They Do That At Walmart?

Two years ago, I was having trouble finding time to get over to employee health for my flu shot.  One day I went to Walgreens for something, and realized I could get it right then and there, so I did.  I admit, I felt a little tainted, like I was aiding and abetting the enemy.  But it was quick, cheap, and convenient – hard to argue with that for a simple flu shot.

A recent article in JAMA talks about the “convenience revolution,” the innovative options for treatment of low-acuity conditions, including store kiosks and retail clinics, employer-based clinics, “clinic in a car,” and e-visits.  These are examples of the kinds of “disruptive innovations” than Clayton Christensen talked about in “The Innovator’s Prescription.”  It’s easy to be dismissive of these as a “doc-in-the-box,” but we need to be mindful of why they have been growing.  For many conditions, especially in pediatrics, it’s frankly difficult to demonstrate much of a difference between providers and settings in the quality domain of effectiveness.  Let’s face it, most of the time kids with simple illnesses are going to get better no matter what.  So from a consumer perspective, if effectiveness is the same, then the other domains, especially efficiency (i.e., cost), timeliness, and patient-centeredness (i.e., service) are going to be more important.  There is no difference in how well protected I was against the flu by my Walgreen’s shot than by one administered by MCW Employee Health.  But I didn’t have to make an appointment or walk across campus to get it – I could do it when I happened to need to go to the drug store to buy razor blades anyway.

OK, perhaps a flu shot doesn’t matter.  But even something as simple as a sore throat – will the provider at Target perform a strep test correctly?  (Answer: Probably – it’s really not that hard.)  Will she be able to recognize the rare case of epiglottitis or diphtheria? (Answer: Is that a serious question?)  And what happens if everyone starts going to retail clinics for routine things, and only come to their pediatrician or Children’s for things that are more complex?  Or worse, those “convenience clinics” start dealing with some of the more complex things, where there may be a difference in effectiveness or safety.

The answer to those questions is, we can’t let them.  I don’t mean we lobby for restrictions to prevent it – that probably won’t work.  I mean we have to outcompete them.  We must acknowledge the importance of those other domains – service, cost, timeliness – and provide a similar level of convenience.  What kind of “disruptive innovation” can you think of in your area.

And by the way, last year, employee health came to me.

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