This week, the Public Health Council approved regulations authorizing introduction of in-store health-care clinics in Massachusetts. These are basically kiosks, within, for example, a CVS store, where a nurse-practitioner can treat common conditions. They limit their practice to conditions for which there are clear diagnostic tests and clear safe treatments.
I chose to actively support this modest step forward — testifying in support of it — because it is an example of a category of innovation that we need to promote: Innovation in health care and education that makes less be more. Online learning, which I have also been actively supporting, is a parallel example.
Most of us agree in principle that we need both more health care and more education.
Leaders across the political spectrum promise to achieve universal health insurance coverage and to assure that coverage extends to all potentially valuable treatments and also that the quality of care is consistently superlative.
Leaders across the spectrum agree that in a global economy we need to provide first rate education in order to remain competitive. Many are advocating the extension of learning time and early education for all, and just as in health care, there is increasing focus on the quality of education — the preparation of teachers and the achievements of students.
On the other hand, education and health care account for roughly half of all state and local government spending and they are both growing rapidly. There is a counter-current of resentment among taxpayers and businesses about the high cost of health care and even the high cost of schools. Few in positions of political accountability are remotely willing to embrace the broad-based tax increases that would be necessary if we were to really
deliver on all of the ambitious proposals for expansion.
In this double-bind, the common response is to suspect the providers — the
teachers, the nurses, the doctors, even the superintendents and
administrators — and suggest that they are too highly compensated. In
reality, the compensation is all too often insufficient to retain people in
these high-stress jobs.
The net result is that year in and year out we use the language of “crisis”
and “break-down” in describing our health care education and school
Ironically, the United States is still a world-wide destination for those
seeking good health care and education. We certainly have some great
material to work with.
One fundamental insight as to the way forward, which Clayton Christiansen of
Harvard Business School has framed in studying disruptive innovation in
other industries, is that some customers are overserved by our high-quality
systems. Sometimes, less is more.
Certainly, we all want a one-on-one consultation with a highly-trained
physician, whenever we feel a little under the weather. She might be better
able to recognize the early manifestations of a potentially fatal disease in
our runny nose. But, in practice, we’re probably fine and a quick visit to
a nurse at the CVS down the street is preferable to a trip downtown and a
long wait in a room full of other sick people.
In the same way, we all want a personal lesson from a sympathetic teacher
when we are struggling to master a new idea. He will be able to meet us at
our own level and take us to where we are trying to go even when we don’t
know the right questions to ask. But, in practice, being able log-in to an
online course on our own time without changing out of our pijamas is
preferable to schlepping to school and sitting in a class in which some are
moving faster than we are and some are moving slower.
Tom Friedman has written that “the world is flat”. Technology is changing
the way we work and breaking apart old models. Health and education
professionals have nothing to fear — the need for their services will
continue to grow. Technology change also operates to expand demand for both
health care and education.
But we need to let patients and students get care and education in the least
expensive and most convenient forms possible, which often may not involve
the direct services of the most highly-qualified professionals. This will
free the highly qualified professionals to do the most important and
challenging work — for doctors, treating the more complex cases and
managing the more difficult patients; for teachers, leading classroom
discussions about hard-to-frame issues and coaching and mentoring kids when
they need help most.
I don’t for a second mean to suggest that any single innovation will “solve”
our “crises” in health care and education. We need to be realistic about
the difficulty of change and commit to the long haul.
But I do believe that we can see the future in the changes that are emerging
today and that there is some cause to be hopeful, especially when
leadership moves to embrace change. The Public Health Council vote was good