Using science fiction to fix healthcare: Dr. Stephen Klasko's 12 disruptors

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Stephen Klasko, MD, president and CEO of Thomas Jefferson University and Jefferson Health, first wrote a book about a medical student who was abducted by aliens. But it was the premise for his second book that seemed even more unlikely to his publisher.

Why does the premise of We Can Fix Healthcare Now seem less likely than extraterrestrial intervention in med school? Because it outlines a hypothetical bipartisan collaborative push to mend the healthcare industry under reality-bending circumstances.  

"In fact, the original title of the book was going to be I Messed Up Healthcare: Put Your Name Here," Dr. Klasko says.  

One of the things that precludes stakeholders from having frank discussions about problems with healthcare in America is individuals have a very hard time admitting fault, Dr. Klasko says. But by using a science fiction-type framework and what he calls a history of the future model, Dr. Klasko says he was able to take a hard look at the core issues plaguing healthcare as it stands today, and propose solutions to move past them.

"The first chapter is titled "2016: When Politics and Healthcare Became Fun Again," which is not what people would say about either right now," Dr. Klasko says. "If you go to anybody and say, 'What do you think healthcare is going to look like a year from now?', our sphincters tighten — we talk about Obamacare, we talk about malpractice and it's ugly. But if you say what if it was 2026 and we're looking back on what happened in 2016, 2017, or 2018, people are more agreeable."

To get the lay of the land, Dr. Klasko and his co-authors, Gregory Shea, PhD, and Michael Hoad, interviewed more than 150 sources, from the CEOs of large health systems and pharmaceutical companies, to patients and politicians. Dr. Klasko says they hoped to get a comprehensive picture of the state of healthcare and answer one very important question with the promise of anonymity — if you took yourself or your company out of the equation, what would you change about the industry right now?

Those responses helped the authors craft what they call the 12 Disruptors, which rise from the demise of the old healthcare system, Dr. Klasko says. Although the disruptors come about in the hypothetical and speculative landscape of We Can Fix Healthcare Now, they are all based on the responses and insights the authors received from industry stakeholders at every level.

Here are the 12 Disruptors outlined in We Can Fix Healthcare Now, in full:

  1. Thou shalt look at healthcare as a team sport and develop a system that is both user-friendly and delivers value.
  2. Thou shalt take the volume incentive out of the payment system and put incentives in place that are aligned with optimal health outcomes.
  3. Thou shalt provide the right solution for the right patient at the right time and provide coordinated care across patient condition, services and time.
  4. Thou shalt select and educate physicians of the future as opposed to those of the past.
  5. Thou shalt never again be surprised that doctors (solely based on science GPA, multiple-choice tests, and memorizing organic chemistry formulas) are not more empathetic, communicative and creative.
  6. Thou shalt use technology to ensure that every surgeon can objectively prove appropriate competence and confidence to perform the requested procedure.
  7. Thou shalt learn the lessons of the now-defunct Blockbuster and move healthcare from a "come to my hospital when you are sick" to a Netflix mindset of "getting healthcare out to where the consumer is." Do not build new inpatient beds when it is clear that there will be disruptive influences that fundamentally decrease the need for expensive inpatient beds.
  8. Thou shalt never use the term "alternate healthcare" for modalities used to treat chronic diseases that are utilized by patients and providers in other countries, and in some cases, have much better results than traditional American medicine in treating said diseases.
  9. Thou shalt de-fragment the application of innovation and clinical research through super-sites. Thou shalt cease and desist constructing walls between institutions of non-interoperability that hamper the acceleration of research and innovation.
  10. Thou shalt create an integrated, interoperable, legacy electronic health record system allowing for vendor-driven, patient-centric apps such that your health information is at least as integrated as your shopping information on Amazon or your viewing information on Netflix.
  11. Thou shalt understand systems thinking and employ said models in your attempts to redesign a healthcare system that actually makes patients and communities healthier. Only then will you be able to "break" the iron triangle of access, quality and cost.
  12. Thou shalt never again be satisfied with any healthcare disparities based on race, creed, religion, sexual orientation, socioeconomic status, or planet of origin.

The authors incorporate both liberal and conservative perspectives into each of the disruptors to demonstrate how, with subtle shifts in perspective, both sides of the aisle are driving toward the same end with means that are not all that different from one another, Dr. Klasko says. All of the disruptors are achievable, he says, and being carried out to some degree somewhere in America's healthcare system today.

"Today what we're seeing are the pressures of opening up access to an inefficient, ineffective and, in some cases, failed system, then being amazed that cost hasn't decreased and quality hasn't improved," Dr. Klasko says. "These are things that could be changed that would really help solve that."

More articles on leadership:

Why don't more CEOs endorse presidential candidates?
Dartmouth-Hitchcock's CEO on what's wrong with healthcare and how to fix it
It's time for hospital executives to pay attention to social media 



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