Foreword – The Innovator’s View

There are two critical pathways for improving the quality and reducing the cost of healthcare. The first pathway is disruptive innovation — technological and business model innovations that lower costs while simultaneously creating access to ever more sophisticated levels of care. My recent book, The Innovator’s Prescription, summarizes the roles that disruptive innovations can play in transforming healthcare.

Dr. John Kenagy leads the second pathway, one of vast and untapped potential. I met John more than a decade ago. He had taken leave of his career as a physician and executive in a highly respected healthcare system in the Pacific Northwest to obtain a Masters Degree at Harvard’s Kennedy School of Government.

In 1997, John crossed the Charles River to enroll in my Harvard Business School course, Managing Innovation. Instantly, he began teaching me how my theories of innovation could relate to improving healthcare. Seeing how his facile mind caught the connections, I supported his appointment as a Visiting Scholar at Harvard Business School and introduced him to Steven Spear, at that time a Harvard Business School doctoral candidate. Steve was helping Toyota understand that their success rested on their unique approach to managing complex, collaborative work.

Steve discovered the underlying DNA of the Toyota Production System; the unspoken Rules-In-Use that govern everyday work. His recent book, Chasing the Rabbit, tells the tale and, in my opinion, he is doing the world’s best thinking on process improvement.

When John began to understand Steve’s work, he saw much more than a powerful manufacturing system. He saw a unique way to manage the complex, dynamic, unpredictable work of healthcare. John has developed Adaptive Design to be the enabling technology and operating system that brings this knowledge to healthcare.

This is a powerful combination and the rest is becoming history.

Hundreds of lives and millions of dollars have already been saved as John, Steve, and John’s associates teach healthcare administrators, physicians and staff how to design and improve their processes and manage the knowledge that is inherent in their organization. However, as profound as these insights and achievements are, they have only influenced a fraction of those who could, and should, benefit. Now his concept of Adaptive Design begins to break a tradeoff that pervades the work of every established, leading organization.

We can’t afford what healthcare costs today, yet we need more. It is a hand-wringing tradeoff between having better quality healthcare, lower-cost care, and more conveniently accessible care. The result? — politicians, employers, and frustrated healthcare reformers worldwide exasperatedly throw up their hands at the intractability of the healthcare problem, their anguish mirroring the facial and body language of the Burghers of Calais that Rodin captured in his timeless sculpture.

But does having more of one thing require compromising the others? Of course not. There is a solution. The problem is that it is a disruptive one, and my work has shown it is almost impossible for an established organization to address the disruptive market successfully. That’s the tradeoff — keep doing what you know how to do, you’ll keep getting what you currently get and find it almost impossible to do something different. In healthcare, that creates a tradeoff — increasing quality increases costs.

Kenagy’s concept of Adaptive Design begins to break that tradeoff. John has discovered that Adaptive Design gives the original, core business far greater flexibility in adapting to the demands of the market than I had ever thought achievable. I said, “It’s almost impossible.” That’s true. But it’s not impossible. Dr. John Kenagy and Adaptive Design are truly expanding the possible for healthcare.

Together, these two pathways of innovation (disruptive innovation and Adaptive Design) have the potential, in my opinion, of greatly improving the quality of healthcare while reducing its cost by 50 percent or more. I am not overstating this potential and I am grateful to John Kenagy and his associates for bringing to bear their wonderfully insightful minds on this topic of global impact.

Clayton Christensen
Harvard Business School

If you’re really serious about leadership, management, and innovation in healthcare, start reading this book... now!

Anthony R. Tersigni,
President and CEO
Ascension Health