This guest blog is written by Jay Gerhart, Vice President of Consumer Strategy, Atrium Health. As part of Atrium Health’s Innovation Engine, Jay has a passion for applying the theories of Professor Christensen, human-centered design, and improv to drive consumer-focused innovation.

In November 2015, Dr. Jean Wright, Chief Innovation Officer of Atrium Health, took an action that fundamentally changed our Innovation Engine team. She sent two of our teammates, Will Behrmann and Ann Somers Hogg, to a week-long course at Harvard Business School. That course was “Building and Sustaining a Successful Enterprise” (BSSE), taught by Dr. Derek van Bever, a colleague of Professor Christensen’s. A day does not go by in which our team doesn’t discuss or apply a theory learned in BSSE. But for us, it’s not an academic exercise–it’s a critical element in our mission to accelerate the transformation of our healthcare system.

For instance, just two years before, Atrium Health invested in a prototyping space for a transformative primary care model, the Center for Proactive Health & Design. As part of an existing internal medicine practice, Proactive Health developed and tested a hypertension program that achieved significant improvements in patient outcomes at lower costs and on quicker timelines than traditional primary care. Based upon those results, system leadership approved the funding of a new Proactive Health practice in 2016, with dedicated space and staff.

At first, this sounds like a straightforward decision. Launch a new medical practice, build a facility, hire staff—business as usual. It wasn’t. Armed with the theories of Professor Christensen, our Innovation Engine team unloaded its new toolbox on Proactive Health after its launch in July 2017. We understood that we had a potential Disruptive Innovation in our hands, and it would be doomed unless we applied those theories with rigor and discipline. As such, we deployed an emergent strategy, engaged in business model innovation, and leveraged the Theory of Jobs to Be Done to launch Proactive Health in July 2017. We are still early in our test of this new model, and success is not guaranteed, but we’ve learned much from applying the theories and frameworks, and are convinced of their power.

You might ask how we knew that Proactive Health had the potential to be a Disruptive Innovation. According to the Christensen Institute, a Disruptive Innovation is not breakthrough technology to make a good product better. It’s an innovation that makes a product or service more accessible and affordable, often targeting “nonconsumers” who formerly could not afford or access it. In the case of Proactive Health, we’ve observed that its team-based model is effectively increasing convenience and access to care for patients. We attribute this in part to the Health Advocate (often called health coach by similar models such as Iora Health) who provides a total health experience to delight consumers, and provide outcomes aligned with a value-based healthcare business model (rather than traditional fee-for-service).

Putting the theories and frameworks into practice

When organizations execute a strategy that is similar to other strategies they have done before, or do regularly, they’re employing a deliberate strategy approach. This is a fairly linear, top-down approach, using established processes, within the established organizational structure, or core business. Since Proactive Health was early in the organization’s development of value-based primary care, unlike what Atrium Health had done before, we knew that an emergent strategy would be essential to learn what it would take to succeed. Emergent strategies are the cumulative effect of day-to-day, tactical decisions made by individuals on the front lines, solving immediate, unforeseen problems.

Proactive Health needed the freedom to respond to challenges as they arose. Accountability for the program was transferred from the traditional medical group structure, which would have compromised agility, to report to Dr. Wright. We did not take the full step of creating a completely new business unit with full financial separation from the core business. This is a key learning for us, as we’ve been inhibited from full execution of the business model.

However, the organizational separation did enable Proactive Health to innovate upon the traditional primary-care business model through different resources, processes and priorities. For example, Proactive Health had to hire differently, into different positions. We had to design new roles such as the Health Advocate and the Enrollment Coordinator. We had to hire “A” players within a short time span. And most importantly, we had to create and preserve the right culture by creating and exceptional onboarding and orientation process for new teammates. This would have been impossible to do in an agile fashion under the traditional organizational structure. By using an emergent approach, and transferring accountability outside of the traditional structure, the Innovation Engine was able to deploy dedicated resources to develop a new value-based business model with different priorities than the traditional model.

Finally, Proactive Health launched its new practice with a deep understanding of what its customers sought to accomplish when they subscribed to this new model. Trained by Bob Moesta of The ReWired Group, The Innovation Engine conducted extensive “Jobs to Be Done” interviews with patients who had been part of the earlier prototyping phase. Jobs Theory is a framework for better understanding consumer behavior. Patients didn’t “hire” Proactive Health for team-based primary care; they hired Proactive Health to make progress in a specific circumstance. By understanding the set of “jobs” that patients were hiring Proactive Health for, our team was able to integrate its operations in order to deliver the best possible experience to help patients achieve optimal health, as they define it. Early results are encouraging—Proactive Health has the highest satisfaction ratings of any Atrium Health primary care practice.

As previously mentioned, we are still in the testing phase of this new value-based primary care model. Even with these elegant theories, deploying a Disruptive Innovation as an incumbent healthcare system is not for the faint of heart. More challenges remain, and success is not assured. However, without the lenses and tools acquired by Will and Ann Somers back in 2015, it is clear that we would not be positioned as well as we are today to reimagine primary care at Atrium Health.

Jay gives special thanks to Ann Somers Hogg and Ben Tingey of the Innovation Engine for their meticulous work documenting their lessons learned through the development of Proactive Health. 


  • Christensen Institute
    Christensen Institute