The Case for Decentralising Healthcare to reduce hospital waiting lists.

Keynote address to The Kings Fund by Clayton Christensen, Professor of Business Adminisatration, HarvardBusinessSchool.

                        Clayton Christensen is no stranger to change. It’s been his life’s work. Analysing various industries and predicting how change has and can improve them.

In his presentation to the King’s Fund he began by saying that although technologies come and go, jobs rarely change. To explain this he used the example of sending a package, explaining that Julius Ceaser would have used a horse & chariot, Queen Victoria a train or telegraph, Churchill an airplain and David Cameron would use Fedex.

In healthcare the job remains to cure patients but the technology has changed massively. Healthcare has been one of the slowest industries to adapt to technology. It has not adapted at the pace of technology, leading to bottlenecks and increasing waiting lists.

Dr. Christensen does suggest a way forward:

1. Bring the problem to the solution (i.e. the patient to a specialist diagnostic centre)
2. Then bring the solution to the problem (i.e. treat the patient locally or at home)

He advocates the use of hospitals as highly efficient and effective diagnostic centres, to get to the right diagnosis quickly and efficiently. This should be provided by specialist clinicians with the best diagnostic equipment. Diagnosis by specialists with the best, often expensive, equipment gets the best results. It’s worth travelling for.

Once diagnosis, and in some cases surgery or other complex interventions (cures), are complete the patient should be handed off to more local and less specialist (intensive & expensive) service sproviders. In short, transfer the patient back into the community as soon as the specialist work is complete, be that Community care, local clinics affiliated to the hospital, GP surgeries or the patient’s home.

The case for specialist centres:

Where hospitals try to do everything Dr Christensen has found that up to 85% of costs go on overheads. Each doubling of a patient pathway causes overhead costs to increase by 30%. He suggests 3 viable models:

1. Specialist diagnostic and solution centres

2. Specialist centres for standard repair work e.g. hernia repairs

3. Facilitated networks for chronic diseases. E.g. Crohns

If you would like to see the talk in full, check out the Kings Fund web site: