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School-based health centers offer disruptive innovation in an educational setting

By Jean Darling, PT, DPT

In business, a disruptive innovation is one that creates a new market and value network, and eventually disrupts an existing market and value network, displacing established products, market leading firms, or alliances.1

As many of you may know, the term was defined and first analyzed by the American scholar Clayton M. Christensen and his collaborators beginning in 1995, and has been called the most influential business idea of the early 21st century. How do we turn this business concept into social change? Clay Christensen reports that the United States spends more money per capita on health care than any other nation, and it offers some of the most sophisticated care in the world.2 Yet it lags behind many less affluent countries on basic health indicators. This pattern of aggressive spending and disappointing returns in the social sector isn’t limited to the United States, of course. Throughout the world, affluent nations, institutions, and individuals generously fund social services that fail to fully deliver on their promise.


Innovation may fall into one of two categories: sustaining or disruptive. Most product and service innovations are sustaining.2 They provide better quality or additional functionality for organizations’ most demanding customers. Some sustaining innovations are incremental improvements; others are breakthrough or “add-on” services or products. While exploring the various forms of disruptive innovation could fill an entire article or discussion, I want to put forth an idea that I believe could offer a uniquely disruptive opportunity for our profession. Perhaps similar to the innovation that began walk-in clinics, I would like to have our physical therapy profession explore providing care in some format at school-based health centers. This would be a method for investing in simpler products or services that are more affordable, far reaching, and engage a broad population base.

As some of you may already know, school-based health centers have been opening across the country as a new method of providing health care to potentially vulnerable populations and as a way for schools to control health care costs by keeping services in-house. In 2014, there were 2,315 school-based health centers across the country, marking a 20 percent increase since 2011, according to School-Based Health Alliance, an advocacy group based in Washington, D.C.3 The clinics appear to be especially prevalent in rural and low-income areas. These clinics, which began as an expansion of the overworked school nurse role, now include more primary care providers. More recently they have added vision screening, dental services, and mental health and social development issues. The centers often provide medical services that students wouldn’t receive otherwise, regardless of their insurance status, especially noticeable in the mental health field. Only a select few have expanded into physical therapy, and I believe this is an untapped market for our profession to offer our services.


Some schools are looking to bring health care in-house for their employees and families as another way to control their health care expenditures. Many districts are self-funded, similar to other industries, and they are looking for innovative ways to save dollars in an ever-changing school budget. Wellness and prevention have swept the nation, and who better to provide both these services to a school district than a physical therapist. In addition, we can offer injury management/screening and onsite rehabilitation to reduce lost work time for staff and create a difference in their bottom line. I believe this is an untapped market, and our profession should view school districts with the same philosophy we have approached industry. As an example, in Wisconsin a few school districts have opened their own Health & Wellness Centers, offering medical care on a walk-in basis and by appointment for more chronic conditions. These centers serve district employees, retirees, and their dependents, all of whom are covered by the district’s health insurance plans. This is an example of where we can make a difference and demonstrate our knowledge and the value of our profession, as well as contribute to cost savings for the district!


1 en.wikipedia.org/wiki/disruptive_innovation. Accessed August 2018.

2 Christensen CM, Baumann H, Ruggles R, Sadtler TM. Disruptive innovation for social change. Harvard Business Review, 2006.

3 www.modernhealthcare.com/section/articles?tagID=5768. Accessed August 2018.

Jean Darling, PT, DPT, is a PPS member and co-owner of Advanced Physical Therapy & Sports Medicine in Wisconsin. She can be reached at jdarling@advancedptsm.com.

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