A colleague recently saw a presentation that suggested that hospitals of the future will look like this. But the Shaping Tomorrow Horizon Scans tell us they will look more like this (click). Hospitals will not keep growing until they become sprawling super-structures. Instead, the size and scope of hospitals will decrease as healthcare delivery transitions from institutional care to the home and mobile/portable locations. “Hospitals will resemble the outpatient clinics of today, with convenient hours and easy access – in some cases much like a drive-thru restaurant operates today. Difficult to imagine – consider back to the days of entire rooms filled with massively wired computer mainframes and how in less than a generation we transitioned to the desktop computer and now to the PDA for our wireless computing needs. The change in healthcare will be no less dramatic. Key point: Wouldn’t it be helpful to know which is right – Will hospitals of the future be larger or smaller? Beyond size, how will health delivery be different? How will medical advances change the way we live? Horizon scanning helps to peek into the future and consider how we need to plan today for the future.
What happens in healthcare when we fail to scan the horizon? The HIV/AIDS epidemic provides an excellent example of the importance for the healthcare industry to conduct continuous environmental and horizon scans to help prepare for and even ward off potential epidemics that threaten to become pandemics. Unfortunately, the Institute of Medicine (IOM 2001) reports that the slow and arduous process of academic research, which isolates itself through elite peer-reviewed journals, results in tremendous lags of sometimes decades in translating critical research into clinical practice. In addition, instead of performing research on the biggest health problems, especially in the global context, there exists a 10:90 gap (Michaud et al. 2001) in which 90% of research spending focuses on only 10% of the illnesses. Alarmingly, diseases with little potential for market profits for drug development are particularly neglected (Yamey 2002) even though those diseases disproportionately affect people in poor countries and represent a great percentage of the global population. What might have occurred with the HIV/AIDS epidemic if medical researchers based their research on weak signals and blips discovered through environmental scans and quickly disseminated their findings to providers? Without a significant realignment called for by the IOM (2001), the world will continue to face global pandemics such as HIV/AIDS, which may in fact prove to be completely avoidable with rapid, responsive, and appropriate action.
Predictive. With the clinical implementation of population analysis and genetic screening, there is attainment of new levels of understanding of those individuals and populations which are at increased risk for certain congenital anomalies, diseases, drug reaction/interaction, etc. Thus it will become even more possible to target individuals or populations for specific screening, diagnosis or preventive treatment. This conserves scarce healthcare dollars to focus on those individuals that are at highest risk. Preventive. As it becomes more possible to identify certain populations and individuals who are at risk, medical education, screening and treatments can become more proactive. By initiating preventive medicine programs, vaccines, treatments, etc it will become increasingly possible to prevent disease rather than treat the acute and chronic sequella. Precise. Our knowledge of what causes disease and our understanding of the most effective treatment for disease will shift from intuitive to precision processes. Panoramic. Until recently, limited healthcare information was available to and about individuals and populations. A single parameter (such as blood pressure) was measured as the sole determinant of a disease (hypertension) and various regimes were instituted based upon the single parameter. Now there are many more diagnostic devices and tests that will be able to contribute to the final diagnosis of a disease, such that using multiple parameters it will be possible to more accurately classify diseases or discover onset of disease earlier than by using a single late-manifesting parameter. The paradigm will be come collecting multiple parameters over time, determining the change over time (which is more critical than isolated measurements), comparing that change to the person’s own baseline in the past, and interpreting these changes relative to a population standard for age, sex, race, etc. Information science permits us to now collect analyze and understand the complexity of the dynamic interactions of multiple parameters over time. Point-of-care. New devices, especially microsensors, biosensors, handheld or portable imagers, will move out of the hospital or physicians office and into the home and/or workplace. Having these devices will facilitate acquisition of data on a more regular basis and be able to identify trends and monitor the course of disease. Because the technology is enabling smaller devices, the sensors and imagers will eventually be micro-sized and embedded in everything, from appliances to the rooms in our house to our clothing. They will become transparent to the person, updating information in an ubiquitous, non-intrusive manner, thus improving compliance by autonomously monitoring on a continuous basis and informing individuals of changes in a real time manner (rather than once a year or less frequently). Personalized. All the above will result in a healthcare that is personalized. Rather than the routine, generic prescribing of vaccine schedule, medications or other treatment modalities, enough information will be available about a person to permit customizing healthcare by time, dose and method of application, rather than a single schedule or dose into which every person must fit. Participatory: The patient shifts from passive to active participant in their health and health care. Eg: Barcodes. The Future P’s may seem like a rather sweeping and expensive change that is unattainable. However, today vast reams of information are acquired and monitored on nearly everything you purchase through the use of the ubiquitous bar code, which appears on most every item you purchase. Not only is the information about the item (brand, cost, etc) encoded in the bar code, but a single swipe of the bar code reader at the checkout counter automatically provides appropriate discounts, updates inventory, analyzes buying habits, and a dozen other functions. Barcodes = Micro-Sensors. Just as the innocent little bar code is a gateway into an entire world and process of information management for purchase, distribution and sale of goods, so to will the micro-sensors, genetic profiling, informatics, etc be the tools to enable the Future P’s of healthcare.
The health system as a networked environment. Today, doctors and hospitals are the primary axes in the healthcare system, but in the future they will be nodes in a large and complex network. Fundamentally new ideas will require new organizational structures. Patients must be educated on how to manage their health and healthcare.
LOS – Length of Stay
In Vitro – out of body
The Human Genome Project (HGP) was an international scientific research project with a primary goal to determine the sequence of chemical base pairs which make up DNA and to identify and map the approximately 20,000–25,000 genes of the human genome from both a physical and functional standpoint. It was completed on June 22, 2000 by the UCSC Genome Bioinformatics Group. The $3-billion project was formally founded in 1990 by the U.S. Department of Energy and the US. National Institute of Health and was expected to take 15 years. In addition to the U.S., the international consortium comprised geneticists in China, France, Germany, India, Japan, and the United Kingdom. Due to widespread international cooperation and advances in the field of genomics (especially in sequencing analysis), as well as major advances in computing technology, a 'rough draft' of the genome was finished in 2000 (announced jointly by then US president Bill Clinton and the British Prime Minister Tony Blair on June 26, 2000. Ongoing sequencing led to the announcement of the essentially complete human genome in April 2003, 2 years earlier than planned. In May 2006, another milestone was passed on the way to completion of the project, when the sequence of the last chromosome was published in the journal Nature. Key findings of Genome Project: There are approx. 24,000 genes in human beings, the same range as in mice and twice that of roundworms. Understanding how these genes express themselves will provide clues to how diseases are caused. All human races are 99.99% alike, so racial differences are genetically insignificant. This could mean all humans are descended from a single original mother. Most genetic mutation occurs in the male of the species and as such are agents of change. They are also more likely to be responsible for genetic disorders. Genomics has led to advances in genetic archaeology and has improved our understanding of how we evolved as humans and diverged from apes 25 million years ago. It also tells how our body works, including the mystery behind how the sense of taste works 5% of the human genome shows evidence of conservation - the isolated physical system does not change as the system evolves. Genetics and Disease Diagnosis - HapMap: The International HapMap Project is an organization whose goal is to develop a haplotype map of the human genome (HapMap), which will describe the common patterns of human genetic variation. The HapMap is expected to be a key resource for researchers to find genetic variants affecting health, disease and responses to drugs and environmental factors. The information produced by the project is made freely available to researchers around the world. Unlike rare diseases, combinations of different genes and the environment play a role in the development and progression of common diseases (such as diabetes, cancer, heart disease, stroke, depression and asthma), or in the individual response to pharmacological agents. To find the genetic factors involved in these diseases, one could in principle obtain the complete genetic sequence of several individuals, some with the disease and some without, and then search for differences between the two sets of genomes. This approach is currently infeasible because of the cost of full genome sequencing. The human genome has approx. 3.3 x 109 base-pairs; if the cost of sequencing is US $3 per base-pair, then the approx. cost will be US $10 billion. At a cost of only US $.01 per genotype it would cost approximately US $200 million to diagnose each disease. The HapMap project proposes a shortcut that will save both time and cost. Although any two unrelated people share about 99.5% of their DNA sequence, some people may have an A at a particular site on a chromosome while others have a G instead. Such a site is known as a single nucleotide polymorphism (SNP – pronounced “snip”), and each of the two possibilities is called an allele. The HapMap project focuses only on common SNPs, those where each allele occurs in at least 1% of the population. Each person has two copies of all chromosomes, except the sex chromosomes. For each SNP, the combination of alleles a person has is called a genotype. Geneotyping refers to uncovering what genotype a person has at a particular site. The HapMap project chose a sample of 269 individuals and selected several million well-defined SNPs, genotyped the individuals for these SNPs, and published the results. The alleles of nearby SNPs on a single chromosome are correlated. This means that if the allele of one SNP for a given individual is known, the alleles of nearby SNPs can often be predicted. This is because each SNP arose in evolutionary history as a single mutation, and was then passed down to descendents surrounded by other, earlier, mutations. SNPs that are separated by a large distance are typically not very well correlated, because recombination occurs in each generation, mixing the allele sequences of the two chromosomes. A sequence of consecutive alleles on a particular chromosome is known as a haplotype. To find the genetic factors involved in a particular disease, one can proceed as follows. First a certain region of interest in the genome is identified, possibly from earlier inheritance studies. In this region one then locates a set of tag SNPs from the HapMap data; these are SNPs that are very well correlated with all the other SNPs in the region, so that knowledge of the alleles of the tag SNPs in an individual will determine the individual's haplotype with high probability. Next, one determines the genotype for these tag SNPs in several individuals, some with the disease and some without. By comparing the two groups, one can then determine the likely locations and haplotypes that are involved in the disease. In other words… The HAPMAP project focuses on only the variables, reducing the need to examine only 250,000 SNPs in Europeans and Asians, and 400,000 in Africans. At a cost of US $.01, the cost moves down to US $2,500 - $4,000 per disease depending upon the various cultures. This is a cost savings of 30-40 fold and will likely drive the next decade of genetic diagnostics, at least for the more common diseases.
Nanomedicine future medical nanotechnology is expected to employ nanorobots injected into the patient to perform treatment on a cellular level. Nanobots are nanotech devices implanted to travel inside the body to deliver drugs or do microsurgery with a single fixed function, typically replacing some damaged or malfunctioning biological system - restoring sight or hearing, scrubbing clogged arteries, generating insulin, etc. Nanorobotic therapy assumes that biological cures (e.g. stem cell based) are not available, as most people will perceive restoration of the body's natural systems (even if technically inferior in function) as less risky. E.g. there are already experiments with implanting cells to generate insulin to cure diabetes. It seems very likely that by the time molecular manufacturing allows in-body nanotech, many biotech-based cures will have already been found. Still, nanotech will likely improve the precision of such treatments, and ultimately that will give doctors sufficient confidence to allow "better than natural" medical improvements. Nubot is an abbreviation for "nucleic acid robots." Nubots are synthetic robotics devices at the nanoscale. Representative nubots include the several DNA walkers reported by Ned Seeman's group at NYU, Niles Pierce's group at Caltech, John Reif's group at Duke University, Chengde Mao's group at Purdue, and Andrew Turberfield’s group at the University of Oxfor Nanosensors can detect traces of cancer causing chemical insdie human cells Bionanobots a very effective method which applies a Trojan horse” therapy to combat cancer using a bacterially derived nano cell that helps to penetrate and disarm the cancerous cells. A second nanocell is then sent to the cancerous cells to kill the cancer cells with chemotherapy drugs. The “trojan horse” therapy has the potential to directly target cancer cells with chemotherapy, rather than the current treatment that sprays chemotherapy drug injections into a cancer patient attacking both cancer and healthy cells. Nanotechnology - technology which deals with matter in atomic scale and are capable of creating small machines which can work in molecular level. Gene therapy with the aid of nanotechnology can cure ovarian cancer.
Smart Clothes. Garments that can measure a wearer's body temperature or trace their heart activity are just entering the market, but the European project BIOTEX weaves new functions into smart textiles. Miniaturised biosensors in a textile patch can now analyse body fluids, even a tiny drop of sweat, and provide a much better assessment of someone's health. Smart Bathroom. Sensors in doors, toilets, taps, light switches and carpets detect every activity and record them electronically. Detemines if the user needs professional health care. A "smart" bathroom mirror displays a touch screen mirror that can remind people to take their medicine, wash their hands or brush their teeth. Smart kitchen. A microwave oven that reads the ID tag on a box of food and cooks it properly without any more help. Smart house. Reminds residents when to take their medication, and it automatically monitors heart and respiration, makes sure no stove-top burners are left unattended and turns off water taps to prevent a sink or tub overflow. If someone falls, or becomes inactive, the house calls doctors, relatives and even police. Through the above technique the environment becomes intelligent. Using many hidden sensors, the system monitors the daily routine of the occupants. Risks can be detected and it is possible to assess whether the situation appears to be deteriorating, or most importantly, whether an emergency exists
Virtual Reality Surgery Virtual reality (VR) surgery is the way in which surgeons of tomorrow will be taught. VR surgery involves immersion into a 3D world where the patient can be touched and operated on. The University of Melbourne, Department of Otolaryngology has developed a virtual reality surgical environment for ear surgery, which has been commercialised by the Australian company, Medic Vision, and was the recipient of the University's Knowledge Transfer Award for 2008. They are are involved in exciting research that will determine how best to train surgeons in VR, and provide real-time feedback to trainees. Da Vinci® Surgical System The da Vinci® surgical system is comprised of a surgeon's console that provides 3-D imaging of the surgical field, a patient-side cart which provides 4 robotic arms, endowrist instruments which mimic the motion of the surgeon's hands and wrists, and the vision system which provides 3-D images of the surgical field. This innovative toolset allows our surgeons to treat various diseases through a minimally invasive approach that benefits both surgeon and most importantly -- patients. Many applications of surgery have been achieved using the da Vinci® Surgical System including procedures in Cardiology, General Surgery, Gynecology, Pediatrics, Thoracic Surgery, and Urology. As one of the world's leading robotics programs the CARES Center at UNC offers various robotic-assisted procedures in Gynecology, Pedicatrics, Urology, and General Surgery.
The eICU system allows hospitals to create a system-wide critical care program built on a powerful technology infrastructure that improves quality, operating efficiency, and economic performance. Reduced local provider staffing, increased access to Intensivists, and better health outcomes – all at significant patient and organizational cost savings – are key drivers influencing hospitals to invest in eICU systems.
Paralyzed People Using Computers, Amputees Controlling Bionic Limbs, With Microelectrodes On (Not In) Brain (July 6, 2009) — Experimental devices that read brain signals have helped paralyzed people use computers and may let amputees control bionic limbs. But existing devices use tiny electrodes that poke into the brain. Neural Implant That Learns With The Brain May Help Paralyzed Patients (June 24, 2008) — Devices known as brain-machine interfaces could someday be used routinely to help paralyzed patients and amputees control prosthetic limbs with just their thoughts.
This chart illustrates price disparities among global providers. The lowest cost providers are shaded in gray. Notice that the U.S. price for a heart bypass is at least ten times, and in some cases twenty times the cost in India. However, medical leaders recognize that patients will not make medical decisions based on price alone and there is at least some measure of value between having a procedure performed at a local hospital and traveling thousands of miles to an unknown land. Nonetheless, cost will continue to be a determining factor. This currently explains why the more elective, and often self-pay procedures, such as a face lift is priced more competitively with global providers than a heart valve replacement, which often takes place on an emergency basis. Therefore, the medical leaders must recognize the need to become more globally minded. The norm today is a focus on how patients perceive value and the future will concentrate more on measured value-based healthcare outcomes.
Evidence-based medicine will be the norm. Simulation models will drive medical decision-making based on the best outcomes and the lowest costs.
Our knowledge concerning the CAUSE of disease and the most effective TREATMENT for each disease will evolve along the continuum from Intuitive … to Empirical… to Precision. Background: The works of Dr. Eddy and healthcare value innovators like him serve as catalysts to guide medicine away from the empirical method toward more mathematically driven medicine. In their book, The Innovator’s Prescription, Christensen, Grossman, and Hwang (2009) argue that healthcare decision-making is rapidly shifting from intuitive to precision medicine. Rather than relying on expert opinion or clinical experience for conditions diagnosed only by their symptoms and only treated with therapies whose efficacy is uncertain, precision medicine insists on care for diseases precisely diagnosed, with understood causes, and treated with rules-based therapies that are predictably effective. The above table illustrates the “diagnosability” of a sampling of diseases along two dimensions with intuitive medicine in the lower left corner and precision medicine in the upper and right quadrants. Somewhere between intuitive and precision medicine rests the field of empirical medicine, best known for its reliance on “pattern recognition.” The empirical scientific method, although widely used in contemporary medical research, nonetheless falls short of precision medicine. It relies heavily on correlations between actions and outcomes that are consistent enough for predicted results in probabilistic terms (Christensen, Grossman, and Hwang 2009). While the location of each disease in this figure is more illustrative than exact, the matrix does provide a graphic snapshot of how various diseases compare along a continuum of medicine’s current understanding of the mechanisms causing disease and the extent of medical treatment efficacy. Diseases clustered in the upper-right precision region tend to be ailments that involve rules-based diagnosis and treatment and no longer require significant expertise. On the other hand, disorders in the lower-left intuitive quadrant must currently rely on complex problem solving offered through the intuition of skilled specialists. While some conditions, such as multidrug resistant TB in the lower-right quadrant involve precision understanding and diagnosis, there is currently no predictable treatment efficacy. Finally, some diseases such as appendicitis in the upper-left quadrant, respond well to dependable therapy but the reason for the treatment’s effectiveness currently eludes researchers. Source: Christensen, C., Grossman, J., and Hwang, J. 2009. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York: McGraw–Hill.
Leadership competencies are critical to transforming organizational change. Understanding how to scan the horizon and plan for the future is one thing, knowing what to do with that information requires strategic leadership.
The reason why most strategic planning becomes ineffective is that the same strategic approach is used universally. One health system has success with a particular strategic approach – it gets labeled as “best practice” – and everyone jumps on board and uses the same strategy process. All the while, they don’t stop to consider where the organization is in its level of uncertainty. Each level requires a different strategic approach and when uncertainty is understood correctly, it reduces risks and adverse impacts.
Diabetes & Obesity 2025 1. The Frog Didn’t Jump Denial Complacency resignation Unwilling to hold society accountable Attention on accommodating obesity No incentives for effective health interventions Twin epidemics run their projected course Diabetes costs $351 billion 2. We Did the Best We Could Free market health system responds with financial incentives Prevention Screening Disease management Payors exclude risk Technological advances Bariatric surgery Multiple obesity drug regimen Tiered health care – “buy up” Empowered self-care (consumer driven) Supported by home tech devices Diabetes costs $395 billion 3. Caring Communities & Access To Health Care Focus on prevention Healthy schools Incentives to change eating habits Healthy community ‘built environments’ Advances in technology focused on effective diabetes mgmt Universal access to basic level of care Early screening & effective mgmt of diseases Must ‘buy up’ for expensive high tech Rx Focus on effective behavior modification Empowered consumers given tools Incentives for healthy behavior Diabetes costs $305 billion 4. Evolving Systems with Enlightened Leaders Effective leadership Society focused on creating health Systematic approach for addressing all 10 components of diabetes & obesity Understanding, innovation, dissemination Deal with social determinants of health Diabetes costs $220 billion Rowley, B. and Bezold, C. (2006). “The futures of US health care: The case of diabetes & the paths for eliminating health disparities,” Institute for Alternative Futures, Retrieved October 14, 2007 from http://www.altfutures.com/.
This figure provides an example of a hospital value curve that compares the typical offerings of an average hospital (blue) and a specialty hospital (black). Each offering receives a ranking according to patient priority. Therefore, while the architectural aesthetics may be important for specialty hospitals, patients who prefer the average hospital may place the architectural aesthetics on a much lower scale when compared to their priorities of price and patient safety. Notice that both groups consider hygiene, price, and patient safety as high priorities. However, patients of the specialty hospital place an equal priority over those offerings and architectural aesthetics. While the offerings illustrated in this figure are typical for many hospitals, health systems should compare the offerings most specific and unique to their organization. For example, an ambulatory clinic may consider offerings such as convenience, intake time, and hours of operation, while a pharmacy may consider offerings such as product variety, processing time, and price. The point to drive home is for Value Innovation Champions to lead the process of developing a representative list of existing offerings and prioritize them according to patient preference or demand. They will find that in some cases, offerings such as architectural aesthetics may require satisficing, while offerings like cost and patient safety necessitate more emphasis.
Future of healthcare
HIV/AIDS emphasizes need for
Lag of +10 years in translating
clinical research into clinical
10:90 Gap - 90% of research
spending on 10% of the illnesses
Neglect greatest health issues
Results - continuous reactive
Point of care
Source: Shortell, S., and Kaluzny, A. (2000). Health Care Management: Organizational Design and Behavior (4th ed.).
The Patient Will Become the Nucleus of Healthcare
Primary care physicians
Simple - Testing for simple
Universal - Testing, treatment and
disorders reaches affordability
critical mass ($350/profile)
prevention is mainstream including
Manmade materials surgical Regenerative biochemical
repair materials, drug delivery, and process and technological advances
Degenerative 80 to 90 years,
aging and metabolic breakdown
years, increased quality of life
Treatment center for
disease - LOS in days
Teaching center for patients ,–
Clinics, surgery centers & hospitals
Avatar, online, “smart”
AI via portable electronic diagnostics
and automated “care”
synthetic biochemical materials
(regenerative organs, artificial
Nearly non-degenerative 125+
LOS in hours
Source: Updated from Coates, J., Mahaffie, J., and Hines, A. (1997). 2025: Scenarios of US
and global society reshaped by science and technology .
Primary Care Doctors
Physician Assistants- PAs
Registered Nurses- RNs
Easier to use
Earlier in the disease
All rights reserved
Economy – back to basics
£/€/$ - pharmaceutical costs
Vaccine to regulated prevention
Nursing & physician shortages
Enhanced graduate medical education
Technology - health extender
Greener health delivery
Pay for performance/outcomes
Incentives for healthy living
Sources: IBM and PriceWaterhouseCoopers
In vitro blood protein
Major organs or cells secrete
protein blood molecular
Single cell analysis
Blood fingerprint will report
organ status, distinguish
health from disease, and
All rights reserved
HapMap £/€/$ of human genetic
variation (disease diagnosis)
“Gene Chip”– multiple gene
Personal genome sequencing
Identified origins and causal
relationships of complex diseases
“Epigenetic" factors linked to diseases,
heritability across generations
Stem cell transplants
Human reproductive cloning
All rights reserved
› Sense body functions
› Evaluate body fluids
› Prepare body nutrients
› Elderly can live at home
Remote 3D diagnostics
Global access to experts
Electronic ICU (eICU):
Sentara Hospitals achievements:
Multi-site access to Intensivists
25% reduction in ICU hospital
17% decrease in ICU LOS
20% increase in ICU capacity
created by shorter ICU LOS
26% reduction in hospital
costs for ICU patients
Source: Pronovost, P. (2002). “Imagining the ICU of the future.” The National Coalition on Health
Care and The Institute for Healthcare Improvement.
All rights reserved
“Neuroprosthetics” - brain
implants to prevent disease
Health avatars capable of
Where does this leave
All rights reserved
Source: Woodman, J. (2007). Patients beyond borders, Singapore Edition: Everybody’s guide to affordable, world-class medical tourism.
Full-scale simulation model of human physiology, diseases,
behaviors, interventions, and healthcare systems
Uses advanced methods of mathematics, computing, and data
systems to determine best treatment option and cost-based
Type 1 Diabetes
Extent of Treatment Efficacy
Multi-drug Resistant TB
Extent of Understanding of Mechanism Causing the Disease
Source: Christensen, C., Grossman, J., and Hwang, J. (2009). The innovator’s
prescription: A disruptive solution for health care.
Life Span increase to 125+ years
End of life issues – patients
choose when to die:
› Immediate – informed
consent based on
› Future – informed consent
based on non-health social
Mental Model 1
Mental Model 2
Western Medicine =
The Health System
Western + Contemporary =
The Wellness System
Face to face treatment
Space to place treatment
Information control by
mediated by government
Open system information
Source: Marsh, N., McAllum, M., Purcell, D. (2002). Strategic foresight: The power of standing in the future.
Information & communication
Public health perspective
Culture values orientation
Innovation by design
Global mind set
Strategic foresight &
All rights reserved
All rights reserved
LEVELS OF UNCERTAINTY
A Clear-Enough Future
A Range of Futures
Each level of uncertainty requires a
different strategic approach
Effective strategy is not “one size fits
Source: Courtney, H. (2001). 20/20 foresight: Crafting strategy in an uncertain world.
DIABETES & OBESITY
The Frog Didn’t Jump
We Did the Best We Could
Caring Communities & Access
to Health Care
Evolving Systems with
Source: Rowley, B. and Bezold, C. (2006). “The futures of US health care: The case of diabetes & the paths for eliminating health
disparities,” Institute for Alternative Futures.
New value innovation strategies
Global healthcare outsourcing shift service delivery variables
From “push” to “pull”
› Current – providers “push” out
service delivery options
› Future – providers “pull” in
patient behavior to determine
service delivery options
Source: Richardson, V. (2009). Adopted from Kim, C., and Mauborgne,
R. (1997). “Value innovation: The strategic logic of high growth.”