How creatively rethinking the fundamentals of care delivery trumps Big Data and Analytics in the quest for a Health Care Happy Ending.

I recently heard Ed Catmull, co-founder of Pixar, speak at a conference on healthcare analytics.  When I mentioned this to a friend in the animation business, his response was something like ‘that’s really cool but what does Pixar have to do with health care?’ 

The topic was building and sustaining a culture of creativity.  One of Ed’s foundational points was that creativity is in essence problem solving. Another was that technology itself can only advance a cause so far.  The take away for me was that while we have powerful new technologies to apply in the worthy cause of transforming health care; mission success requires continuously and creatively rethinking the fundamentals.

One particular statement from the talk struck me as a fantastic summary of the underlying creative challenge we face in health care:

‘Any right process over time becomes stagnant or corrupt’. 

In its simplest form, the care delivery process in the US (and most developed countries) can be simplified to three phases:

Symptom => Individual Clinician Assessment => Intervention

In this model, individual clinicians perform assessments on many patients and funnel those with similar symptoms toward specific interventions.   

During the period of history in which our greatest health challenges were acute, communicable diseases, this process was appropriate and effective. In contrast, today’s primary health care challenges are complex, chronic, non-communicable diseases with latent and overlapping symptoms. 

The net result of applying this antiquated model to complex chronic disease is a scenario in which patients enter the system in and advanced state of decline and are funneled toward a variety of uncoordinated interventions by a number of individual clinicians.  Unprepared patients are then left to coordinate these often conflicting or overlapping pathways for themselves.  

In short, while our technical ability to assess (diagnose) and treat (intervene) for emerging chronic diseases has increased exponentially over the past several decades, the continued application of this stagnant and oversimplified funneling process has created an underperforming industry rife with conflict and waste.

To be fair, an isolated, linear approach to problem solving is not historically unique to health care. In most other industries however, more agile, iterative, and collaborative processes have already taken hold.  These new processes are supported by a near continuous feed of data.

For many reasons, not the least of which was access to data, health care has been slow to adopt these newer, more dynamic and collaborative models focused on continuous improvement.  

Enter the promising new healthcare era of Big Data, Analytics, and Population Health.  These capabilities represent access to data with the potential to drive tremendous positive change for health care however technical capabilities will take us only so far.  We must creatively rethink the fundamentals of care delivery to unlock this potential.  

Much of the early focus for these technologies and this data has been on identifying patient populations and measuring the impact of various interventions.  While we’ve begun exploring creative approaches in the conceptual form of personalized medicine, our attention is consistently drawn to technical capabilities versus creatively rethinking the fundamental approach to care delivery.

Whether we’re talking about population health or personalized medicine, the key to unlocking the potential of the technology and data is creative problem solving at the fundamental process level.  We must rethink the current care delivery model in which individual providers funnel populations of patients with similar symptoms toward common interventions.

Whatever it’s final form; a new delivery model must be dynamic and collaborative.   Rather than focusing on patient populations, it should involve caregiver communities following individual risk-stratified patients and coordinating strategy toward behavior change

The transformation looks something like this:


Symptom => Individual Clinician Assessment => Intervention


Risk Assessment => Care Team Coordination => Behavior Change

In this new model focused on today’s chronic disease challenges, analytics-driven risk assessments replace symptoms, care team coordination replaces individual assessment, and behavior change replaces intervention as the primary goal.

We’ve begun to travel down this path by focusing much of the current health technology discussion on interoperability.  As one of my tech friends likes to say however, ‘getting the computers to talk to each other is easy—getting the people to talk to each other is another story.’  Perhaps we can take a lesson from Pixar and Ed Catmull.  Pixar began as a technology company.  In the end Ed’s passion became developing and sustaining a culture that aggressively fosters and defends creativity.  In turn, that creative culture is constantly vigilant for processes that have become stagnant or corrupt. 

Perhaps following Pixar’s lead can help write a happy ending for Health Care.