Apologies for being off-line but I have been taking a bit of r&r.

The current debate around health care reform is both interesting and depressing. While it is reassuring to see America finally tackle the issue of universal health care access the bigger debate about affordability seems to be going nowhere. Much of the conversation seems to be based around the role of prevention in bringing health care costs down but as Matt Miller pointed out in his Fortune article, prevention does not bring down the cost of health care - if anything it may actually force it up. He argues that a high proportion of health care costs happen in the last few months of life and no amount of prevention can avoid the inevitable.

This may be an extreme argument and few would argue that reducing obesity or smoking and increasing excercise does not have a beneficial effect. However it is correct to assert that prevention alone will not create a sustainable and affordable health care system. And system is the operative word here. Innovations have to occur across the whole system if sustainable change is to happen.

Productivity is just as important as prevention when it comes to creating affordable health. The tendency is for the political argument to jump straight to rationing as the cost control strategy but I believe there is a wealth of opportunity for innovation that creates greater productivity. Some of that will come from technology (although there are precious few examples of that so far) but much can also come from process innovation. Kaiser Permanente found ways to bring the time it takes nurses to change shift down from 40 minutes to 12 by going through a design based exploration led by nurses and other practitioners. Multiplied by every nurse on every shift on every ward in all forty hospitals this added up to a huge amount of extra time available to serve patients. The key here was that the innovations came from the ward floor, not from the executive suite, never mind Washington. Getting design thinking into the hands of health care practitioners may just offer one route to affordable health.