HEALTHCARE ESTATES 2021 PRESENTATIONS
Left: From a book by US author, Clayton Christensen, who Stephen Wright explained had ‘done some thinking (fundamentally in the US context) about how a healthcare business model might work’, and how it ‘creates value’. Right: Demonstrating ‘Governance’.
the healthcare system, and what we get out.” The business model would, he said, ‘attempt to think through that’. Here he showed a slide – which he said featured in the book previously mentioned that he had co-written (but also in books by US author, Clayton Christensen, who Stephen Wright explained had ‘done some thinking, fundamentally in the US context), about how a healthcare business model might work’. This highlighted how the organisation ‘creates value’, ‘how it decides on where it wants to go with the value proposition’, and the way it assembles the things it needs to achieve that – ‘an iterative process over time’. The speaker added: “It leads, in Christensen’s mind, to just three business models in health, and also in institutions like hospitals. He defines these as being ‘solution shops’, which are, to quote him: ‘Institutions built to diagnose and solve
unstructured problems’. It’s sort of a craft or handicraft approach, and the point that Christensen makes is that most hospitals – including perhaps most particularly tertiary ones, and almost all primary care facilities – are like this, so hospitals are fundamentally ‘solution shops’, which are doing things to try and work out what this problem is that they’re facing, and what’s the best way through it.”
Value-Added processes
Clayton Christensen, he went on to explain, also ‘isolated out’ Value Added processes, which, in the context of hospital care, would be ‘focused factories’, i.e. places that offer, for instance, Orthopaedics, or eye care, ‘where you can transform in repeatable ways standardised resource to deliver high-quality output’. Stephen Wright said: “This is probably the domain of ‘Lean healthcare’, more so than it is in
‘solution shops’, where the problems can be too diverse and too amorphous to be able to capture easily by ‘transforming’, factory-type processes.” He continued: “The third option is so-called ‘Facilitated Networks’, where the user or consumer is also a ‘producer’ of care. When we worked on these models in the book, we eventually decided they weren’t actually that good, although they were good enough to start a dialogue with.” This, he said, highlighted the point the hospital ‘needs to decide what it’s for before it tries to do anything else’.
Deciding what to do
Here Stephen Wright turned to the question: ‘How do you use this ‘tripod’ – of governance, models of care, and business models – to decide what to do?’ He said: “Here I slipped gracefully into talking about the capital investment decision. Which hospital should you invest in, which
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