Healthcare Development & Architecture

Will What Got You Here Get You There? Thriving in 21st Century Healthcare

Healthcare Development & Architecture

Healthcare circa 2013 is a good news/bad news/good news story. The good news; healthcare work is important and will never go away. The bad news; most healthcare organizations are not on the path to thrive in the 21st century because success factors have changed. In the 20th century, healthcare thrived by improving quality and increasing cost. But for healthcare to prosper in the future, providing more and better care and continually lowering cost are essential. That’s high-value healthcare.

Can you provide more and better care and continually lower cost?  Can you provide high-value healthcare now?

If the answer is no, and you keep doing what you are doing, you’ll keep getting what you are getting.  Thriving in 21st century healthcare, for most of us, requires a new kind of adaptive vision and work.

So here’s the good news: You can thrive!  You and your organization can learn to adapt.  That’s Adaptive Design.

Adaptive Design increases the adaptive capacity of current resources to create new value in changing times.  It’s the key to success because, as Charles Darwin said, “It is not the strongest of the species, nor the most intelligent that survives. It is the one that is most adaptable to change.”

As much as that sounds like good old-fashioned common sense, adaptive capacity is rare in most organizations.  Since 1998, in a database of 750 companies, only 6 percent were able to consistently shed and adapt to create new value. You can be one of the 6 percent innovators.  Let's look at what healthcare leaders can do to adapt to create High-Value Healthcare.

       1. Know when it’s time to adapt: Here are five questions to ask yourself when considering whether it is time to adapt:

  • Is our current work delivering what we need to thrive?  If the stress scale is increasing, it may be time to adapt.
  • Are we downsizing, cost-cutting and consolidating services?  That’s the traditional response of poorly adaptive systems.
  • Do frontline staff, physicians and managers see problems as permanent, pervasive and personal?  If so, that’s definitely an opportunity to adapt.
  • What are the benefits of adapting? List them all—large or small, immediate or long-term.
  • What are the consequences of not adapting? Doing nothing comes at a cost. If we keep doing what we’re doing, we‘ll keep getting what we’re getting.

If these questions suggest it’s time to adapt, here’s the next step.

       2.  Understand that “What Got You Here, Won’t Get You There.” Compare these two lists of great companies. What is the main difference between List 1 and List 2?

All List 1 companies were leaders in their industry until they failed to adapt to innovations needed for dramatic, new levels of performance creating more value for less cost.  Each of the List Two companies realized that the very vision and workmanship that got their industry to where it was now (with success, profit, and notoriety) would not get them to new levels of value performance.

If thriving in 21st-century healthcare means providing High-Value Healthcare (i.e., more and better at continually lower cost), then thoughtfully ask yourself, “Will what got us here get us there?”

Answering “No” opens the door. You can feel proud of where you’ve been.  No one is to blame. The world has just changed. Trying harder at what you are currently doing now is not going to get you to more care at less cost.

The time to adapt is now.  The history of innovation and the experience of Adaptive Design make your next step obvious: Do what the 6 percent successful innovators and List 2 companies did to increase the value of their organizations.

  • Transition from old, traditional drivers of innovation and adapt to create new drivers. Here’s an example of how new adaptive methods and structures will allow you to adapt to healthcare.  After studying hundreds of companies, the data is clear: The List 1 companies who failed to adapt stayed with the Traditional Drivers of innovation in Table 1 below.  The more successful companies shed and adapted by moving to the Adaptive Drivers of innovation.

Drivers of success and innovation

This paradigm shift demands change–in both thought and action. The history of healthcare innovation is clear: Most organizations will fail to thrive because they can’t adopt the thinking and acting that led to their past success. Healthcare organizations that create high-value healthcare will thrive by shedding the old drivers and becoming adaptive innovators.

Adaptive Design incorporates a forward-thinking mindset with a tested and validated set of methods, skills, and tools derived from studying the successful 6 percent of companies able to create new value.  Adaptive Design reliably delivers high-value care fast.

Here is one of many examples:  A busy medical/surgical nursing unit in a Mid-Western hospital shed and adapted its way to amazing results all within one year: iii

  • Decreased length of stay by 8 percent (More care!)
  • Increased RN productivity by 14 percent (More productive nursing = more care!)
  • Decreased staff turnover by 51 percent  (Staff wants to provide more and better care!)
  • Most improved patient satisfaction in a 17-hospital system (Patients love it!)
  • Reduced the cost of care by $1,700,000 (Staff, patient, and management like lowering the cost of care!)

Adaptive Design is not another flavor of the month.  It is a good news story for 2013 healthcare and the DNA for thriving in the 21st century.
Adapt to create high-value healthcare.  That’s more than good news. It’s the best news!

© 2013 John Kenagy, All rights reserved.


iCapozzi, Kellen, Smit. The Perils of Best Practice: Should you emulate Apple? The McKinsey Quarterly, September, 2012.
iiKenagy (2009) Designed to Adapt: Leading Healthcare in Challenging Times. Second River Healthcare Press; Bozeman, MT; pp. 27-33.
iiiIbid; p. 28.

About the Author

Dr. John Kenagy knows healthcare as a physician, healthcare executive, Harvard Business School Visiting Scholar, author, speaker, advisor and, most importantly, a patient.  His book Designed to Adapt: Leading Healthcare in Challenging Times was named 2011 Book of the Year in Healthcare Management.  Organizations can use his Do/See/Know Innovation Assessment to decide if ‘what got them here will get them there.’  Experience Adaptive Design, his new online learning course for thriving in 21st Century healthcare, will be available in early 2013.

Email him at or see  Adaptive Design and Learning Line are registered trademarks and Experience Adaptive Design a trademark of John Kenagy, MD.

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