Every week, medical journals bring us news of astounding scientific discoveries: CRISPR gene editing, or CAR-T cell therapy for cancer. And yet just as frequently we hear, “Why can’t health care be more innovative?” The resolution of this paradox lies in recognizing that when people lament health care’s lack of innovation, they’re referring to how we deliver services to patients. That distinction makes the paradox even starker: “So, you’re telling me that you can reprogram T cells to find and kill cancer cells, but it took four months to get my mother an appointment with a neurologist; she spent two hours in the waiting room; and then she got an exorbitant bill that read, ‘This is not a bill’?”
Improving patient scheduling, service, or billing should not be as hard as harnessing clustered regularly interspaced short palindromic repeats to edit nucleotide sequences. And yet it seems to be. Why is that, and what can we do about it?
A big difference between innovating in the molecular sciences and in care delivery is that molecules don’t fight back. Bacteria may exchange plasmids, but they don’t practice guile. Nor do they take comfort in doing things the way they’ve always been done. The resistance to change in health care is sometimes simple intransigence but mostly it is the natural byproduct of thoughtful professionals trying to avoid mistakes in a setting that is expensive, regulated, and high stakes. Yet, successful health care innovation follows the pattern of successful science; it requires laboratories where experimentation is encouraged and can proceed safely so that change seems less fraught.