Innovation, innovation everywhere

Look around you. When was the last time you recognize something innovative in healthcare?

The Harvard Business Review has an entire section of posts looking at innovation in healthcare.

The Agency for Healthcare Research and Quality (AHRQ) has an Innovations Exchange website where “innovators” can post their healthcare innovations and share with others (worth checking out).

There is even a Center for Medicare and Medicaid Innovation (CMMI).

According to West et al. Innovation can be defined as:

“Innovation can be defined as “the intentional introduction and application within a role, group, or organisation, of ideas, processes, products or procedures, new to the relevant unit of adoption, designed to significantly benefit the individual, the group, or wider society”.

The problem with innovation in healthcare is often not coming up with the innovation but rather figuring out a way to adopt and maintain the innovation. This is in part because innovation in and of itself is something different than what is currently seen. Innovation often disrupts the status quo (often a good thing in healthcare), but requires a shift in how organizations manages the new service (or innovation). To this end, innovations often are driven by grant dollars leading the innovation to cease once the grant dollars run out. This is often due to the failure of a system or a state to change policies supporting the innovation.

This brings us full circle to the ongoing need for disruption in healthcare. While we have Continuous Quality Improvement (CQI) in healthcare (a very good thing), why don’t we have something like Continuous Disruptive Innovation (CDI)? There are likely many reasons for this. Clay Christensen points out why we need disruption in healthcare:

“Make no mistake: the U.S. health care industry is in crisis. Prestigious teaching hospitals lose millions of dollars every year. Health care delivery is convoluted, expensive, and often deeply dissatisfying to consumers. Managed care, which evolved to address some of these problems, seems increasingly to contribute to them—and some of the best managed-care agencies are on the brink of insolvency. We believe that a whole host of disruptive innovations, small and large, could end the crisis—but only if the entrenched powers get out of the way and let market forces play out. If the natural process of disruption is allowed to proceed, we’ll be able to build a new system that’s characterized by lower costs, higher quality, and greater convenience than could ever be achieved under the old system.”

What innovations have you seen in healthcare? Have these innovations been adopted and maintained? It appears that without radical changes in the system (changing attitudes and culture), many of the most brilliant innovations will have trouble being around in the future.

Malcolm Gladwell really hits this point hard in his segment below on healthcare innovation (we have to deal with the “frame”):

Finally, see below for one “low cost” healthcare innovation in Peru:

Let’s work on innovation while simultaneously working on the “frame” that all the innovations are placed in.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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Posted in healthcare, Innovation
  • Mark

    I have demur to the Gladwell video. He captures the issue of innovation in healthcare clearly and concisely. In my mind the innovation I am seeing is less about individual items, tools, etc. It is more about the larger sense of revolution occurring and the sense of need to fix this system albeit small for now. The most important point that Gladwell makes and one that is near and dear to me is the reference to framing. How do we frame both the new innovations and the larger movement toward changing healthcare. That is where innovation becomes realized how we frame it.

  • Carmen

    When Gladwell speaks of a Cezanne-like model that the Japanese use, he’s really talking about a “skunkswork” effort where you work outside the norms and come up with solutions and develop them. If healthcare teams at every hospital were empowered to experiment, we’d create several pockets of innovation all at once.

    One idea that caught my eye was performed not too long ago in Africa as part of an HIV-treatment program, designed to boost patient adherence. The idea was to pair neighbors with HIV-positive patients to serve as medication monitors. These neighbors where equipped with smartphones, and hired/trained to act as medication monitors. They then visited their assigned patients everyday to dispense the medication and verify that the patients had taken their pills. This system dramatically boosted compliance rates, encouraged real community involvement, and created new jobs for the hired neighbors. As with a lot of our problems, healthcare or otherwise, when you establish a person-to-person connection, you can make a big difference.

  • Bruce Ramshaw

    Thank you for this message and the great videos. It has been frustrating trying to implement a disruptive model for academic medicine within established organizations (one attempt within a traditional academic medical center and one within a large community hospital). As explained by Clayton Christensen, the only way we were able to get things established was to do it ourselves outside of any established organization. In the Cesanne way of trial and error, we are getting close to starting a team-based, person-centered model where our divisions are defined not by physician specialty, but by problems and diseases that allow us to identify patient groups. Our teams define care processes and apply principles of clinical quality improvement to the most important process to be measured and improved- the patient’s entire cycle of care. A core component of the model is to include (and develop relationships with) the patient and family on the teams and engage them in the design and implementation of the care. Instead of trying to apply improvement to a part of the process (the emergency room wait time, the OR turnover time, etc.), we are looking at the patient’s cycle of care as a whole. By focusing on the whole, we hope to minimize the unintentional harm that is done by our current system structure which is designed and functions in fragmented parts.

  • Dr. April C. Foreman

    This is wonderful, Ben. The project I did in rural Kansas, involving text messages and mood tracking was listed in the ARHQ database. But it involved inexpensive technology that was far from “cutting edge.” The hardest part was *not* figuring it out. It was talking administration into letting me do it. The patients, myself, and the IT were ready to go. It was changing attitudes that was the barrier we had to overcome.

    I wonder, often, why “privacy” as a concept is so highly emphasized, and in such an emotional way, when it comes to these kinds of innovations? Similar to Gladwell, many of my patients often express disinterest in the “privacy” of their health information, but often find COST a barrier to getting the healthcare they need, and efficiency and safety to be similarly frustrating issues. My guess is that it is easier to track and punish healthcare providers and systems when it comes to privacy than when it comes to efficiency and cost. If healthcare providers and organizations were fined or sued for inefficiency or ineffectiveness, my guess is that the cultural climate for innovation would drastically change.

    We’ve made it too risky for healthcare providers to innovate, so it makes sense that very few of us persist, even when we are naturally driven to do so. My friend often says, “You get what you incentivize.” I think it is time to be honest with ourselves how our healthcare system rewards bureaucratic behavior, and punishes efficiency and effectiveness. I spent more time this week discussing HOW to document care to protect myself than I spent learning how to provider better care. I think that says something about the way our system treats providers, and how that has resulted in poorer care for patients. Patients may not get optimal care, but they are guaranteed to have reams of documentation (not great/useful documentation, just lots) that they probably can’t access.

    Imagine what doctors could do if they could just flip the documentation/innovation ratios. Imagine how the patient experience would be changed. Imagine what would happen if our doctors were rewarded for extra time/attention w/ pts., versus exhaustive documentation?

    Gladwell is right. We definitely have a “framing” problem.

  • Ann Becker-Schutte

    In mental health, the frame is everything. Some of the most effective work that I do with my patients is helping them change the frame of their experiences or their thoughts. I love seeing these new ideas, and it makes me wonder what castle we need to storm in order to shift the institutional frames.