Disruptive Innovation to Improve Care

Dec 22, 2014, 2:58 PM, Posted by Rebekah Gee

Pooja Mehta, MD, is a generalist obstetrician/gynecologist and a second-year Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, with support from the Department of Veterans Affairs. Rebekah Gee, MD, MHS, is Medicaid Medical Director for the state of Louisiana, an assistant professor of health policy and management, and obstetrics and gynecology at Louisiana State University and an alumna of the RWJF Clinical Scholars program.*

Pooja Mehta

The theory of disruptive innovation seeks to explain how complicated, expensive systems may eventually be replaced by simpler, more affordable solutions, driven by new entrants into a market who “disrupt” an older, less efficient, and less accessible order.

In the new issue of Current Opinion in Obstetrics and Gynecology, we track the history of the RWJF Clinical Scholars program (CSP) in the field of obstetrics and gynecology, and offer a curated selection of pieces that suggest that our discipline—now peppered with experts in health services research and health policy trained through the CSP—could be teetering at the precipice of an era of such disruptive innovation.  

Highlighting the work of nine current and past scholars, among more than 40 Clinical Scholars working in the field of obstetrics and gynecology, this journal issue covers a range of cutting-edge concepts currently being developed and employed to transform our field from the inside out.

Nathaniel DeNicola, MD, (‘11) discusses the potential uses of social media to disseminate and advance new findings and recommendations to broader audiences. Laurie Zephyrin, MD, MBA, (’03) illuminates how efforts to integrate systems, create interdisciplinary initiatives, and how research-clinical partnerships have allowed for rapid organizational and cultural change and have advanced reproductive health care in the Veterans Affairs system.

Elizabeth Krans, MD, (‘09) writes about ways in which new public funding is allowing for disruptive innovation in the delivery of prenatal care—for example, through dissemination of the highly decentralized, patient-driven Centering Pregnancy model. Working from within a city health department, Erin Saleeby, MD, (‘10) writes about how participatory approaches to public health governance can engage community and clinician leaders in the process of redesigning reproductive care and transforming outcomes.

Rebekah Gee

Brownsyne Tucker Edmonds, MD, MS, MPH, (‘09) reviews academic research on shared decision-making and patient-centeredness, highlighting areas where the literature leads us to no clear ‘right answer’ and where patient voices could therefore be easily heard.

Finally, Lisa Harris, MD, PhD, (‘98) discusses the importance of bringing historical context and the construct of “reproductive justice”—a term used by women-of-color advocacy groups around the country but largely ignored in obstetrics, gynecology, and family planning literature and leadership—into contemporary debates in our field. She specifically examines the debate over abandoning Medicaid restrictions on informed consent for postpartum tubal sterilization, put into place long ago due to a history of forced sterilization in low-income and minority populations in our country.  

Speaking from our personal perspectives, the opportunity to contribute to this issue allowed us to do exactly what the CSP has allowed us to do for the last 18 months—step outside of the silo of our clinical training, make connections across disciplines and conversations, and try and position the daily challenges and limitations of clinical obstetrics and gynecology in a broader context.

For Pooja Mehta, reviewing recent literature on maternal and reproductive health disparities was a sobering reminder that despite significant advances in reproductive science and insurance coverage, disparities in perinatal and unintended pregnancy outcome by race and income are worsening.

The Affordable Care Act provides some new resources and opportunities to address these issues of equity in care, but in isolation, it will likely prove inadequate to bring about the kind of participatory, community-engaged change needed to address the social and neighborhood determinants that appear to be fueling continued health and health care disparities. New efforts to understand the dimensions of persistent disparities must acknowledge poverty and identity along lines of sexual orientation, gender identity, legal status, and geography as well as race.

In the closing piece for this valuable issue, two other current clinical scholars, Michelle Moniz, MD, (‘13) and Elizabeth Patton, MD, (‘13) write with Rebekah Gee about the impact and legacy of the CSP on health services research in obstetrics and gynecology. Indeed, in an era of fresh legislative opportunities and barriers, shifting payment models, new technology, care innovation, and pressing priorities for historically marginalized populations, the need for clinician-researchers trained in health policy, community-based participatory research, and health services research has never been greater.  We hope that this collection can be seen as a call to action to those in our field to embrace new vision and create new opportunity for the interdisciplinary training and thoughtful consideration of pressing problems in health care fostered by the Robert Wood Johnson Foundation Clinical Scholars program.

*Mehta has an interest in public policy and the use of community-based participatory approaches to address disparities and gaps in safety net care. Gee has served as chair or co-chair of several national committees on maternity quality and prematurity reduction for CMS, HRSA and ACOG. She is the health policy resident expert for the journal Obstetrics and Gynecology and serves on the Institute of Medicine (IOM) Board of Health Care Services.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.