Healthcare Policy November 2, 2011

It’s All About Jobs

by Barry P Chaiken, MD

What would Steve do? Steve Jobs, the 20th century’s greatest and most successful innovator, engrained that mantra into the heads of every Apple employee. Only those staff members who thought through problems the way Jobs did would offer solutions that were acceptable to their boss. Jobs relied upon his own research and intuition, not focus groups, to guide him. When asked about the research that went into the design of the iPad, Jobs replied “None, it’s not the consumer’s job to know what they want.”

Although physicians employ tablets in many clinical settings, the tablet computer functions as a front end to existing EMR and other clinical applications. The tablet is not an innovation in and of itself but a tool to innovation, and few healthcare information technology (HIT) vendors actively leverage the “innovation” inherent in the tablet in their clinical applications.

What would Steve do?

Therefore, we must ask ourselves, what would Steve do in healthcare? First, Jobs would not be constrained by current practice. Like hockey, solutions come from skating to where the puck will be rather than where it is. In addition, he would consider all problems together in an effort to create an “ecosystem” that binds one product with another, the same way Apple now threads together the iPhone, iPad, and iMac with iTunes and iCloud. Jobs cherished style and ease of use, combining them with function and utility. Any Jobs-inspired healthcare application must be intuitive to use, support efficient workflow, and facilitate the delivery of safe, high-quality care to the patient.

Jobs’ vision of integrated, beneficial products does not exist in healthcare today. Clinical applications function within silos struggling to share data with each other, with many incapable of doing so between different releases of the same application. In spite of the government’s effort to develop and promote data exchange standards, health information exchanges struggle to achieve widespread use.

How do our clinical applications compare to the ease of use of an iPad? While most of our clinical applications require hours of training to achieve an even novice level of proficiency, the iPad does not require a users’ manual. The iPad works seamlessly with the iPhone and iMac, while few if any of our clinical applications work together at all. This requires the writing of expensive custom interfaces and the deployment of single-sign on to glue them together in a Rube Goldberg sort of way. This leads to inefficient workflows driven by unintuitive user interfaces that satisfy the needs of no one.

What should it look like

Applying Jobs’ thinking to healthcare requires us to envision what we want healthcare delivery to look like. This encompasses everything from wait times in physician offices to access to actionable medical knowledge by both patient and clinicians. The entire spectrum of delivering healthcare at every level must be looked at in its entirety, rather than as it is today within silos of points of care and episodic disease events.

Although only Jobs could create a vision for healthcare that accurately reflects his innovative genius, he inspires HIT leaders to apply his lessons. Although many areas require significant rework such as health information exchange, EMR user interfaces, and clinical decision support, Jobs’ impact on what consumers do and how they do it forms a starting point for innovation in healthcare.

Follow jobs

To follow Jobs, jobs, the tasks each healthcare worker is assigned and held accountable, must be radically changed. Assigned staff duties driven by tradition and linked to professional titles must give way to care delivered by the most prepared, competent, and least expensive resource.

In this new healthcare delivery world, physician activities become more challenging on a cognitive level as other routine tasks such as drug dose recall, use of best practice order sets, and drug-allergy checking become automated. Physician expertise is assigned to more important tasks including solving difficult diagnostic problems, devising customized patient treatment plans, and influencing patient adherence to chronic disease care regimens. HIT applications matched intelligently to devices facilitate the workflow and focus physicians on the important tasks that leverage their skills and experience.

Work for nurses and other healthcare professionals changes dramatically, too. More tasks, formerly done by physicians or healthcare specialists, are completed by these professionals guided by innovative HIT. Such HIT places the right professional, with the right knowledge, in the right process, utilizing the right workflow to deliver the best evidence-based care to the patient. Care delivery is focused on patients and their needs rather than the requirements of poorly designed applications deployed on hard to use platforms.

It is difficult to imagine what healthcare delivery would look like today if Jobs applied his genius and vision to care delivery rather than consumer goods. He, as much as anyone, turned a work tool—the computer—into a personal device. Would he have put together a team that meshed together all the needs and capabilities of healthcare workers, patients, providers, and payors into a harmonious unified ecosystem of applications and devices that facilitated the delivery of safe, high quality, and efficient healthcare? Considering the political, social, and economic impediments to achieving such a result, it is unlikely he would have succeeded. Even so, I have no doubt that if Jobs chose that path, patient care would be better due to the marvels he would have created for all of us to use.


  1. Chaiken, B. (2007). Revolutionary HIT: Cure for insanity. Patient Safety & Quality Healthcare, 4(6), 10-11.
  2. Markoff, J. (2011, October 5). Steven P. Jobs, 1955-2011; Redefined the digital age as the visionary of Apple. The New York Times.

Excerpts from “It’s All About Jobs” published in Patient Safety and Quality Healthcare

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