Harvard business guru to apply lessons of change from industry to the challenges Harvard Macy scholars bring to the annual leadership program

Each June, leaders in health care delivery and medical education gather in Boston united by their need to drive change. They arrive at the Harvard Macy Institute’s annual Program for Leaders in Medical Education well aware of the difficulties of creating and sustaining progress. What they seek is insight into how to overcome the countless obstacles that stand in their way. There is no “magic bullet” that will solve all of their problems—education reform is the work of evolution, not revolution. Participants, however, will leave the program with a well-developed action plan for leading and managing change that will serve to challenge both them and their institutions.

Dr. Clayton Christensen

At the 2004 program, Dr. Clayton Christensen, professor of business administration at Harvard Business School, will again present his theories about innovation—ideas that have made him one of the world’s most prized speakers on leadership. He will talk to Harvard Macy scholars about the potential to effect radical change and achieve lasting, sustainable benefits by applying his principle of “disruption“ to issues affecting health care delivery and medical education.

The thesis of Christensen’s 1997 best-selling book The Innovator’s Dilemma—which sold 500,000 copies in 10 languages—is that successful organizations run the risk of losing their competitive advantage when they focus exclusively on delivering what their best customers want. This sounds like sensible business management, but as Christensen pointed out, this “stay the course” mentality can open the door for smaller competitors to subvert the market leaders by developing and delivering to market a “disruptive” innovation or technology. His latest book, entitled The Innovator’s Solution (2003), picks up where the earlier book left off, targeting a readership of leaders who would rather disrupt than be disrupted.

Changing the way we look at change
Companies that manufacture products from computer chips to cameras to plastic storage containers have embraced Christensen’s theories—and applied them to very profitable pursuits. What does his philosophy, widely accepted among leaders in high-tech and manufacturing industries, have to do with health care delivery and education? Christensen believes that an organization’s success lies in its ability to look beyond industry-specific situations and product differences. Rather than dissecting successful organizations in order to discover what makes them work, Christensen surveys the business world like a physicist, examining closely the different forces that shape industries and act upon leaders.

Such an approach is well suited to the health care delivery systems and academic health centers led by the Harvard Macy scholars who participate in the June program. While success in both of these arenas depends on establishing and meeting standards of quality and excellence, it is clear that in order for leaders to introduce innovative methodologies into their hospitals or schools, they must confront a host of external forces over which they have little or no control. If they neglect or fail to deal with those forces—whether economic, cultural, or otherwise—they may, like their counterparts in the computer industry, end up watching the innovations that change their industry pass them by.

Fifty-one scholars made up the class of the 2003 Program for Leaders in Medical Education.

The health care innovator’s dilemma
The average American hospital provides one example of how change in the health care industry is being affected by the principle of disruption. In the U.S., hospitals are moving to offer more high end services, focusing on intractable, multi-dimensional diseases. The disruptive innovation in this case is coming from technology that enables procedures that used to be performed in hospitals to be dealt with in specialist outpatient centers, while procedures once handled in outpatient centers are now handled in doctor’s offices. Beyond the doctor’s office is a category of medical services, such as dialysis, that patients can perform themselves, in their own homes.

In order to satisfy demand and compete in the health care marketplace, American hospitals are placing a heavy emphasis on reducing their operating costs. Christensen, looking at the hospital and health care delivery system just as he would a computer chip maker or automobile manufacturer, sees a strategic miscalculation in this approach. He believes that instead of making hospitals less expensive, leaders in the U.S. health care system should be thinking about how to help the inexpensive venues, such as outpatient clinics and doctor’s offices, do more. Is this a disruptive idea? It is, because merely cutting the hospital operating costs is work that deals with the status quo. It is in the less expensive health care settings, not the high end, where innovation can take place to improve productivity, access to care, and patient convenience.

Dr. Elizabeth Armstrong, director of the Harvard Macy Institute, said that program participants respond well to Christensen’s approach to exploring strategies for leading change. “Beyond a unique way of looking at medical education and health care, Dr. Christensen is gifted with the ability to take very abstract theories of industry and management, and discuss them in a clear and interesting way that is rooted in the real world of leadership, and thus meaningful for our scholars.”

The 2004 Program for Leaders in Medical Education will be held June 13-18 in Boston. This continuing medical education program will be co-directed by Armstrong, Christensen, and Dr. Joseph B. Martin, dean of Harvard Medical School. Past participants have included leaders at all levels of health care education and delivery whose major responsibilities require them to introduce and manage significant interdepartmental changes or innovations at their institutions. Ideally, the program is intended for teams of two or three leaders from the same institution, though the Institute welcomes individuals as well. Applications to the June program are currently being accepted through the Institute website: www.harvardmacy.org.