By Tom Debley
Harvard Business School Professor Clayton Christensen has taken to the pages of Business Week magazine to argue we would better off with health care systems in which doctors and insurers are on the same side of the ledger as the patient. That would be a system such as Kaiser Permanente. So what is the difference between his position and that of Sidney R. Garfield, the physician co-founder of Kaiser Permanente? Well, 65 years.
Professor Christensen, an expert on the topic of disruptive innovation, says that to do otherwise means “we’re guilty of business model malpractice on a grand scale.” As the headline on Christensen’s article put it, “The way to cut costs is to put care and insurance in the same bed.”
Dr. Sidney R. Garfield in 1975
Dr. Garfield, in designing Kaiser Permanente, made that argument 65 years ago when he addressed the Multnomah County Medical Association on April 4, 1945.
Garfield, talking about what he called his “new economy of medicine,” responded to the belief expressed a day earlier by another physician who claimed the most expensive thing in a hospital was an empty bed.
“He wasn’t referring to our hospital,” Garfield told his Portland, Oregon, audience, referring to the first Kaiser Permanente hospital in the Pacific Northwest, built during World War II in Vancouver, Washington.
“The most expensive thing in our hospital is a filled hospital bed,” Garfield added. “This new economy is geared to the preventive medicine of the future. It puts the patient, the doctor, the hospital, the employer and the insurance company all on the same side of the ledger. They all benefit by the patient remaining well.”
Garfield was a disruptive innovator long before the modern term was coined by Professor Christensen in 1995. As Garfield once said, “We are talking about changes – and changes are irritating and disturbing, but being disturbed is essential to progress.” (See my earlier blog, “Disruptive Innovation” at the Core of Kaiser Permanente History.)
Argues Christensen today, integrated delivery systems, including Kaiser Permanente, “can provide better care at 20 to 30 percent lower cost. Clearly, systemic problems require systemic solutions.”
If Dr. Garfield was 65 years ahead of the curve on that one, consider that it was 50 years ago this spring that he first argued that the computer should become the center of medical care delivery. Last week, on March 3, he would have been smiling as Kaiser Permanente announced that every medical facility within its health system — 431 medical offices and 36 hospitals — is now equipped with Kaiser Permanente Health Connect®, the largest private sector electronic health record in the world.
We’ll have more to say about Dr. Garfield and the computer on the 50th anniversary of his first talk on that topic in May.
Tom Debley is director of Kaiser Permanente’s Heritage Resources program and author of “The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” available directly from the publisher, The Permanente Press, as well as from Amazon.com both in paperback and on Kindle.
