Newtown, CT – March 5, 2016
Innovation is most often proximal, bounded on one side by the forces that oppose it because it might threaten their economic interests, and on the other side by the comfort that proximity brings to those who might adopt it. And then there’s the non-proximal innovation; that which, in Schumpeter’s words, incessantly revolutionizes the economic structure from within, incessantly destroys the old one, incessantly creates a new one. The proximal innovation in caring for the “least among them” – kids in foster care, kids in unsafe family environments, kids coming out of the juvenile incarceration system or at risk of ending up in it – has led to incremental and mostly ineffective results. The barriers to non-proximal innovation, to imagining different outcomes and different methods to achieving those outcomes, seem insurmountable, laden with habits from governmental agencies, health care providers, and policy makers that weigh down the potential of any effort. And yet, in New York City, The Foundling has done just that, not by accident, but by methodically analyzing the evidence of what might work, testing it, adapting it, and unwaveringly getting it done. The process is seemingly simple, as non-proximal innovation often is, determining the needs of these children and their families, and then deploying the teams that can deliver the services that cater to those needs. The teams go to the needy, and not the other way around. And therein lies the power of non-proximal care innovation.
What this means to you – Innovation in health care is largely proximal. For the most part, the manifestation of patient-centered care is actually centered around the physician, the facility or the health system. “Innovative” health plans, like Oscar, are new packaging on the same delivery system using the same payment systems and with predictable results. But sometimes the innovation is distant, seemingly unreachable, inconceivable by most and resisted by many. They break barriers, overturn conventional “wisdom”, disrupt the status quo and replace it with something much much better. Think of the original Mac combined with Mosaic Netscape. They leapt over proximal innovations and created new proximities, new innovation neighborhoods, new springboards for yet more distant innovation. They turned institutional and machine-centric computing into a distributed power in the hands and at the service of the person. The menacing HAL became the welcoming Mac. And that’s what The Foundling has done, focusing on the most adverse of adverse selection of patients, the kids that no one wants and most have given up on. They’ve changed the approach to care and changed the lives of those in their care. Thousands of youths whose future was dismal now have a future to look forward to, and the innovation deployed to change their lives has the potential to change the lives of many more, and not just children. Because, after all, it’s simple. Understand the needs of those you serve, assemble a team that can meet those needs, and center the team around and at the service of the patient. Of course, for those who preach the gospel of proximal innovation, where everything radiates from the primary care physician, The Foundling’s innovation will seem impractical, or be written off as a special case. But then again, that’s what IBM said about the mouse and the PC. And for those who saw the internet-connected Mac and recognized the dawn of a new era, see what happens when you create real patient-centered care.
Francois de Brantes