John Kenagy

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John Kenagy, MD is a physician, executive, academic researcher and advisor. In addition to his clinical experience as a vascular surgeon, he has been Chief of Surgery, Chief of Staff and Regional Vice President for Business Development in a not-for-profit healthcare system.

His frustration with current methods was fueled by an injury – he suffered a broken neck in a fall from a tree. Critically injured, he discovered that his recovery depended on the efforts of dedicated individuals working in an unpredictable and often unresponsive system.

Searching for new answers, he became a Visiting Scholar at Harvard Business School. His initial research included developing disruptive innovation strategy for healthcare with Harvard Professor Clayton Christensen. That research lead to the first article published on disruptive innovation in healthcare in the Harvard Business Review article.

In addition, in collaboration with Don Berwick, MD, then CEO of the Institute for Healthcare Improvement and Harvard Professor Miles Shore, MD, he used the resources of Harvard Business School to research service quality in healthcare. The results of that research were published in the Journal of the American Medical Association and named Medical Management Article of the Year by the American College of Physician Executives.

Kenagy then collaborated with Harvard Business School Professors Steven Spear and H. Kent Bowen, who were working on understanding the underlying principles of the Toyota Production System (TPS) as something different than Lean. Upon seeing their initial results, Kenagy recognized that Toyota's purpose-driven, rule-based TPS was not just a manufacturing system but was also a unique way to manage very complex, dynamic, unpredictable work that could also apply to the complex world of healthcare.

He proposed that Spear and Bowen test their theory in healthcare. After apprenticing himself for two years to Toyota, Kenagy began adapting and customizing the TPS framework to the complex, dynamic, unpredictable world of US healthcare. The resulting methodology has come to be called Adaptive Design® because it focuses on cultivating adaptability in the daily work of an organization and its people “by design.”

Unlike Lean, Six Sigma and other project-based, process-reengineering methodologies, Adaptive Design is a self-sustaining, clinically intelligent system for designing, doing and improving complex work, both vertically and horizontally, within and across disciplines.

His other contributions have been widely recognized:

  • Clinical Professor of Surgery, University of Washington
  • Adjunct Professor of Pharmacy and Therapeutics, University of Pittsburgh
  • Guest Lecturer – American College of Surgeons Course on Leadership, Surgeons as Leaders
  • His best-selling book Designed to Adapt: Leading Healthcare in Challenging Times was named Healthcare Management Book of the Year by the American College of Healthcare Executives


  • Kenagy, John. “Designed to Adapt: Leading Healthcare in Challenging Times” Second River Healthcare Press, September 2009
  • Christensen, Clayton M; Bohmer, Richard; Kenagy, John. "Will Disruptive Innovations Cure Health Care?" Harvard Business Review, September 2000.
  • Kenagy J, and Spear S. “Deaconess-Glover Hospital A,” Harvard Business School Case 0-600–070. Boston, MA: Harvard Business School Publishing, Feb. 23, 2000.
  • Fisher, Daniel. “The Man Who Would Save Health Care.” Forbes Magazine, December 11, 2000 issue
  • Kenagy, Sundahl, Udall. "Delivering on the Promise: An Adaptive Approach to Information Technology in Healthcare"
  • Kenagy, Berwick, Shore. "Service Quality in Health Care." (Abstract and link to full text.) The Journal of the American Medical Association, 1999;281:661-665.

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