Dear CSS Colleagues:
I previously sent you this message, and I include your comments and discussion on this article:
If you fancy yourself an entrepreneur or innovator, you should read the article by Rick Matsen and colleagues: “Assessing the Value to the Patient of New Technologies in Anatomical Shoulder Arthroplasty.” The authors conclude, in their metanalysis of 20 years of shoulder innovation, that no value has been created for patients.
I am also enclosing an opinion piece from Seth Leopold: “When Should We Adopt New Technology in our Practice.” Dr. Leopold expresses the opinion that new technology should not be adopted unless it clearly provides value.
First of all, I will disclose that I have not only a Conflict of Interest (COI) but a Conflict of Ego (COE). Many of our colleagues have both, even if they believe it to be otherwise. In the last case, we all believe we can re-engineer an approach or implant to improve patient outcomes or solve an existing unsolved problem; however, we fail to discount our inherent bias, and unfortunately, this is the lens through which we see these problems. Moreover, many of us have a true COI through the Royalty or Equity that such innovations promise. While I don’t 100% agree with the opinion and views of Dr. Matsen or Dr. Leopold, the author of the enclosed article, I can’t deny their point of view. That said, value is measured in many different ways and it is temporal. As Dr. Leopold notes, he did not adopt cross-linked polyethylene initially for his joint replacements and clearly the data supports this as a more durable outcome for joint replacement patients vs conventional polyethylene. Moreover, we can create value by reducing cost or improving outcomes. Then it becomes a tug-of-war to deliver that value to the patient when the hospital or the surgeon lose value in the process due to added cost or time. Finally, there are many examples of harmful effects of innovation. To name a few, remember Thermal Capsulorrhaphy for shoulder instability, or intraarticular pain pumps for postoperative pain control, or metal-on-metal hip replacement.
You should decide yourself what innovation means to you and how you create value for your patients. I know that I’ll always look for a better way to help my patients but keep these points in mind as I try to create value.
Both these articles and your comments are provided in this post.
Professor Robert Kaplan of Harvard Business School agreed to take on a discussion of Innovation and its relationship to value. Professor Kaplan presented a framework to think about this problem and led an interesting discussion in which he took questions from our group. He presented an HBS case study on this topic and I am including that here as well.
You can view our webinar on the following link to VuMedi here:
(Please note that you can sign up for VuMedi for free if you do not already have access). We welcome your input and please consider posting your thoughts directly in the chat box on Vumedi or on the Codman Shoulder Society WhatsApp chat group:
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“JP” Warner, MD