Healthcare Innovation Challenge: Using lean entrepreneurship to lower cost and increase value

Cost growth leaves us no choice but to challenge our fundamental assumptions. Our current approach generates more cost than value. We can shift how we integrate and take advantage of natural forces. This last article in the series points to a new platform grounded in today’s system science and experience. 

Today’s centralized networks cannot keep pace with the natural co-evolution of healthcare’s Complex environment. What we know from system science and industry experience is that we need networks that can adapt and evolve with the environment. 

The Curandi™ Model uses an open, distributed and self-organizing network to support healthcare’s true purpose; proper outcomes for each person. The model uses language to enable a diverse set of clinical services and the development of collective intelligence to serve the needs of each patient at each Point of Care.

Figure 1

We need to consider.

  • The importance of language

  • Optimizing the Point of Care

  • Integrating Points of Care through an open platform

  • Accelerating the development of enabling technology

“Language shapes thoughts and emotions determining one’s perception of reality. — Benjamin Whorf

The Central Role of Language

Networks are information and service conduits. We know that computer networks use a variety of specialized languages for protocols and data management. What we don’t appreciate is how specialized language affects human networks and our perception of reality

Healthcare’s business management hierarchy is a network. In the executive suite, specialized language and concepts supports the success of the business. This language is informal and communicates important environmental facts and business reality. The commitments that come with it inform the executives’ perception of reality. Many times, this view of reality is incomplete or is different from reality elsewhere in the organization. And in healthcare, the Point of Care is another universe.

The Point of Care is a profoundly human environment. People are helping people who are known to them. Success is not simple and the consequences of error can be grave. The language at the Point of Care is a clinical narrative with basic facts, specialized vocabulary, meaningful ambiguity, situational knowns and unknowns, aspirations, along with important gaps to be uncovered and understood. The language and reality at the Point of Care often depend on many factors beyond the narrow band of structured data the we store and analyze. 

These two languages are not new but differences have become more pronounced with the rise of computerized infrastructure and data driven methodologies. 

Figure 2

Current healthcare information systems languages produce a sense of control and stability by excluding hard to manage data inherent to human complex adaptive systems. The outputs drive assumptions and management paradigms that often produce unintended consequences and unrealistic demands at the Point of Care. This lack of a common clinical operating language between patient care and system management prevents the development of a common reality that leads to effective solutions. 

A clinical language gives us the capability to create natural integration that is native to healthcare. To do that, we must rethink both the Point of Care and how it integrates within the clinical universe.

Optimizing the Point of Care.

Each Point of Care, whether a solo practitioner’s office or surgical suite, is a Clinical Microsystem. The organization may differ based on the service provided, but each is a unit that must run as effectively as possible. These small units are the building blocks of healthcare and where its value is created. A clinical language enables us to describe problems and circumstances in more realistic terms. This supports better outcomes, identification of resources and an adaptive platform.

Process optimization and co-location at the Point of Care have proven effective, but without adaptive design in place, continued evolution of the environment will tend to undo the good work done. Diverse microsystem operations stay efficient and health professionals at the Point of Care maintain clear purposerelevant information and simple rules following John W. Kenagy MD’s Adaptive Design.† Although each Microsystem is unique it can take advantage of a common adaptive paradigm and platform to sense and respond to shifts in the environment. 

We will also use clinical language to guide the development of a new adaptive clinical network platform.

Integrating Points of Care through an open platform

Every network is based on communication of service protocols that are matched to its role and requirements. Today’s networks understand little of the complex nature of the clinical space. A clinical language changes that and will enable the development of new services and technologies to support the point of care. A network cannot adapt with the environment unless it uses an equally comprehensive and adaptable medium. That medium is defined in language.

Building that platform needs new technology that can work with a more robust language.

Accelerating the development of enabling technology

Moving from where we are to a system where the Point of Care has access to a broad and dynamic network of support is a big change. To get there, we need a consistent strategic direction provided by an adaptive model that can create new value and “pay its way” as it goes, and a process that continuously adapts and learns. Curandi offers that model and an accelerator process to enable collaboration, incremental innovation, and accumulation of generated knowledge and tools. It is a healthcare version of business accelerators using “Lean Startup” †† concepts. 

Lean startup is a way of managing new development or innovation in incremental steps. Each step ensures that each innovation remains feasible and will perform as expected. At every step, we learn and adapt. This agile process ensures the resulting innovation will be what the system needs and what its users want. Innovations that will ultimately fail, fail as early as possible. If during development, we see that it is not feasible, will not be accepted or will yield too little benefit, we move on to something better. 

Figure 3

Each innovation begins small as a minimum viable product. The product might be a service or a new way of organizing care. It must have actionable outcomes and a business model that clarifies the value we will create. That value can come from clinical microsystem improvement and/or building the future network platform. Along the way, we capture learning to the knowledge base and new language or technology components to a code base. These enable members of Curandi to innovate faster by learning from the experience of others.

Each innovation spinning out of the accelerator must reduce cost, improve care and create new opportunity. By emphasizing value development within a coherent process, the accelerator helps us to stay focused on productive work and to learn from our mistakes. Timing couldn’t be more critical.

We spend over 2,300 BILLION DOLLARS annually for healthcare in insurance payments alone. Adopting the Curandi model and processes that have worked for other industries will enable us to create a new system that delivers better care at lower cost, with new markets and new opportunities for those who act early.



† “Designed to Adapt: Leading Healthcare in Challenging Times”, John W. Kenagy M.D.
†† “Why the Lean Startup changes everything”; Steve Blank; Harvard Business Review May 2013 and “The Lean Startup”; Eric Ries