Views & Reviews Review of the Week

Hospitals within hospitals

BMJ 2009; 338 doi: (Published 05 May 2009) Cite this as: BMJ 2009;338:b1787
  1. Chris Ham, professor of health policy and management, University of Birmingham
  1. c.j.ham{at}

    A new proposal for healthcare reform that values the potential of disruptive innovation is unlikely to succeed in the fee for service system of the United States but may well work elsewhere, thinks Chris Ham

    With healthcare reform back on the agenda in the United States, The Innovator’s Prescription offers a timely critique of the travails of the country’s health services. It also has some provocative ideas that will make it of interest to healthcare reformers everywhere. At the core of the book is the notion that disruptive innovations have the potential to transform health care in the same way that personal computers and budget airlines have revolutionised those sectors.

    Christensen and his coauthors argue that hospitals and doctors’ clinics combine three very different functions: solution shops that diagnose patients’ problems; value adding processes that provide effective treatments after diagnosis; and facilitated networks that manage chronic diseases. Advances in medicine make it imperative that these functions be separated for high quality care to be delivered at an affordable cost.

    The authors contend that this is most likely to happen by creating “hospitals …

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