Confront the Right Side of the Curve
Everyone knows the famous bell-shaped curve from the research on dissemination of innovation. And everyone finds the work on the left side of that curve exhilarating – the innovation, which is created by the 2% of people who are free thinkers, reading and learning from other industries; the early adoption by the 14% of people who may not be reading or learning from other industries but are open minded enough to be watching the innovators carefully; and then the first big bolus of the early majority, who are willing to change their behavior when evidence accumulates that a new way is better.
What is not so exhilarating is dealing with the right side of that curve – the late majority, who are not inclined to change even if the evidence suggests they should. These people usually need peer pressure, the fear of standing out in a bad way if they do not conform to the growing norm. And then there are the traditionalists, the holdouts who will not buckle even to peer pressure. Often they will only change when confronted with authority, such as the loss of credentials at their hospital or exclusion from contracts.
In the conflict-averse world of medicine, particularly in the ecosystem of delicate egos that exists at most academic medical centers, the right side of the curve is often addressed inconsistently and ineffectively. In my work at Partners, I have learned that doing my job means being willing to take on the right side of the curve. You might not have to do it right away, but you eventually have to do it.
For example, when we began pushing electronic medical record adoption in our network in 2003, only 9% of community primary care physicians and 2% of community specialists were using them. We began with carrots – that is, incentive dollars from our contracts. But once we felt that we were past "the tipping point," when more than half of the primary care physicians were using electronic records, we went to "sticks" – and told physicians that they would be out of our network by a certain date if they did not adopt. Using this approach, we were able to transform our network so that 100% of primary care physicians and specialists now use the electronic record. To reach that 100% level, we had to kick out about 160 physicians (from a total of about 6,000). They were angry, and we were sorry to see them go. But we had to confront the challenge of the right side of the curve.
About the Author(s)Thomas H. Lee is President, Partners Healthcare System
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