Monday, February 27, 2006

The Paradox of Success and the Healthcare Industry

The Cycle of Renewal

It may not look like it but many of the woes we see as a looming crisis in our Healthcare System are the result of our successes, not our failures. During my sabbatical I had the opportunity to reflect on my personal life as well as professional career. Recently I read John R. O'Neil's book, The Paradox of Success, and could not help but notice the parallels between what I experienced personally and what I observed to be happening in healthcare. O'Neil refers to it as the "Cycle of Renewal" and notes it is as important for individuals as it is for organizations. I think it applies to systems as well and what all the signs of the crisis are saying is it's time for renewal.

Surfing the S-Curve

The Paradox of Success utilizes an S-curve to describe the major stages one goes throughout the cycle. The bottom of the curve is the initial phase where the greatest amount of chaos exists. Learning is slow and frustrating. As one ascends the curve competence improves markedly and confidence builds. Performance continues to improve in a non-linear fashion until it reaches the top of the curve as one approaches the peak of success. Along the top of the curve the slope levels off and the pace of learning slows. We reach the point of diminishing returns and the slope begins to descend. We appear to be at the summit of our success but are beginning to stagnate. We've become so use to the non-linear growth phase we assume it will continue forever but as the cycle predicts it doesn't. It's a dangerous time. Doubt replaces confidence and slowly the crisis begins to build. Our first impulse is to fight this feeling. It can't be happening, we assure ourselves, but it is. We want to return to the glory days when we were on the rise up to the peak and each day brought new and exciting challenges. In our panic we can continue our futile struggle or choose to undergo renewal. Renewal is where hope lives. O'Neil draws the analogy of the surfer "who senses the dynamic wave beneath him, and... knows it is time to abandon the sinking or breaking wave and catch a new one that is building."

"You cannot solve the problems of the present with the solutions that produced them."
Albert Einstein (1879-1955)

In Geoffrey A. Moore's book, Dealing with Darwin, he also describes a similar cycle that he refers to as a "category-maturity cycle". A technology, service or industry will inevitably pass through this cycle and face the challenges each category provides. This cycle also has an early phase followed by a growth phase. The growth phase is a time when each day brings new and exciting challenges. Growth is non-linear and it is assumed it will continue forever. In time, a mature phase sets in when the disruptive innovation that initially precipitated the growth phase becomes entrenched. As it develops it soon becomes a legacy system which becomes large and less maneuverable. Much like the Titanic, the impending collision with the iceberg is inevitable but the great ship cannot turn in time to avoid a crisis. The crisis for mature phase industries is the approaching declining market. Depending on the solution they innovate they can either extend the shelf life of the current innovation or create a disruptive innovation and enter a new market. It is the new and typically disruptive innovation that helps solve the problems created by the old innovation.

"The Times They are a Changin."
Bob Dylan

Healthcare is made up of many people and industries each of whom will achieve some measure of success. The paradox is that as we achieve this success and rideout its natural cycle there is a tendency to view both ourselves and the industries we support as somehow failing after we reach the summit. The point of diminishing returns and the crisis it can invoke is not a sign of failure but a sign of past success receding and the need to prepare for a new cycle. I think our crisis in Healthcare is such a sign. It is going through a transformation from what it was to what it will become. Both of the above authors advocate for greater awareness and preparing for the next cycle or phase. Whether it is the "renewal imperative" or "repurposing resources for core" the encouraging news is that this crisis too shall pass.


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