This was a lecture from the ASA national meeting;
What will be your job in 10 years?
That was the practical question at the heart of the ANESTHESIOLOGY™ 2014 annual meeting Opening Session yesterday. Change is coming to anesthesiology, and physician anesthesiologists are poised to lead the way in implementing the Perioperative Surgical Home model of care.
“You have made anesthesia, perioperative care and pain management so safe that your job is too often taken for granted,” said Jason Hwang, M.D. M.B.A, author of The Innovator’s Prescription: A Disruptive Solution for Health Care. Dr. Hwang is an internal medicine physician and Chief Medical Officer/Co-founder of PolkaDoc, a telehealth company.
Changes that have already come to health care, and even greater changes that are coming, mean that other providers want to get into your space,” he said.
There are two ways to manage change, Dr. Hwang said. One is to support the status quo by refining and improving the practices and procedures that created today’s success. The other is to embrace change and shape the future to support your core values.
The safer route, supporting the status quo, can be a recipe for disaster. Just ask former executives at Digital Equipment Corporation (DEC), once the most successful computer maker in the world. DEC made the minicomputers that brought hospitals, banks, government and other major organizations into the digital age in the 1970s.
But the PC killed DEC. The problem wasn’t that DEC couldn’t adopt the new technology that was disrupting the computer world. DEC tried, and abandoned, multiple PC projects. The company and its employees had too much invested in familiar technologies and familiar ways of operating to do more than improve what was already the most powerful business computer of the era.
“DEC rightly saw that the PC couldn’t do most of what its cheapest minicomputer could do,” Dr. Hwang said. “DEC’s customers scoffed at PCs. But the PC appealed to another group — you and me. We were non-users of minicomputers but we were voracious users of the PC. DEC went bankrupt along with almost every other minicomputer maker. Do you want to follow that model?”
Anesthesiology is facing a similar decision, he said. There are unmet needs and opportunities in pre-surgical assessment and perioperative care. There are opportunities in bundled payments. These are open doors for anesthesiologists and for other providers. The anesthesiologist of the future has to move ahead… or someone else will.”
Innovation comes in two forms. One is modular, like PCs. Because the different components must work together, change and innovation come in small increments. Any change to storage, chip sets or input/output devices is limited by the need to work with older, less advanced components.
“Health care is a component system,” Dr. Hwang said. “It is impossible for physicians, hospitals or payers to change how health care is delivered in any fundamental way. Each component has improved incrementally, but the system has changed very little.”
The other form of innovation is integration, the Apple Computer model. Apple controls the design, the look, the feel and the performance of every component. One result is that the smartphone, led by the iPhone, is eating away at the computer market. The phone that most attendees carry can do virtually anything that can be done on a laptop or desktop computer.
“There is a danger that anesthesiology will remain in the modular world,” Dr. Hwang said. “The Perioperative Surgical Home is an innovation that reworks old providers to do new things and new providers to do old things. The changes around the profession are not a threat but a series of opportunities. Great innovation is knowing how to build and create the future. The future of anesthesiology is very bright indeed.”
The key element that separates great organizations from the ordinary is their ability and willingness to change. Everything is open to change except the core values, said Mark Warner, M.D., 2010 ASA President and Executive Dean of the Mayo Clinic College of Medicine, Rochester, Minnesota.
“Our core values are a commitment to treating critical illness and acute and chronic pain, and to always improve the safety and the quality of the care we provide,” he said. “Everything else is open to change.”
Every day, patients who should have lived die because they failed to receive appropriate management during perioperative care, Dr. Warner said. Physician anesthesiologists have the skill and the training to provide that management.