Interview: John Kenagy

John Kenagy, M.D.

Kenagy knows healthcare as a physician, healthcare executive, scholar, advisor, patient and, most recently, as the author of a new book Designed to Adapt: Leading Healthcare in Challenging Times. As healthcare reform moves through Congress and increasing pressure develops to lower costs, the health care landscape is changing in unpredictable ways. Therefore, companies adept at managing innovation will be best positioned to respond and prosper. His research as a Visiting Scholar at Harvard Business School rigorously explored how the successful management methods of adaptive companies like Toyota, Intel, and Southwest Airlines enabled them to prosper when others failed. He discovered they shared common principles for managing complex, dynamic, unpredictable work. Over the last 12 years, he tested, validated and improved these concepts in the world’s most complex business, U.S. healthcare.

Based on his research and experience, Kenagy developed a set of methods, skills and tools called Adaptive Design® that redesign healthcare organizations to deliver exactly what the patient needs, safely, at continually lower cost. Adaptive Design has helped Mayo Health System, Ascension Health, Palomar Pomerado Health and many other healthcare organizations improve efficiency and lower the cost of care by addressing problems as they happen and then testing, validating and replicating successful solutions as close to the patient as possible. Moreover, Adaptive Design® eliminates ambiguity, assumptions, workarounds and tradeoffs that distract from the primary job of patient care and enables management to develop people with the control and accountability to problem solve the system in real time as part of their everyday work.

Here is an excerpt from my interview of Kenagy, an excerpt that is somewhat longer than I usually provide because of the importance of the issues that he addresses. The complete interview is also available.

Morris: You characterize Adaptive Design® as “wisdom in action.” Are you confident that, over time, there will be increasingly greater acceptance of that wisdom by healthcare organizations, their strategic allies, and by various governmental entities?

Kenagy: I believe we have tremendous amounts of knowledge in healthcare. I frame our problem as not a lack of knowledge, but rather a shortage of wisdom on how to use that knowledge effectively. We are not missing the pieces; it’s putting the pieces together wisely that is the key.

I’ve been in healthcare for almost 40 years, and over that time, we have struggled with the same problems and solutions over and over again (Please see “When Healthcare Solutions Become Problems” in the Huffington Post. I put the blame on an antiquated management system that is better designed for mid-20th century factories than 21st century healthcare. Our problem is not a lack of knowledge, but rather a shortage of wisdom on how to use that knowledge effectively.

It’s just not wise to gather more data and have more meetings. Instead, management needs to tap into the wisdom of everyone in the organization to make it continually better for patients. That’s the focus of Adaptive Design – get patients exactly what they need at continually lower cost. That’s leveraging all our wisdom to fix healthcare.

Morris: Which question do you wish you had been asked during this interview – but weren’t – and what is your response to it?

Kenagy: If you would have asked me if information technology will ever achieve its promise, I would answer, yes, but not the way we are currently approaching healthcare IT. Consulting work I did for Microsoft several years ago taught me a great deal about how we might deliver on the promise. The problem with current IT solutions is that they focus on very expensive data warehouses and enterprise-wide, top-down solutions. Think desk tops, laptops, expensive, centralized, and massive roll-outs that can’t be changed or improved until the next version is designed, built, purchased and implemented (again).
The National Academy of Sciences recently reported (see NRC Report ) our current IT approach will not achieve the quality and safety goals outlined by the Institute of Medicine. That’s not delivering on the promise.

I have recently written on our healthcare IT opportunities. My 12 years of experience in testing, validating and improving real time problem solving capabilities in healthcare makes it very clear what delivering on the IT promise will look like. Systems that will deliver are less costly, modular, fast, flexible, friendly, and responsive. Think frontline decision support through smart phones, distributed networks, intra-operability and local improvability.

It’s a great opportunity area and it’s not rocket science. You just have to think and act adaptively to be able to get there.

In all of my work in and outside of healthcare, I’ve found one aphorism to be true over and over again: “You can’t think your way to a new way of acting; you have to act your way to a new way of thinking.” That’s the essence of Adaptive Design®. The book is a guide to acting your way to a new way of thinking.

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For those who are interested in more information, my website at www.johnkenagy.com is under construction as a continually evolving resource for adaptive work. In addition, there are hundreds of people around the county from the C-suite to the frontline that are using Adaptive Design®. My goal is to link those individuals together as a virtual community focused on getting patients exactly what they need at continually lower cost. Those who want more information can contact info@johnkenagy.com or me directly at john@johnkenagy.com. It’s the way we will fix healthcare.

If you wish to read the complete interview, please contact me at interllect@mindspring.com