It's no secret that health care delivery is convoluted, expensive, and often deeply dissatisfying to consumers. But what is less obvious is that a way out of this crisis exists. Just as the PC replaced the mainframe and the telephone replaced the telegraph operator, disruptive innovations are changing the landscape of health care. Nurse practitioners, general practitioners, and even patients can do things in less-expensive, decentralized settings that could once be performed only by expensive specialists in centralized, inconvenient locations. But established institutions are fighting these innovations tooth and nail. Not only is this at the root of consumer dissatisfaction with the present system, it sows the seeds of its own destruction. The history of disruptive innovations tells us that incumbent institutions will be replaced with ones whose business models are appropriate to the new technologies and markets. Instead of working to preserve the existing systems, regulators, physicians, and pharmaceutical companies need to ask how they can enable more disruptive innovations to emerge. If the natural process of disruption is allowed to proceed, the result will be higher quality, lower cost, more convenient health care for everyone.

Supplements the (A) case.

Chronicles the initial efforts to teach a health care organization to manage itself according to the principles of the Toyota Production System (TPS). Describes the decision and dilemmas that arose from the implementation experiment. Builds on Bowen and Spear's earlier research in industrial settings. They found that TPS is an integrated approach to designing, doing, and improving the work of individual people and of groups of people working collaboratively to produce and deliver goods, services, and information. The Deaconess-Glover Hospital project tested the efficacy of the TPS in a nonindustrial setting (i.e., health care) and also offered insight into how to convert an organization, managed by its existing management system to one managed by TPS principles. This case provides background on Deaconess-Glover Hospital and on the TPS teacher, John Kenagy. Describes how Kenagy observed the work at the hospital to understand the system. Given how Kenagy gathered data and based on what he directly observed, what should he recommend to managers about their next step?