Chapter 10
Creating a Roadmap 
for Change
Revisiting the Challenge of Industry Transition
As we have argued throughout this book, the healthcare
industry is clearly an industry in transition. Like other indus-
tries that have traveled this route before, healthcare faces
unprecedented change. However, unlike others, the assaults
are coming simultaneously from all four of the factors that
create transition in any industrysignicant changes in the
regulatory environment, a dynamic and rapidly changing com-
petitive landscape, shifts in technology, and changing market
expectations. In the face of this, all industry players must chal-
lenge fundamental assumptions about their business models,
how they go to market, the types of products and services
they offer, the nature of their customer base, and the compe-
tencies that will be critical to continued success.
Even under normal circumstances, managing through this
set of changes is hard. When all four forces descend at once,
successful navigation becomes that much harder. Not surpris-
ingly, there is enormous resistance to the needed changes. On
the face of it, the resistance makes sense. Organizations have
198 ◾  Healthcare at a Turning Point: A Roadmap for Change
built infrastructure to support their current business model,
and staff have been rewarded and promoted on the basis of
it. Investments in the model have generally paid off. To make
things harder, the current business model is still throwing off
cash. So the challenge comes down to building the new amid
uncertainty and general turbulence, while generating revenue
from the old.
Despite the warning signs that the road ahead is “out” and
a detour needs to be taken quickly, the momentum of the cur-
rent way of doing business is so intense that it’s going to be
hard for many to avoid going over the cliff.
We have needed healthcare reform in this country. For the
reasons we’ve outlined, the industry sectors didnt take needed
action to fix serious problems when they could. In the face of
the Patient Protection and Affordable Care Act (PPACA) they
have been forced to. And the dust hasn’t yet begun to settle.
As one industry executive recently put it,
PPACA was a bullet to my head. … Our entire indus-
try had opportunity after opportunity to fix the prob-
lems facing us—lack of customer responsiveness,
lack of transparency, lack of efficiency, lack of ser-
vice integration, lack of meaningful choice—and we
essentially chose to do nothing about it. Our future
survival depends on our ability to reinvent ourselves
… and some of us are unlikely to make it.
A sobering thought, and one we hear expressed often from
industry executives—behind closed doors. PPACA, regardless of
the view one has of the legislation, has created enormous dis-
ruption, and with it comes enormous opportunity as well as risk.
Unfortunately, we have proven ourselves capable of only sub-
optimal solutions to date. Without real clarity on the goal and an
overarching, integrated strategy for how to realize it, with lots of
choice in the process, we wont get the result we need. PPACA

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