Steve Jobs is widely lauded as the world's most innovative person and one of the world's greatest minds. His contributions to the technology world are unparalleled, and Apple currently is the world's most valuable company. Forbes ranked the company No. 1 on its list of World's Most Valuable Brands in May 2015, reporting a market cap of $741.8 billion. He was at the forefront of the technological revolution. As healthcare is in the middle of its own digital transformation, it begs the question, what would Mr. Jobs think of today's healthcare industry?
Though Mr. Jobs achieved monumental success, his path wasn't straight and narrow. He was kicked out of Apple and went on to launch a new company called NeXT in 1985. At NeXT, Mr. Jobs planned to create a computer focused on the education and scientific community, but it ended up failing, largely because it was priced out of reach of most of its target buyers.
NeXT decided to move away from hardware and focused on opening its software's operating system to run on other platforms.
Around this time, Sumit Nagpal, currently cofounder and CEO of healthcare outcomes company LumiraDx Care Solutions, had started a consulting company focused exclusively on the NeXT market to help companies learn how to use NeXT's technology. Mr. Nagpal started consulting for NeXT, working with Fortune 50 early adopters of the technology and selling NeXT's vision of quickly building critical business apps using its platform.
Here, Mr. Nagpal discusses working with Mr. Jobs, the biggest challenges and issues facing health IT and what Mr. Jobs might think of the state of healthcare today.
Note: Answers have been lightly edited for length and clarity.
Question: How closely were you working with Steve Jobs?
Sumit Nagpal: An example is over a project for a large Fortune 50 company in New Jersey to help them adopt NeXT technology. I remember a meeting back then, around the time Steve was about to launch a new product. We were in a client presentation together, and he leaned over and asked me what I thought about the new product which I had some experience with. We had a very candid conversation, and then a few hours later my phone exploded because the message had made its way back to California. My candid comments had been taken very seriously.
Q: What are some of the parallels between Steve Jobs' work with NeXT and Apple and the current healthcare landscape?
SN: What Apple struggled with in the early days of personal computing, and what innovators are struggling with today in healthcare IT — especially innovators targeting the enterprise — is virtually identical. As long as the buyer is not the actual end user, with an array of choices and the ability to switch solutions with relative ease, risk-averse enterprise and public sector procurements are dominated by "safe" decisions, leaving innovation for early adopters to try out. Unfortunately, these "safe" choices are rarely optimized by the rigors of an unencumbered free market — end users pay the price in cumbersome workflows, lost efficiency and even patient safety concerns as we are hearing more with the large scale adoption of EHRs in the U.S. market, for example. This happens when a few dominant suppliers are shielded from competitive market forces, especially from end user choice. Change happens slowly, with great expense and very incrementally.
One of the biggest strengths of the original Macintosh was that it took very little work to install and operate it. What that meant was the consultants who were recommending systems to large companies to adopt for workstations and desktops had very little incentive to recommend the Macintosh. The end users were frequently tangential to the purchase process, and buyers making decisions felt strongly dependent on consultants and system integrators who benefited from complexity — so not the Macintosh. As a result the Macintosh gained very little traction in the enterprise in those days.
In healthcare it's very similar. The IT systems that are purchased by healthcare organizations are frequently purchased with token involvement of end users. Patients are hardly ever considered or involved in the purchase of these systems. Doctors are more involved, but get to choose among a small set of "safe" options — not the crucible for disruptive innovation or transformation. The end result is — and this is not a shock to anybody — plenty of commentary from end users that they're using their system because they have to, but the systems get in the way and aren't helping them to do their jobs more efficiently.
To tie this back to Apple, what changed when Steve came back to Apple was one of the biggest changes that we saw in Apple's approach to the market. They became just passionately focused on consumer experience and selling directly to the end consumer. Frankly, so many of their products that had targeted the enterprise market essentially dropped away. The real magic behind the reversal in Apple's fortunes, which were declining after Steve had left, was that Steve refocused the company on fewer products but products that were directly purchased by the user. And the rest is history.
Q: What are some leadership lessons we can learn from Steve Jobs?
SN: I've learned directly from my experiences while working with NeXT, and then watching Steve's approach evolve over the years and its profound impact. I think Steve believed — and [Tesla CEO] Elon Musk explicitly says — that given that we're all working in a market full of very smart, creative people, the only difference between those who change the world and the ones who don't is how hard we work.
Number two would be the lessons learned from failure. If you don't succeed, try, try again. That's been a foundational building block of both of their successes. It's not that a much needed innovation that has not caught on is necessarily wrong or that the market doesn't need it — it's that we haven't yet solved an important challenge, or explained it well, or the right conditions haven't yet arisen for the idea to catch and succeed. But that doesn't mean you discard rational ideas and abandon market changing goals. That kind of dogged persistence, that incredible stubbornness, the ability to keep going, is really vital to the type of success Steve Jobs represents.
Q: What would Steve Jobs think of healthcare today? What do you think his criticism of healthcare design would be, especially on the IT usability side, since much of Apple's products are centered around and designed for consumer usability?
SN: Rather sadly, Steve got to experience our healthcare institutions and their challenges firsthand. He got to see firsthand just how disjointed the system is, despite the best efforts and incredible skill and dedication from care providers. From everything I've heard and read, he was appalled. Had he lived long enough, there's enough reason to believe that this is a problem he would have focused on. When you see the current wave of products coming out of Apple, you see increasing focus on individual health — the ability to track how you're doing, see your own values, connect and share that information with others, get the personalized help you need to become self-determining. All these features are aimed at putting the individual at the center and more in control of their care. The stuff happening with HealthKit and ResearchKit is so transformational for how participant data is collected and shared and made useful.
Apple is leading the way yet again with making these kinds of things far more democratic and far more engaging for individuals. One piece of magic Steve did every time with every product was taking huge amounts of complexity, abstracting it to its fundamentals and creating an experience that hid all the complexity from the end user. Care providers don't say that for any of the dominant health IT products out there.
Healthcare happens to be one of the last remaining holdouts to this kind of innovation where consumers are driving change, consumers being doctors, nurses, nurse practitioners, office managers, patients, their friends and families — the end users. It's a very hard nut to crack because for the foreseeable future, they are not the buyers.
Q: Did you see the new movie "Jobs"? What were your thoughts on it?
SN: It was the first Steve Jobs movie I didn't run out to see, and the reason I have not been tempted to go out and see it is that whatever I've read so far and have heard from people who also knew Steve is that this is not the Steve we knew. Also, it's just a fact that Steve evolved and grew as a person, as a human. He did so every day of his life. You can't judge who he became and his relationships and his contributions only by who he was in his 20s, having opened the doors of a giant industry that didn't exist before he showed up. Like most incredible leaders, he was a phenomenal learner, so the Steve who led Apple to this massive, incredible success, becoming the most valuable company on the planet, that Steve had grown far beyond what the original Steve had ever imagined.
I saw the brilliance first hand of Steve Jobs' creations and how passionate he felt about life and satisfying the end user. So the memories I have of Steve Jobs and his ability to make the complex seem so practical can never be depicted on a movie screen, but I hope to help drive his passion onward in healthcare in real-time results.
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