Message From the President
“Disruptive innovation”…This term has been floating around now for over 20 years, and it seems like there is no lack of participants for what has proved to be a powerful way of thinking about innovation and the realities inherent to the process. What is it, and why is this important for nurses? “Disruption” describes a process whereby a smaller organization with few resources is able to successfully challenge a larger well-established organization (Christensen, Raynor, & McDonald, 2015), and it has recently been heralded as a way to control health care spending in the United States (Hwang & Christensen, 2008), although there are relatively few medical providers who are familiar with the concept (Dalziel & Shah, 2010). One could point out that coronary artery stenting has disrupted cardiac surgery, bedside emergency ultrasound has disrupted computed tomography scan in the emergency departments (Dalziel & Shah, 2010), or advanced practice providers have disrupted physician primary care practice. However, is this a descriptor that advanced practice providers are willing to accept? If disruptive innovation is really a concept that replaces a status quo technology or process by offering a reliable, less expensive, and lower-quality alternatives, then it does not align with the Centers for Medicare & Medicaid Services' concept of value-base purchasing in the Affordable Care Act's implementation of accountable care organization models. Furthermore, it does not describe advanced practice providers as evidence suggests that nurse practitioners provide a quality of care that is equivalent to physicians in a number of settings as well as provide a range of services traditionally offered by physicians (Dalziel & Shah, 2010). According to the very author of this disruption theory, the core concepts and basic tenets have been frequently misapplied with the term being used quite loosely to support whatever innovation is desired (Christensen et al., 2015). One of his points that can be applied to health care is this: For an innovation to be truly disruptive, it will not catch on with mainstream customers until quality catches up to their standards (Christensen et al., 2015).
The use of advanced practice providers is not a novel concept and has often been used as a good illustration of disruptive innovation for several reasons: They are already involved in primary care as well as role substitution in hospital and ambulatory settings (Dalziel & Shah, 2010), and they are the largest group of health care professionals in the United States (Kuehn, 2010). I would argue that the jury is still out as to whether nurse practitioners or physician assistants will be successful disruptive innovators or simple innovators. The 2010 Institute of Medicine report advocates eliminating legislative barriers to practicing medicine for nurse practitioners to meet the demand for primary care providers. However, there is no mention in the report regarding maintaining competencies or ensuring patient safety (Institute of Medicine, 2010); so according to Clayton Christensen (Christensen et al., 2015), we are bound to fail…but will we?
There is no doubt that significant efforts on the part of policy makers to monitor quality and support appropriate education will be needed and, predictably, the fierce opposition from physician-led groups will require well-constructed policies. However, let us not forget that this is not new. Changes to medical models are generally regarded with reticence, but we have been proving our worth by silently meeting the health care needs of underserved populations or special medically complex patients for decades. Disruptive innovation in nursing does not happen overnight or without a strategy, but it does happen, and it is powerful.
Christensen C., Raynor M., McDonald R. (2015). What is disruptive innovation? Harvard Business Review
, 12, 44–53.
Dalziel P., Shah T. (2010). Disruptive innovation. The Medicine Forum
, 12(4), 4–7.
Hwang J., Christensen C. M. (2008). Disruptive innovation in health care delivery: A framework for business-model innovation. Health Affairs
, 27(5), 1329–1335.
Kuehn B. M. (2010). IOM: Boost nurses' role in health care. Journal of the American Medical Association
, 304(21), 2345–2346.