Individuals and systems

The reason why integrated health systems have all implemented proprietary electronic medical record systems is that their processes of care, compensation, costing, procurement, and management are interdependent—in unique and proprietary ways. Rather than force their processes to conform to a standard-format electronic medical records system, it is much more natural and cost-effective for them to develop a system that conforms itself to their own organization’s established processes, not the other way around.

In addition, just as doctors are individual actors within a larger system, so are those hospital systems—they’re subsystems within a larger system. It is simply not in their best interest to force-fit their operating processes into a standard format so other providers in other systems can easily care for their patients. In other words, we cannot expect entities whose scope is that of individuals within a subsystem, or subsystems within a system, voluntarily to invest to solve higher-level systemic problems. We have gotten exactly what we could expect.

Christensen, The Innovator’s Prescription, pp. 137-138

Although my review of Christensen’s The Innovator’s Prescription is still forthcoming (I have about 100 pages left to finish the book), I keep finding gems along the way that raise important issues for leadership.

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Morality versus the marketplace

This post may be jumping the gun a little, because I haven’t finished The Innovator’s Prescription yet, but I found myself drawing some interesting contrasts already between Christensen’s work and T.R. Reid’s (see my review of The Healing of America for a fuller consideration of his ideas).

The most striking contrast to me so far has been the different grounds from which each writer believes health care reform will emerge.

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