers that technology provides useful, actionable information. Some surprises here: Scanadu will be shipping 8,800 units in March to its Indiegogo supporters and is going into a Scripps Health clinical trial; Dr. Kvedar admitted that the latest CCH startup, social wellness site Wellocracy [TTA 30 Oct] is “still searching for its audience.” The headline is “Mobile health has a lot of power, but it’s raw and new”–but is that helpful in positioning it to the Big Users–payers, pharma, providers–who are not all that daring? Mobihealthnews 

Everyday Health with the Digital Health Summit announced on Thursday their 2014 awards for innovation to five US companies for ‘achievement in technology innovation aimed at improving health outcomes.’ They include Scanadu but also four less heralded companies: (more…)

Harvard Business School + Harvard Medical School = Forum on Healthcare Innovation

Definitely for your weekend perusal, the report issued earlier this month from the first collaboration between HBS and HMS, the Forum on Healthcare Innovation, is derived from the five-panel, two-day conference, ‘Healing Ourselves: Addressing Healthcare’s Innovation Challenge’, held last November at HBS. It centered on ‘Five Imperatives’ :

1. Making Value The Central Objective
2. Promoting Novel Approaches to Process Improvement
3. Making Consumerism Really Work
4. Decentralizing Approaches to Problem Solving
5. Integrating New Approaches Into Established Organizations

Dan Munro’s Forbes article is an excellent summary of a 26 page report. Additional content and videos are available on the Forum’s website. The one certainly worth watching is Clayton Christensen’s as moderator of Panel 4 – Improving the Patient Experience (link) which focused on decentralizing care–pushing care out to consumers via clinics and decentralizing the innovation process. (The Innovator’s Prescription discusses this at length.) What is notable from the initial reading is that no one is discussing ‘technology’, HIT or mobile health specifically or as a panacea–but it is shadowing everything : effectively using patient data, the quality of that data, and ways patients can use information to guide their choices. This doesn’t seem like a single shot effort, so we’ll be watching for Round 2.