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A View From Mauritius: The Prospects for Health Care Disruption

02/18/20

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Tom Robertson, Executive Director, Vizient Research Institute

Standing roughly three feet tall and weighing almost 40 pounds, with bright yellow feet and a black, yellow and green beak, the Dodo bird must have been a sight to behold. Its appearance is known only through drawings, paintings and the written accounts of sailors who visited the island of Mauritius, located east of Madagascar in the Indian Ocean. The species disappeared in the 17th century, and has since become a symbol of extinction. Often portrayed as clumsy, the Dodo is actually believed to have been remarkably well-adapted to its ecosystem. Biologists believe that the Dodo became flightless due to bountiful and readily available food and the absence of predators on the remote island.

First mentioned by Dutch sailors in 1598, the last known sighting of the Dodo came in 1662. Its extinction was hastened by hunting and the intrusion of invasive species – including rats, cats and pigs – that were imported by newcomers to the island upon its settlement. Safe and content in a virtually idyllic environment for no one knows how long, the Dodo’s vulnerability was exposed in a very short time. The bird was gone in less than 100 years.

A lot has been written about disruption in health care. Too often we try to predict specific disruptors and to identify the things that they will displace, an almost impossible task. A more practical approach asks what about the current system could be disrupted with the least objection by consumers, regardless of whether it turns out to be a wristwatch, a robot or a molecule that ultimately tips the balance. A good place to start is with elements of the current delivery system that provide the least value to patients – or even worse, serve to reduce consumer satisfaction.

Think about waiting rooms, bills and insurance forms, or multiple trips to a provider location to get an answer or to solve a problem. Think about the number of telephone calls patients have to make. How about things that hurt? Phlebotomy, catheters or incisions. And avoidable emergency room visits or low-acuity hospital admissions. It’s hard to imagine consumers objecting strenuously if any of these components of the current system went away.

Another tack is to consider how much of the status quo exists primarily to serve providers rather than patients. The system was built by providers, not patients, so it comes as no surprise that examples of infrastructure and processes designed around provider preferences and not patient needs are plentiful. Had patients designed the system, it’s unlikely that we would have single specialty group practices or individual physician offices. For that matter, physician-owned facilities or equipment in free-standing locations may never have evolved.

Patients consider themselves a whole, so the health system orientation by body part is counter to how patients would have designed it. One visit to an ambulatory facility – from the front desk to the exam rooms to the revenue cycle – and it becomes immediately clear that it was designed around us, not the patient. And if you have spent any time as an inpatient, or visited a family member who did, the uncoordinated rounding by multiple specialists who do not talk to one another is hard to overlook.

Perhaps the target most ripe for technological disruption is the broad swath of interactions for which the principal purpose is the collection of information/status/signals/samples as opposed to the interpretation of those signals or acting upon them. Historically, we have had the patient come to the provider to talk, to be touched, or to take samples, images or measurements. We have built enormous architectural footprints and operational infrastructure around millions of patient encounters that are largely devoted to gathering information, not treatment. What would happen to our business models – and to our ability to cover fixed costs – if a large subset of those “reconnaissance” encounters went away?

The risk of disruption to health care providers is not of extinction, but of an interruption of business as usual. Not unlike the introduction of invasive species into a previously insulated ecosystem, the effects of technology, changing consumer expectations, and the inversion of the population pyramid threaten to disrupt the U.S. health care system, which in many ways has resembled an island far off the coast of Madagascar.

While the Dodo may be the most famous example of extinction, it’s not the only species to disappear from Mauritius and in so doing vanish entirely. The saddle-backed great tortoise was similarly pushed aside by the disruptive impact of invasive species. It’s not clear if anyone could have predicted that it would be Dutch sailors who would eventually colonize Mauritius, nor that specifically rats, cats and pigs would accompany them on their ships. What doomed the Dodo was not the nationality of the settlers or the precise composition of their livestock, it was the inherent vulnerability that comes from being perfectly adapted to an insulated environment. Health care providers would do well to take heed – and to focus not on the disruptors per se but on their own vulnerabilities.

About the author and the Vizient Research Institute™. As executive director of the Vizient Research Institute, Tom Robertson and his team have conducted strategic research on clinical enterprise challenges for 20 years. The groundbreaking work at the Vizient Research Institute drives exceptional member value using a systematic, integrated approach. The investigations quickly uncover practical, tested results that lead to measurable improvement in clinical and economic performance.

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