Healthcare: How to achieve innovation without getting stress ulcers!

Initially, read this: Innovation- Harvard Business Review Then come back.

Inventions are not innovations. Many organizations define innovation as novel technologies, processes, and business models. They may regard artificial intelligence, just-in-time supply chain, or bitcoin as innovations. These things, at least in their early phases, are more accurately called “inventions” rather than innovations. Inventions are important, but they only rise to the level of innovations when they are broadly adopted to transform behavior and functioning of users or organizations or even society as a whole. In other words, innovations are inventions that have successfully scaled.

Artificial intelligence and machine learning are the two buzzwords that have kept ringing for the latter half of the decade that just went by. Hospitals (or service providers) usually feel the “urge” to invent.

In one of my previous employments, the organization had its purpose labs with a dedicated animal house. The idea was great (which pushed me to get an idea about translational oncology). However, the organizational dynamics played its role. I interacted with various scientists, and it became apparent that few of them were doing commendable work. For example, one of them had worked on the migratory patterns of glioblastomas in rat models (elucidating a molecular detail). However, the brilliant work wasn’t translated into any definitive multiparametric imaging because it seemed to offer no immediate returns on investment. There are several other numerous examples but last heard, her lab was shuttered after funding dried up.

Should hospitals have their own “invention” pipeline? It appears that it would follow the classical “J-Curve” as inventiveness has nothing to do with the idea that would possibly scale up. As such, while the committees have a laudable end goal to fund science, the venture is risky because it offers no visibility in “returns on investment”.

It gets me to the next part- outcomes-based healthcare delivery (instead of volumes). (see below).

But inventing and innovating are two different skill sets. The Wright brothers invented airplanes and left it to others to innovate with the creation of airports and airlines. Jonas Salk didn’t patent the polio vaccine, enabling others to adopt public health and practice innovations to disseminate it. Inventions are everywhere, waiting for innovators to scale them, and your organization can play.

Organizations need not invent to innovate.

However, the last line brings an interesting conundrum. If the stated mission (or vision) is bringing about an impact on the global scale (for argument’s sake), should you have your own “in-house” labs/incubators” or “partner” with the extramural organizations to provide you with a steady pipeline?

There are no easy answers to it. Larger companies swallow smaller ones for their product pipeline. Either because it is innovative (with potential to scale) or represents an existential threat to them. Fortunately/unfortunately, healthcare services are resilient to these disruptive waves (due to massive investments in greenfield ventures). Finding the right fit with the extramural partners or organizations is usually a matter of good luck to have a shared vision to grow together. Unless the labs want to pursue a different agenda or the union gets mired in terms of royalty payments, for example.

External contractual work for pharmaceutical companies is primarily a “low-hanging fruit” that doesn’t move the needle, in terms of inventiveness or innovation. Compensation arrives for sequencing/standardizing or perhaps finding new patterns but offers no real recourse to patients.

Incremental innovations are not necessarily less impactful on the quality of care than radical ones. Incorporating thorough hand washing into clinicians’ routines — once considered an innovation — is the very definition of incremental. It doesn’t take a lot of extra time or cost very much. But its impact on cutting infection rates and saving lives is incalculable. If only every innovation had that kind of payoff.

Improvements in hospital processes appear radical but would help to shave off precious time leaving the professionals with a “higher-order-of-thinking”. Not everyone focuses on improving processes to minimize time on repetitive tasks.

A thousand small tweaks can transform a mediocre performance into a great one. When scholars study how organizations wind up dominating their industries or fields, they often find a pattern of continuous incremental innovation over a period of years. This type of innovation enables the organization to learn which changes are working and which are not and adjust their course accordingly.

I was reminded of yet another place of employment where it was incredibly difficult to fill up forms for onboarding. Simple digitization of processes would have been more fruitful for the employees, but they are stuck in a rut by doing the same thing repetitively. No wonder, it saw a high rate of burnout/attrition.

A good example is the 2009 U.S. government mandate to adopt electronic health records (EHRs). While the debate over this approach to radical innovation will probably rage for another decade, two facts are indisputable. First, the health care industry as a whole had not at that point made significant progress in adopting electronic records voluntarily and left to itself might still be relying on paper folders today. And second, it was a necessary change if the health care system were ever to reap the staggering potential benefits of digital information and networks.

Some providers embraced the innovation, planned for it, and reshaped their organizations to take advantage of it. Others had it thrust upon them, treated it as primarily a burden to be endured, and reshaped their organizations reactively, to the extent they reshaped them at all.  It’s no wonder that the results 10 years later are mixed. However, despite the amount of criticism directed toward EHRs, no one seriously suggests a return to paper.

Digital scribes is a good point here- while many practices are reporting a physician burnout, I doubt if those reports are taken seriously. Digitization has “potential benefits”, but it requires careful planning of inputs. Pre-filled forms, for example, by automating the repetitive tasks, can appear to “lessen the burden” of filling an empty page.

EHRs required thoughtful redesign of workflows and roles at every level of a provider organization, as well as leadership, monetary and staffing resources, strategies to mitigate risk, and (maybe most important) stamina. Implemented correctly, they had the power to change an organization’s political and cultural fabric, as access to data deepened its knowledge of itself, its patients, and the services it was providing.

I totally agree here. Most of the EHR’s are not geared for the proper user interface and interaction, but instead have endless rows/columns that make it a drab affair.

Revamping chaotic outpatient scheduling processes, for example, may require the boring and pedestrian focus on getting rid of stupid and wasteful work and confused accountability. It’s not going to win anyone an award for innovation, despite its dramatic potential impact on organizational performance and quality of life for staff and patients alike.

Whether we are innovating or just improving, the questions are the same: What do we need to do? What resources are required? Who will do it? How do we manage risks? And how will we know if we have been successful?

Process improvements are again fraught with several issues. How does it translate into “more revenues” by pushing towards “process improvements”? Appointment systems are still fraught with shortcomings. Not everyone gets to see the physician at the appointed time since delays are built in the process. A better way to handle it is to have a triage system- for example, out of the appointed patients, those with reports are usually more fraught with anxiety than patients who are on a long-term follow-up. A little insight in this would help to organize workflows better. It will not lead to more revenues but patient satisfaction. That translates into a more loyal set for those markets where competing for healthcare resources becomes a priority based on patient feedback.

Transforming health care delivery into a system that is more value-based (where pay is based on outcomes rather than the volume of services) and patient-centric will require a commitment to change, whether it’s radical innovation, incremental innovation, or simply trying to do better. The innovation journey will be more effective if we remember that organizations don’t need to invent to innovate, that a steady stream of incremental innovations can lead to significant gains, that radical innovations require careful management, and that innovation is the means, not the end.

This is the most instructive takeaway. (emphasis mine).

Outcomes-based approaches work best in a scenario where organizations are working on getting the same pool. Multi-disciplinary approach with rational billing for the treatment journey offers a better insight into anticipated costs. Of course, there will be some abuse built-in for those who are insured, but outcomes-based practise would lead to better delivery of care by emphasizing niche care. I call it “organ-based-oncology”, but it is difficult to put off due to entrenched interests in referral patterns.

Patient centricity would require rejig (and often rethinking) of the hospital processes to deliver efficiency and value-based care. Technology, luckily, is disrupting our old ways of thinking, and we need to be able to better adapt to changing times.