Disruptive Innovation in Health Care: Challenges for Engineering

Seven years after the publication of two seminal reports by the Institute of Medicine, To Err Is Human (IOM, 2000) and Crossing the Quality Chasm (IOM, 2001), which documented uneven quality, dangers, and inconsistencies in health care delivery, a majority of the nation’s health care providers are still struggling with those same challenges. Simultaneously, a backlash against the managed-care systems of the 1980s and 1990s has led to very rapid increases in health care expenditures and consequent rapid increases in the number of uninsured and underinsured people, both of which continue unabated. Today, there is a growing consensus that the twentieth-century model of health care is no longer sustainable. After nearly a decade of subcritical attempts in the public and private sectors to improve the quality of health care and bring costs under control, a buyers’ revolt, led by businesses and insurers, combined with advances in medical and information and communication technologies (ICT), has begun to open the closed market for health care services to new business models, as well as to new models of care delivery. Innovative, “disruptive” models of care delivery are opening the way to a new division of labor among health care providers and changes in the structure and location of care delivery. Eventually, they could catalyze a wholesale transformation of the overall health care system by accelerating the development and application of ICT tools and techniques that would Jerome H. grossman is director