What Do Patients Really Want? Part I

I recently wrote about an innovator’s dilemma of sorts – or call it a paradox – in healthcare. The paradox is that as we look to innovate in healthcare, the very authority figures we must turn to for fact-checking our innovative ideas are conflicted and highly motivated to support the status quo. I’m talking about physicians of course.

In a fee-for-service world, physicians are both the fountain of relevant knowledge and the source of all revenue. So we have built our workflows, systems and processes around their comfort and success. As physicians succeed, so does the rest of the healthcare juggernaut. I know other industries fall victim to these kind of MC Escher-like business models, but it seems particularly acute in healthcare.

My belief is that this paradox makes our industry highly susceptible to under-imagining what real innovation could look like. We have some pretty deep blinders on, it seems. One of my favorite Steve Jobs legends is that when asked about the consumer research that led to the development of the iPad, he quipped, “We don’t expect consumers to be able to tell us what they don’t realize they need.” [I am paraphrasing, but this is reasonably accurate.]

As we trot out our prized innovators in healthcare, we don’t seem to hear that kind of talk. We hear about improved ‘door to balloon time’ in the care of acute MI, about using Lean to improve hospital work flow and supply chain management, about programs to encourage more generic drug prescribing and about decision support systems that help doctors avoid wrong dosing or prescribing medications that negatively interact with one another. Indeed these are innovations, but they are all innovations that Christensen would classically call incremental.

At the Center for Connected Health we purport to be patient-centered in our approach. I think we do a decent job at this. But try as we might, it’s hard to get at two things. One is a true patient perspective that is imaginative, articulate and consistent.

I’m making a pitch to our Symposium organizers that this year we devote a good deal of space on the program to drawing out the patient perspective from multiple angles. We’ll see how persuasive I am.

The second challenge is finding patient advocates who do not feel intimidated in front of an audience. We also have trouble finding advocates that are ‘pure’, i.e., folks simply disguised as patient advocates but really championing a different cause. I have to give thanks to the tireless work of folks like Dave DeBronkart and Sarah Krug who are tireless advocates and my friends at the Society for Participatory Medicine. But we need more like them.

In the meantime, consider with me how we as innovators should best create the programs, technologies and services that chronically ill patients don’t know they want or need yet. How do we develop devices to motivate and monitor activity for the fitness buffs who think they are content with a good pair of running shoes and a gym membership? How important is the patient perspective in the development of connected health programs and services?

In my next post, I’ll share with you my impressions of an article that appeared in JAMA last month about patient perspective.