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Learning About the Process of Innovation Through Disparities Reduction

By Paul Plsek, MS, Paul E. Plsek & Associates and Former Member, Innovations Exchange Editorial Board; and Brenda Leath, PhD, Westat

Disparities in the U.S. health care system are well-documented1 and therefore should be an obvious focus for innovation efforts. Further, reflecting on the innovation process focused on underserved populations might also help us improve mainstream care for all.

Search for and combine innovative ideas from other contexts

One approach to innovation is to adapt commonplace ideas from one context to another.2 For example, while drive-through windows are commonplace in fast-food restaurants and banks, it would be considered innovative to put a drive-through in a doctor's office (to provide, for example, influenza shots or quick consults). Could service delivery concepts from other industries help health care address issues such as access to care and adherence to treatment plans?

While adapting an idea from fast-food restaurants to health care is generally considered more innovative than adapting an idea from one health care setting to another, any adaptation can be considered an innovation. So, for example, while it is true that the Migrant Clinicians Network Prenatal Care Program might be described as rather commonplace telephone-based case management, to do so would miss a key point about disparities reduction. We have disparities often because past innovations in general health care delivery have not been made readily available in all possible contexts. The Migrant Clinicians Network also further developed the innovation of telephone-based case management by combining it with bilingual, culturally competent staff and the ability to manage medical records over time and geography. How many more innovations for disparities reduction could we envision by simply looking to adapt and combine innovations from more mainstream care?

Disparities reduction ideas as potential "disruptive innovations" for mainstream care

Christensen3 notes that "disruptive innovations" that bring major change to industries often begin in a segment of the marketplace that is neglected by mainstream suppliers. Innovations for disparity reduction that focus on greater patient-centeredness and thinking of the patient in a more holistic manner might therefore be nascent disruptive innovations that could improve mainstream care.

For example, consider the efforts of:
  • The Salud Mobile Outreach Program in rural Colorado, which traveled out into the community to "scout out" the habits of its target population as input to the design and operations of it mobile clinic.
  • The innovators associated with the Teens Against Tobacco Use program in Washington State who worked carefully with members of the Hispanic and Native American communities in order to adapt an existing program to better fit the culture and values of those it was intended to reach.
Could mainstream health care providers, who tend to meet with other health care professionals within the walls of traditional health care settings to discuss the latest ideas for more "patient-centered care" and "wellness," learn something from these disparity-reduction innovators? Do even traditionally well-served populations perhaps have sub-populations with different needs, lifestyles, habits, cultures, and values that need to be better understood?

Beyond the topic of patient-centeredness, the challenges associated with reducing disparities might provide further insights and useful change concepts in other areas:
  • Note how the Bi-Lingual International Assistant Services in St. Louis combined medical screening, counseling, and psychotherapy services, links to social services, and training for professionals, and consider other opportunities for similar service integration and bundling.
  • Look carefully at the San Francisco General Hospital's innovation of visual medication schedules and consider alternative ways of communicating health information to all patients.
  • Consider how the Work Healthy and Teens Against Tobacco Use programs trained and used peers and make note of this the next time you struggle with changing patients' behaviors.
Does innovation really require massive new funding?

Another important lesson that one can gather from disparities reduction case studies is about being creative in the use of infrastructure, funding, partnerships, volunteers, and members of the target population themselves. While resources are no doubt needed to do anything of value, these innovators demonstrate that creativity, persistence, and a fundamental belief in the necessity for a new approach can carry an innovative idea a long way initially. Further note how they leveraged the success of their initial efforts and built a case for ongoing funding to sustain the effort.


1Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Ethnic and Racial Disparities in Healthcare. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Institute of Medicine. Washington, DC: The National Academies Press; 2003.

2Plsek PE. Creativity, Innovation, and Quality. ASQ Quality Press, 1997.

3Christensen CM. The Innovator's Dilemma. New York: HarperCollins Publishers; 2000.

Disclosure Statement: Mr. Plsek and Dr. Leath have not indicated whether they have financial interests or business/professional affiliations relevant to the work described in this article.

Original publication: June 27, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: July 30, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: June 20, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.