Disruptive Innovation and the Specialty of Anesthesiology: the Case for the Perioperative Surgical Home.

• Volume 120 • Number 5 www.anesthesia-analgesia.org 1155 We believe that now would be a good time for readers of Anesthesia & Analgesia to review the concept of disruptive innovation and its relevance to our medical specialty. The term disruptive innovation was first introduced by Clayton Christensen in 1997, referring to it as a process “by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors. ”a In 2008, Christensen et al.1 authored the book The Innovator’s Prescription: A Disruptive Solution for Health Care, in which they apply the principles of disruptive innovation to the health care system in the United States. In the following The Open Mind article, we will apply some of the principles of disruptive innovation in health care and examine their relevance to the perioperative environment and the field of anesthesiology. The concept of disruptive innovation may be best demonstrated by examples from the computer industry. In the 1970s, Digital Equipment Corporation was one of the world’s leading computer companies and focused on the development and production of the expensive mini-computers. At that time, a new product, the personal computer (PC) was being developed and introduced to the marketplace. In contrast to the mini-computer, the PC was an inferior product that was not as powerful and could not perform at the same level of a mini-computer. As a result of the PC’s inferior performance, most mini-computer companies scoffed at those involved in making PCs. They underestimated the marketplace, however; the general public was delighted with the introduction of the PC. Most individuals, small businesses, and educational institutions did not need a high-performance mini-computer; they only needed a simple electronic machine that could perform basic functions such as word processing and spreadsheet development.b As sales climbed and the underlying technology improved, PCs became more sophisticated and capable.b In just a few years, there was a total transition in the market leading to the demise of mini-computers. Digital Equipment Corporation failed. Ultimately, the downfall of nearly every mini-computer company of that era was the irresistible temptation to favor incremental improvements instead of the pursuit of disruptive technology. Why is this example relevant to anesthesiology? Incremental improvement in the future may not support the continued evolution of the specialty. Anesthesiology has been touted in the past one of the most transformative medical specialties with regard to patient safety.2 Since then, however, it can be argued that the specialty has improved patient care and safety only incrementally. In addition, market forces associated with payment trends of commercial insurers and government health care agencies suggest that there is an increasing reluctance to provide incremental payment for anesthesia services that are only marginally improving patient safety and cost-effective care. We submit the urgent need for anesthesiology to develop and adopt transformative changes. Such transformative changes may include the development and wide adoption of new integrated perioperative patient care models. The key word here is “integrated” compared with disjointed, fractured, or modular. Let’s return to the computer industry, using the recent devolution of the PC as an example. PCs are modular, with parts coming from many manufacturers and assembled into working units. Different parts, modules, or functions such as faster processors, bigger hard drives, and more memory may be improved from year to year, but the impact is incremental improvement in PC performance. Apple Computers, Inc., realized 10 years ago that it needed to jump beyond incremental improvements in its PCs and develop a more integrated system for the market. The company transitioned, moving to mobile electronic devices and integrating the production and assembly processes of its products. The company even changed its name (Apple, Inc.), but it never changed its core principles: empathy for the needs of their customers, focus on the things that really matter, and providing a professional, creative product. Disruptive Innovation and the Specialty of Anesthesiology: The Case for the Perioperative Surgical Home