A Punk Rock Ethos of Disruption

It’s December 1, 1976, and the Sex Pistols are being interviewed on live television.

Appearing on the British Today show at the supper hour, the Pistols' frontman John Lydon (Johnny Rotten) responded to interviewer Bill Grundy’s command, “Say something outrageous,” by calling him a “dirty fucker” and a “fucking rotter.”

The newspapers put the Sex Pistols on the front page for a week with screaming headlines like “TV Fury Over Rock Cult Filth” and “Punk? Call It Filthy Lucre”. Members of Parliament denounced them.

“Anarchy in the U.K.” entered the charts at Number 43, but record company executives refused to handle it as EMI was fast buckling under the public pressure. The Pistols added to the outrage by refusing to apologize, and by doing long interviews in which they denounced the entrenched system of music ratings and sacred luminaries like Mick Jagger and Rod Stewart. They went on tour, traveling around the United Kingdom in a bus, arriving at gigs only to discover that they had been banned in the township. Out of twenty-one scheduled dates, the Sex Pistols played three.

So incendiary was their impact at the time that in their native England, the Houses of Parliament questioned whether they violated the Traitors and Treasons Act, a crime that carries the death penalty to this day. The Pistols would inspire the formation of numerous other groundbreaking groups, and Lydon would become the unlikely champion of a generation clamoring for change.

“No regrets,” proclaimed Malcolm McLaren, the Sex Pistols’ infamous manager, after the swearing-on-TV incident. “These lads … want a change of scene. What they did was quite genuine.” Here's the clip:

There are as many theories about why punk rock came to be as there are punk-rock progenitors, but like all good revolutions, this one was born out of deep discontent with the times. It was propelled by technical accessibility and entrepreneurship: it was simple and easy to pull off by pretty much anyone. In December 1976, the English fanzine Sideburns published a now-famous illustration of three chords, captioned "This is a chord, this is another, this is a third. Now form a band."

Punk was hardcore Zen, a completely different operating philosophy that undermined the integrity of the culture in which it was introduced. It altered what was meant by a 'new industry model', changing those deeply embedded habits of thought which give a system its sense of what is the natural order of things.

Or to frame it in terms of today's lexicon, punk was...innovative...disruptive....transformative. Nothing was sacred. You could lose yourself in a reactionary had-it-up-to-here fury while also fully savoring the rupture, the novelty of the moment as a cathartic split from convention and cliche.

Punk was a completely different wattage.

A Total Change in Context

Frost & Sullivan predicts the 'outcomes-based care' focus will scale and globalize dramatically, with at least 15 percent -- about $1.5 trillion -- of the $9 trillion healthcare economy worldwide tied to value-based models. Presumably, there will be an invisible hand doing the tying; left unsaid is whose invisible mind is guiding the invisible hand. (Maybe it's better to think of “value” itself as new market space to develop, where B2B strategy and sales will lead the way to above-average growth. Check out McKinsey on this here.) 

Critics say today's health market CEOs have proved unwilling or unable to shift their strategies to meet the demands of consumers accustomed to rapid, high-quality service in other industries. Writing in Modern Healthcare ("As Healthcare Changes, Systems Need to Broaden Search to Find Disruptive CEOs"), Harris Meyer describes the pressure on CEOs to adapt to a total change in context for strategy.

Incoming executive leadership, Meyer says, need a new frame of reference for how hospitals, pharmaceutical and medical device companies, and other delivery systems will be "transformed in the coming years into very different-looking organizations whose focus is on [new industry ecosystems] that keep patient populations healthy in the most cost-effective ways."

"With healthcare changing rapidly, hospital CEO positions turning over at a high rate, and baby boomer senior executives eyeing retirement, some hospitals and health systems realize their next leaders will need a different set of experiences and skills to successfully navigate that new world."

They're in need, it seems, of a Punk Rock vision, a radically different mindset that can navigate the transition and tension between entrenched and emerging modes of being.

The thing missing from the conventional perspective is new understanding: the pieces matter less than the whole, "things" are secondary to experiences. The new business value to extract from healthcare is not from the discrete use of applications or the latest cool tech pilot, but the way these components can meld together to interact and form a broader architecture for managing information.

Quoting CVS Health CEO Larry Merlo:

"[Industry] does not place enough of a focus on outcomes or managing the patient in a holistic way, and all of that leads to -- pick the adjective you want to use -- wasteful, avoidable, preventable spending that amounts to billions of dollars."

Read more of the January 1, 2019 interview with Merlo in the Richmond Times-Dispatch here: CVS got Aetna. Next up, reimagining health care

There are multiple billion-dollar business models and markets to develop based on improving outcomes and squeezing inefficiency from healthcare. (This week, Alphabet's Verily got $1 billion in a new funding round led by Silver Lake to execute its strategic focus on helping healthcare navigate the shift towards evidence generation and value-based reimbursement models.) The path to get there is to make technology so immersive that it disappears into the experience.

A New System of Markets

The next health economy solves for ‘market interoperability’ first, data interoperability second.

New market winners understand that “value” is created above and beyond a single organization — by a new system of markets intentionally designed to dissolve boundaries, produce coherence and deliver a stream of benefits over time. The economic models are positioned to serve (and sustain) 'continuous health engagement'. And if you buy into the logic that it's not just one market that improves outcomes, but many markets simultaneously and interactively, then advantage goes to those who are better at ‘system entrepreneurship’: the capability to re-conceptualize the premise of strategy itself.

At stake is a new category of growth and creative leadership.

Ultimately, health market fragmentation is a design problem. There are islands of features everywhere from too many vendors and too many markets wandering on the edges, pushing point solutions to small problems. The challenge is pulling it all together in a way that a whole system is born and becomes focused on generative value. The new data that flows from this new system, and then refined into specialized cognition, is the thing that generates new business value, supports population health and guarantees performance.

Data on purpose. You design for the analytics you want to capture.

Or to put it another way, the transformational remit for today's health market leaders is the ability to creatively explore and conceptualize a new territory, quickly assemble the intellectual viewpoint, and then design the new industry infrastructure -- the nervous system -- to own the space. Which is the role of “digital” in this story. It's value is expressed in the ability to dissolve boundaries, create new identities, remove friction and re-configure entire business systems, practically overnight.

Anger is an Energy

From the publisher's note to Anger is an Energy, John Lydon's autobiography:

"This autobiography is by John Lydon in his own words. Sometimes, the organization of those words does not conform to the traditional rules of grammar. In some cases, the reader will happen upon words not listed in the dictionary, or used in ways one might describe as "unorthodox." The publisher is aware of this -- they are not typos or misspellings we have missed; they are part of Mr. Lydon's unique "lingo" and, as such, have been given (mostly) free rein. As John might say, "Don't let riffles cause fraction."

We are now in the 50th year of the official US healthcare "crisis." For more than half a century, ballooning health care costs have been a source of concern, confusion, complexity and impending catastrophe to the American economy and employer operating margins when, on July 10, 1969, President Richard Nixon proclaimed, "We face a massive crisis in this area." Without prompt administrative and legislative action, he added at a special press briefing, "we will have a breakdown in our medical care system."

A Punk Rock solution breaks from the herd of independent minds passing as disruptive. It's about a shift in how to think, not in what to think. It's about using new words to think new thoughts.

Says Michael E. Porter, Harvard Business School and Co-Founder of the International Consortium of Health Outcomes Measurement (ICHOM) in teeing up #ICHOM2019 on May 2-3, 2019 in Rotterdam: "We are starting a transformation of what healthcare is, how we think about it, how we deliver it, how we measure it and the results we are actually achieving."

🤘

/ jgs

John G. Singer is Executive Director of Blue Spoon Consulting, a global leader in Strategy and Innovation at a System Level. Blue Spoon was the first to apply systems theory to solve complex market access and integration challenges in the pharmaceutical industry.

Originally published as “Healthcare Needs a Punk Rock Vision” on LinkedIn, January 3, 2019