Health Care: New Structures and New Behaviors
Scholars: Elizabeth Teisberg, Scott Wallace, Toby Cosgrove, Tim Brown
The Cleveland Clinic does not hire smokers. Nor does it serve foods containing trans fats in its cafeterias or stock soda and candy in its vending machines. "We need to consider the health of our community, not just the sickness of our community," explained Dr. Delos "Toby" Cosgrove, president and CEO of the $4.6 billion health care system. Tim Brown, president and CEO of the global, award-winning design consultancy IDEO, conveyed a similar message: "The challenge of making society healthier is the big challenge of today."
During a two-day event on health care innovation at the Darden School, Cosgrove and Brown joined Darden professor Elizabeth Teisberg and visiting professor and Batten Fellow Scott Wallace in an exploration of innovative approaches that deliver high-quality outcomes of care and promote good health while controlling costs.
The event began with an invitation-only workshop on health innovation for health sector leaders. Teisberg and Wallace led a day of discussion in which participants shared insights from their ongoing initiatives to design and offer dramatically improved solutions for patients with chronic diseases. Teisberg is internationally recognized for reframing health care strategy to focus on improving value, and Wallace is an authority on transforming health care delivery to support chronic health.
The event culminated on day two with a symposium before a packed audience of health care professionals, business leaders, Darden faculty, students and community members. Brown, Cosgrove, Teisberg and Wallace discussed innovation that improves health and care. The four experts agree that dramatic improvement in health and health care value can be achieved with interdisciplinary teams, the measurement and reporting of patient outcomes and the design of services that support healthier behaviors.
Cosgrove, a world-renowned cardiac surgeon who invented numerous medical devices and surgical techniques, has led stunning innovation in the organization of patient care in the Cleveland Clinic's $4.6 billion health care system. He started from a conviction that every aspect of the organization should be devoted to serving patients. Some of his first moves addressed the culture. He handed out 40,000 buttons with the words "Patients First," and he reconsidered longstanding attitudes about medical professionals. "I saw false divisions in the organization, such as the one between doctors and all the other employees," Cosgrove said. "All of us are essential to patients — not just the docs. Now everyone is considered a caregiver."
In line with that shift, Cosgrove restructured the Cleveland Clinic around diseases and patient problems, not medical specialties — an innovation that breaks down what Cosgrove considered other false divisions between specialists, grouping professionals from various disciplines into patient-centered teams. This interdisciplinary structure is an application of the approach that Teisberg and Harvard professor Michael E. Porter set forth in Redefining Health Care. In that pathbreaking book, Teisberg and Porter argue that participants in the health care system have competed on costs instead of creating value — for patients and all industry players. Patient-centered teams are a large component of Teisberg and Porter's value-based approach. They improve outcomes, reduce waste and accelerate learning. "Innovation," Cosgrove said, "happens at the borders of disciplines," as professionals from different fields interact to address patients' issues.
Under Cosgrove's leadership, the Cleveland Clinic has also become a leader in measuring and disseminating patient outcomes. By gathering and reporting long-term outcome data, the organization drives ongoing improvement and has sparked competition on quality with other institutions.
To Cosgrove, the reforms at the Cleveland Clinic are about health care instead of the usual model of "sickness care." To that end, he champions a culture of health not just for patients but also for employees and area residents. Cleveland Clinic programs have reduced smoking in their county from the highest in the state to the lowest in the state, improving health and thus reducing health care costs.
Promoting good health was also central to the comments of Tim Brown, whose world-renowned design firm, IDEO, now does 40% of its work in health care. "The root cause of high costs in health care is our behavior," he said, "not a bug that can treated with a vaccine."
Drawing from IDEO's work in such areas as financial services and energy conservation, Brown presented examples of the design thinking for which IDEO has become famous. "We already design our lives," Brown noted, but often with goals in mind other than health. The key to helping people change their behavior is to build on what they already do. For example, through its consumer research, IDEO noticed that many people were in the habit of rounding up when they paid their bills. When asked about this behavior, most said they saw it as a way to make sure they kept up with their payments. Recognizing this as a form of personal saving, IDEO used this insight to help Bank of America develop its "Keep the Change" program, in which the bank rounds up customers' debit card purchases and transfers the difference from their checking accounts to their savings accounts.
During the symposium, Brown shared some principles for encouraging health-promoting behaviors. Changing rules, influencing social norms, introducing new tools, establishing participatory systems, enabling self-measurement, engaging communities and reframing problems are among the ways to design the behavior changes that could alleviate some chronic diseases.
The symposium concluded with a panel discussion in which Brown, Cosgrove, Teisberg and Wallace discussed strategies in health care that envision different possibilities by designing for health and by redefining health care delivery.