Yesterday afternoon, I had the pleasure of listening to Michael Porter speak about value-based strategy in the health care system. (Since then, two people have asked me, “Who is Michael Porter?” Answer, for non-MBA types: “He is the Wayne Gretzky of business strategy.” Think 1980s and substitute Harvard Business School for the Edmonton Oilers.)
Having previously only read Porter, I was delighted at his level of passion and engagement with the audience. From the second to front row, I got a great view of all he did well. I would argue that this was not entirely necessary. As I mentioned to a fellow attendee: when your name is Michael Porter, with that particular crowd, you could count on the audience doing some work to understand you.
My take on the top-level was likely the same as everyone else’s. The current system is not set up to allow practitioners or patients to succeed. Too many people are asked to do the impossible. (That those in the system continue to do toil is a comment on very human-centric motivations!) The answer is to let people/system pieces excel in very specific areas. The success of niche players in business (Apple specializing in “cool,” Wal-Mart doing “cheap,” and Starbucks continually polishing their “experience” are all well-known examples). There is a German health centre that specializes in “headaches.” That is the future of health care.
We all have our “things” and Porter’s is “value-based competition.” Given that my “thing” is “getting the right ideas implemented,” I smiled (then cringed) when Porter glossed over the need for a “broad consensus” required to implement any of these changes. He quickly alluded to all the egos that prevent people from “stepping back and thinking rationally, ” and half-heartedly urged any board members in the audience to use their influence to champion attention to patient-outcome value.
I am unsure if others picked up on the importance of this point. It is a huge barrier to the right conversations ever beginning. Porter is right that it has to start somewhere: indeed, it has already begun. “Broad consensus” may be a challenge, but a good dose of “couldn’t this be WAAAY better” from various places in the system can help. I will continue to try to do my part. Intolerance is good.
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