Module 1

1/15/20 – I have never thought of viewing healthcare as a NASCAR race before, but after watching the two videos from Clayton Christensen and Atul Gawande I can see the similarities. Christensen’s concentric circle analogy seems even more apt when taken in combination with Gawande’s likening of medical workers to pit crew employees; applied together, both talks shine light on where medicine is and (more importantly) where medicine seems to be going. As technology advances, more individuals other than physicians are able to still deliver high-quality health care. A nurse practitioner can give a colonoscopy. A pharmacist can fine tune diabetes treatments. Watches can diagnose heart arrhythmias. In theory, all of these components are working together—just like the members of a pit crew—but in practice, the current structure of our health care system limits these interactions. To win a race, everyone has to be on the same page. Everyone has to work together. As discussed in this module, to bring costs down in medicine, it is becoming more crucial to better understand this point. To win the race, it must be done together. #HEALTHinnovations. #UABSOPH. Module 1.

Response 1 – I agree with the likening of healthcare to a series of concentric circles. Healthcare is a unique industry in that everyone presents with variations of similar types of problems. This can unfortunately limit the standardization of certain processes (which increases costs), but I believe over time as technological costs fall and adoption rates increase, personalized medicine approaches will help to make healthcare more effective and less costly.

Response 2 – I also agree with the idea that everyone only has a “piece of the care.” While our collective increase in understanding medicine has helped usher in more forms hyper specialization, these types of approaches may not be the most effective. As mentioned in Atul Gawande’s TED talk, the best form of care statically is not the most expensive form of care, and I agree that while specialization can help improve our understandings of science and medicine, generalization helps to bring these improvements to the masses at a more affordable rate.

---

Module 2

1/15/20 – Last module, the two YouTube videos both discussed the importance of bringing technology into the medical industry. The main reason for this is that successful implementation of newer technologies can allow many different types of providers to deliver high quality healthcare at more affordable prices; this results from the effects of economies of scale. However, this module seems to shed light on important potential barriers to the implementation of new technology. Specifically, it focuses on the risks associated with poor adoption. When newer products come into the marketplace, the probability of users adopting new technology is based on multiple macro- and micro-level decision models, and without understanding how these factors contribute together, it can be hard to gauge adoption rates (source: https://www.sciencedirect.com/science/article/abs/pii/016920709190001C). As mentioned in Clayton Christensen’s presentation in “Module 1,” to bring about change in healthcare, it seems necessary to have a common understanding of the issues and steps necessary to correct them. #HEALTHinnovations. #UABSOPH.

Response 1 – I agree that these complicated issues facing healthcare have potentially stymied the implementation of new developments. Given that there are high initial capital outlay costs associated with implementing new protocols, people may be hesitant to adapt if they are uncertain it will be able to drive costs down in the long run.

Response 2 – I think that more discussions can also lead to greater awareness of our own health and “wellness” can lead to improvements in public health. As mentioned in the Clayton Christensen video from “Module 1,” the best way to improve health is to emphasize disease prevention. Greater education and awareness seem like one way to achieve these improvements.

Module 3

1/25/20 – As argued last module, to properly innovate and push healthcare forward, people need to have a common understanding of the issues and a common understanding of the potential steps necessary to correct these issues. However, coming to a consensus can be easier said than done. As discussed in the assigned reading, “What Is Population Health?” many researchers disagree on a common definition to the concept of “population health.” While this seems like one isolated instance, upon Googling, “What are the problems with healthcare?” multiple peer-reviewed websites all offer differing opinions. Many agree on common issues: high costs, lack of access, excess litigation. However, upon closer looks, even with these common issues there are still disagreements. High costs to some may include being billed from multiple sources for one procedure, but high costs to others may be the discrepancies between in-network and out-network providers. In my opinion, to bring effective change into healthcare we have to try and analyze the same problem. Many argue change is necessary, but what type of change are we looking for exactly? #HEALTHinnovations. #UABSOPH.

Response 1 – I agree that one central issue towards healthcare innovation is simply figuring out the “correct” issue to address. It can be hard to pinpoint exactly what the major cost drivers and critical points are in the healthcare process, and I agree that lack of communication helps play a role in this. However, these issues are easier said than done. While physicians are excellent at applying science and medicine, they may not be the best at learning to apply these topics to guide business decisions. Similarly, business executives may not fully understand the ramifications their policy changes create if they do not understand the underlying principles of the science and medicine they are directly affecting.

Response 2 – Like others, I believe that one way to help make improvements is simply figuring out what questions should be asked. Getting to the root causes of issues often involves drilldowns that are predicated on asking questions; this seems similar to a process of “pimping” in the medical field, where attendings keep asking residents and medical students questions about their cases to ensure they understand exactly what is happening at every step (regardless of how minor).

Module 4

2/1/20 – For the past couple of Modules, I have talked about the benefits change could bring to healthcare. However, creating effective change is easier said than done. As argued by Dr. Andrew Hargadon in this module’s assigned video, one such way to bring about effective change is through the process of network building. He argued that while individuals attribute revolutionary products to singular people (for example, Thomas Edison being the sole inventor of the lightbulb), in reality multiple people are required to develop revolutionary innovations; Thomas Edison was the inventor of the lightbulb not because he developed it by himself but because he brought together the right team of people that helped to develop the lightbulb. Hargaodn argues that the best innovations are developed from people who can develop the best networks; change does not happen in isolation. I admit before having seen his presentation I never realized the impact network building can have on inciting change. However, to solve the complicated, multi-faceted problems healthcare faces, I believe that developing the right networks—and mindsets—will help lead to solutions that will benefit all.  #HEALTHinnovations. #UABSOPH.

Response 1 – Similar to what others have said, I agree that networking is incredibly important. As mentioned in my initial response, I did not realize how important developing networks could be in developing innovations. However, as studied in my other MBA classes, after having reviewed many case studies it seems these same principles apply across all industries—from aerospace to healthcare.

Response 2 – I agree with others that the way we approach the delivery of healthcare should change as time progresses. For example, in my AHRQ assignment, the innovation, “virtuwell,” is one such platform that is trying to change the way healthcare is delivered: instead of having to physically show up to a primary care physician, they perform the appointment and write all medications virtually, without the need for one to leave his or her home. 

Module 5

2/8/20 – Last module, I described the problems facing healthcare as “complicated” and “multi-faceted.” I also argued that a unified understanding of these problems can help bring about effective change. While I did give examples of these problems in “Module 3,” this module gives a more quantitative approach towards trying to find issues in healthcare. Specifically, this module focuses on the importance of using psychometrics to try and find root causes to direct issues facing hospitals. One way this can be achieved is through designing studies and questionnaires that utilize item response theory (IRT), which utilizes mathematical models to try and explain relationships between intrinsic input factors and their outcomes (source: https://www.mailman.columbia.edu/research/population-health-methods/item-response-theory). In the case of Dr. Ford’s study mentioned in this module’s video, some contributing factors to a hospital’s ability to implement new EMR technology include upfront costs, physician willingness to adopt, and IT support/training. The practice of medicine is always described as being evidence-based, and studies such as these can help to provide more potential insight and “evidence” into factors that both help and (importantly) hinder change. #HEALTHinnovations. #UABSOPH.

Response 1 – To me, I think that the use of statistical modeling and studies like this one mentioned are extremely beneficial in helping to understand what factors are important in leading change in healthcare. Without more insight into factors like these ones, it can be hard to figure out what the root causes are for these central problems. 

Response 2 – I also agree to an extent with the point that certain technologies are not utilized simply because “their time hasn’t come.” However, I believe that part of this issue results from not understanding the market. Items like Google Glass did not become popularized because there was not a market that found value in the product—at least in its current iteration. Similarly, implementing technology in healthcare can run into that same issue unless there is value to be gained—such as the use of surgical robots in complex micro-surgeries. 

Module 6

2/15/20 – Having had the opportunity to shadow physicians in my hometown, I have been able to see firsthand the tension physicians face adopting newer technologies such as fully electronic health record keeping (EMRs). The individuals hesitant to adopt these types of technological changes are not necessarily the white-haired, older physicians that tend to come to mind; freshly minted attendings in their early 30’s seem to struggle to support the use these EMRs, even as the population as a whole becomes more technologically savvy (source: https://www.beckershospitalreview.com/healthcare-information-technology/atul-gawande-why-physicians-hate-ehr-software.html). This module discusses the concepts of disruptive innovation and discusses the diffusion of innovation theory. Interestingly, the study mentioned in this module, “Forecasting the Maturation of Electronic Health Record Functions Among US Hospitals: Retrospective Analysis and Predictive Model,” indicates that the full adoption of EMRs in the United States can take up to 2035, significantly longer than what policy makers had hoped. In conjunction with the last module, which discussed the use of IRT to find factors that influence adoption rates in hospitals, one factor mentioned was willingness of physicians to adopt. Anecdotally, one major reason physicians seem to dislike using EMRs is the lack of customization: physicians have to choose from hard-coded treatment plans (which they may deem incorrect or ineffective for particular patients) as opposed to simply writing out what they believe would be effective. This seems to result from a combination of insurances’ willingness to pay for particular treatment methods and a disconnect between the products designed for use in the medical field versus what is actually needed. As mentioned throughout this class blog, it seems that the biggest issue is the lack of a unified understanding. #HEALTHinnovations. #UABSOPH.

Response 1 – I agree and have seen similar examples of this type of diffusion in other industries. For example, the adoption of electric cars seemed minimal until manufacturers like Tesla developed products that had higher perceived value to rivals at more reasonable costs. The same thing seems to apply to the medical field, where even markets as small as what brand of scrubs to use are affected the differences of perceived and realized value.

Response 2 – I agree with others and have even seen similar instances of slow adoption when shadowing physicians here in Birmingham. For example, certain physicians can be slow to switch to different brands of scopes for colonoscopies if they do not feel that they deliver more superior results. However, sometimes this can be problematic if there is brand loyalty; they may believe one brand has better products due to brand preference, but in reality, newer products may be safer or more effective—even if they are from startups or brands with no recognition. Just as mentioned in this module, end-user support can be a strong determinant in the ability to implement change.

Module 7

2/22/20 – Throughout these course modules there has always been one common theme: disruption. As mentioned in this module’s readings, that is not by accident. Disruptive products and ideas have the potential to incite dramatic change and have the ability to reshape even the most obstinate ideas. As mentioned in this module’s reading, this has been seen in industries ranging from personal photocopiers to cars. However, I think when discussing the concepts of disruption, it is equally important to discuss how disruption happens—or where disruptive ideas arise. From this, I found this study, “A disruption framework,” published in ScienceDirect which argues that while stochastic in nature, disruptive processes do not always arise by accident: disruptive processes are more likely to arise when searching for a solution using a common framework. While vague in nature, I believe this sentiment applies to all the teachings and readings studied throughout this course. To create disruptive change, there needs to be a common approach to a common problem using common solutions. While simple in nature, this formula can yield incredibly complex results. As argued in the beginning module for this class, “Module 1,” only by learning and working together can we create real changes in healthcare. These changes, while potentially disruptive, can help lead to better improvements so that healthcare is more accessible and more cost effective for all. Similar to what we have done in this class, through greater collaborations and discussions I believe we can find the disruptive solutions necessary to drive change and more-effectively heal not just others but—as mentioned by Atul Gawande in the impactful “Module 1” video—“heal medicine.” 

Response 1 – I agree with the ideas presented that the four major business models apply to the medical field. While I have mentioned Clayton Christensen’s “Module 1” video many times throughout this semester in this blog, to me, his presentation was extremely effective in elucidating some of the issues we face in healthcare. As mentioned in the video, hospitals effectively operate by employing some mixture of different business models; this occurs because hospitals need to be able to treat any type of person that walks in through the doors. However, this type of model creates cost parities that cannot be overcome without rethinking—and disrupting—the concepts of how a hospital should do business.

Response 2 – After reading different responses, I believe that one potential way to help improve the delivery of healthcare would be to employ more checkpoints and “redundancies.” While counterintuitive, this serves as the premise for a paper (“Balancing Act” by Brown and Duguid) studied in another MBA class. The authors argue that one difference between Eastern and Western practices of doing business is that Western companies focus on efficiency while Eastern companies focus on redundancies. As argued in the paper, while carrying a negative connotation to many in the US, redundancies offer greater amounts of checks and balances. While being more streamlined and efficient has been the underlying business model for US-based hospitals, I think it would be interesting to see how a more Eastern approach to healthcare would affect patient outcomes and costs.