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The Apple Revolution

From: The Hospitalist, November 2011

HM should look to Steve Jobs’ legacy as inspiration for health-system improvement

by Joseph Ming-Wah Li, MD, MPH, SFHM

Joseph Ming-Wah Li, MD, MPH, SFHM

Steve Jobs was right. Challenges create opportunity. What are the opportunities in hospital medicine today? Take a lesson from the iPhone: Give them what they need when they need it.

I was in a restaurant in Denver the night I saw the news on the TV. “Steve Jobs dead at the age of 56.” Was I surprised? Yes…and no. Everyone knew he was seriously ill; he acknowledged as much when he stepped down as Apple CEO. While not unexpected, his death was still surprising and an emotional jolt.

I quickly finished my meal and went back to my hotel room, where I turned on CNN. I sat back and watched Anderson Cooper talk about Jobs’ life and legacy. Apple co-founder Steve Wozniak was on the telephone with Cooper. Wozniak said when he heard the news, he felt numb, much like he did when he heard about the deaths of John Lennon or President Kennedy.

I felt the same way. I never knew Steve Jobs, but Steve Jobs knew me. He influenced my life in ways unimaginable.

A Revolutionary Persona

On the flight to Denver, I passed time watching a movie produced by Pixar, the movie studio he founded. When I landed, I used an app on my iPhone to find this restaurant, which was close to my hotel and had great reviews. I am typing this month’s column on my Macintosh laptop. How did I let someone I never knew get so close to me and have so much influence on my life?

This is Steve Jobs’ legacy. He did what others couldn’t do. He didn’t invent the personal computer, but he made one that was easy to use. He didn’t create animation, but he showed Hollywood how to create more intriguing movies faster and cheaper. (The smartest thing Disney did was to buy out Pixar before Pixar grew big enough to buy them.)

He revolutionized the music industry. Remember when Napster had the music industry on its heels? Recording labels were suing people and college kids were going to jail for downloading pirated songs. Seemed crazy to send kids off to jail for lifting a few songs, but it was happening. Then came the iPod and iTunes. Not only could I pay 99 cents for a song, I could carry my entire music library in my pocket. Duh … why didn’t I think of that? And he did it all while living with pancreatic neuroendocrine cancer!

One of the things I watched on CNN that evening was a segment from the commencement speech Jobs gave to Stanford University’s graduating class several years ago. He had just recovered from his surgery (visit http://news.stanford.edu/news/2005/june15/jobs-061505.html for the complete transcript). He described how his firing from Apple spurred creativity and resulted in innovation.

“Getting fired from Apple was the best thing that could have ever happened to me,” he said. “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.”

This made me think back to 1994, the year I graduated from medical school and about two years before Drs. Wachter and Goldman coined the term “hospitalist” in that fateful New England Journal of Medicine article.1 In 1994, I could not have imagined the iPhone; I could not have predicted the field of hospital medicine. Don't worry if you couldn’t, either. I really think that if this is how we define innovation, we have set the bar too high. Innovation does not have to be complicated. In fact, the greatest innovations are simple. Hand your iPhone to a five-year-old and they can figure it out. Can you do that with a PC?

Steve Jobs

Challenges Ahead, Ongoing

How does this apply to hospital medicine? These are challenging times for hospitalists. American healthcare costs too much, and some people are saying hospitalists are part of the problem. Hospitalists are discharging more patients than ever from our nation’s hospitals, and more patients than ever are finding themselves readmitted within 30 days. Quality and process improvement is the mantra in healthcare today, and too many hospitalists have little understanding of what is necessary to participate in quality and process improvement.

Steve Jobs got fired from the company he created. Could hospitalists be removed from the program they started? Jobs was right. Challenges create opportunity. What are the opportunities in HM today? Take a lesson from the iPhone: Give them what they need when they need it.

For example, why do so many hospitalist programs staff in-house only during daytime hours? Patients don’t become acutely ill only during the day. Most of us will be hospitalized at some point in our lives. Will there be a hospitalist to see you when you are short of breath or having chest pain? Hospitalists need to be in house 24 hours a day, seven days a week, providing care when patients need it. I know that we don’t have enough money to pay for this and we don’t have enough hospitalists to staff 24/7, but that is the innovation part. I can assure you that while the iPhone is easy for the end-user, an incredible amount of infrastructure had to be created in order to support that easy-to-use experience for the consumer. Jobs and Apple overcame hurdles to create the iPhone. It’s our job to overcome the hurdles to provide safe, timely, and high-value care for our patients.

Steve Jobs’ legacy is Apple.

What is your legacy?

A Call for Research

Most of you are aware that Jobs died from pancreatic neuroendocrine cancer. This is a relatively rare disease, which is in dire need of additional research. Patients with rare diseases find themselves in the difficult position of trying to understand why little is being done to help them.

I, unfortunately, know something about this, as someone very close to me has this disease. Research requires funding. One way to honor Jobs’ legacy is to support pancreatic neuroendocrine cancer research. One organization I have personally supported is the Caring for Carcinoid Foundation. This foundation has contributed millions of dollars toward carcinoid and neuroendocrine tumor research.

If you want to learn more about the Caring for Carcinoid Foundation, visit www.caringforcarcinoid.org.

Dr. Li is president of SHM.

Reference

  1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American healthcare system. N Engl J Med. 1996;335:514-517.

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