BY KIM BELLARD
I read two articles this week that got me thinking: Robert Charettes “In the hidden world of the old IT systems”(IEEE spectrum) and Douglas Holts “Cultural innovation”(Harvard Business Review). Both deal with what I’ll call legacy thinking.
It is a particular problem for health care.
If you work in a large organization, especially one that has been around for at least a few decades, you are likely to be drawn to the words “legacy system”. If you’ve dealt with an organization like this, legacy systems have likely contributed to any problems you may have had with them. Think health insurance claims systems, hospital billing systems, financial institution account records, or virtually any government system.
Dr. Charette mention, that::
Although these systems cover practically every aspect of our lives, we don’t think about them any further because for the most part they work. It doesn’t even occur to us that IT is something that needs constant attention in order to stay functional. “
Since they usually work perfectly, management often does not want to risk that they may be replaced or modernized. Hence, they keep getting older, with more and more layers and the people who originally created them or who understand the language in which they are written (e.g. COBOL) is gone.
The problem is, not only could older systems fail, but Tony Salvaggio, CEO of Computer Aid, Inc.., told him, new technologies will “blow up 30 to 40 percent [existing] Business models. “Companies that rely on outdated legacy systems may not be able to keep up.
I worked on a big blue plan for several years to bring it into the digital age. Legacy systems have been the bane of our endeavors. Thinking in legacy systems limited the developers’ approach to our projects, the skills made available to them, and the management of the projects. I like to think we won the war, but we lost more battles than won, settled for more compromises than we should have, and always had to know that these legacy systems would limit what our customers could do.
And my blue plan was considered one of the most innovative blues.
Legacy systems restrict health care not only in how it can be innovative, but also in how it can think about innovation. Which brings me to the second article.
Dr. Holt, former professor at Harvard Business School and now advisor on branding and innovation, differs between incremental innovation – “building a better mousetrap” – and “cultural innovation” – reinventing the market. As he says:
Cultural innovation works on qualitative ambitions: change the understanding of what is considered valuable.
He goes through some examples and uses these five steps to explain cultural innovation:
- Deconstruct the culture of the category
- Identify the Achilles heel
- Mine the cultural avant-garde
- Create an ideology that challenges the Achilles heel.
- Present symbols that dramatize ideology
He reminds us, “Markets are belief systems adopted by those entering a category: businesses, consumers, and the media.” I would never have thought of healthcare as a belief system, but it’s a good mental model I’ve heard .
When I get sick, I go to the doctor. I can ask a few questions, have a few preferences, but the doctor is the expert. When I’m sick enough, I go to the hospital where they do more expensive things to me. Oh, and as much as possible, someone else should pay for my care. I wait a lot for something to happen.
That is a fragile belief system.
Healthcare doesn’t have an Achilles heel. it is almost nothing but Achilles heels. There is no shortage of “cultural avant-garde” nibbling on the fringes of healthcare, such as: DIY, Biohacking, or also SDoH. But none of them have spoken out in favor of a new ideology that really questions our existing status quo. So far, none of them are forcing us to investigate health care from the outside.
Dr. Holt continues:
Even if they don’t think so, companies dominate the existing culture of their category. You need to excel in your current business. Your metrics and planning will focus on this. As a result, managers perceive the category as an immutable reality, when in fact it is based on a fragile consensus. If you are trapped in the present, it is extremely difficult to examine the category from the outside and identify its emerging shortcomings.
Healthcare is based on doctors, hospitals and insurance companies – but that is our existing belief system. These doctors, hospitals and insurance companies are built on legacy systems – but they don’t have to be. Healthcare is trapped in the present.
Dr. Holt warns:
Incumbents are so intent on winning the category as it is currently defined that they cannot see any cracks in their foundation. Cultural innovators are maneuvering them out because they are looking for ways to blow up the prevailing ideology in favor of a new regime.
As I suggested before Let’s blow up all the hospitals first.
I’ll give an example from another article, Alex Voights Tesla introduced a business model that the world has never seen ((Clean technology). Tesla, that’s the one now largest market manufacturer by market capitalization despite much lower actual salesplay another game. Mr. Voight argues, “Tesla is the only automaker in the world that is continuously improving the vehicles it sells for free.” If you’re an automaker who doesn’t do the same, “you won’t be in business long or shrink until you’re unrecognizable.”
We don’t have a “Tesla” for healthcare … but one day we will. The status quo is not an “unchanging reality”.
If you work in healthcare and rely on older systems, you are in trouble. If you’re in healthcare and don’t know exactly what your Achilles heel is, someone else is going to take advantage of you. Even if you are a new healthcare provider with more modern technology but still based on current ideology, your impact will be limited.
We usually think of “legacy” as something we want to pass on to future generations, but there are too many legacies in healthcare that we shouldn’t. We spend too much time talking about innovation culture when we should think more about cultural innovation.
Kim is a former e-marketing manager on a major blues plan, editor of the late-defeat Tincture.io, and now a regular at THCB.
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