New hero: Phillip Newbold, CEO of Memorial Hospital in South Bend, IN, and the self-described “champion of innovation” at the hospital.  The hospital’s website is Quality of Life dot org, tremendous!

See previous posts on innovation centers here and here and here and here.

The Wall Street Journal brings news of the coolest innovation center yet:

The Innovation Café is an unusual teaching laboratory created by Philip A. Newbold, the veteran chief executive of this midsize community hospital and health system. He converted a failed delicatessen into a venue where staffers and outsiders can learn to craft new ideas.

[snip]

It was a tour of an innovation training center for Whirlpool staffers that sparked the establishment of his teaching lab. He persuaded his employer to become the first U.S. community hospital with an innovation research-and-development budget. The board committed up to 1% of annual revenue for innovation activities. That equals about $4 million a year. The hospital ended up spending just $195,000 in 2005, $622,000 in 2006 and $711,000 in 2007 on innovation efforts such as venture start-up costs and staff training. But the increase in related operating profit was as much as three times the annual expenditure.

Other cool stuff from Mr. Newbold: visits other innovative businesses, rewards staff for “good tries,” developed private label health drink through strategic partnership, worked with IDEO, developed a cryo tank, and shares his innovation ideas with others in the health care field.

Wal-Mart is opening its first Marketside store (yes, that Wal-Mart).  The concept is a 15,000 square foot (much, much smaller than the Super Wal-Mart) neighborhood market.  It’s meant to compete with Tesco’s Fresh & Easy entrance into the United States.

The Financial Times reports the new concept “marks a dramatic break with the branding of the rest of Wal-Mart’s more than 3,400 low-cost US stores.”

What does this have to do with health care?

The trend.  It’s smaller, manageable, intimate, community-like.  If a Super Wal-Mart is 1000+ bed quaternary hospital, then a Marketside neighborhood market is a … to be determined.

Some may think it’s a retail clinic, but the analogy doesn’t hold here.  The retail clinic depends on the foot traffic generated by the big box retailer or pharmacy.  It’s not a specialty hospital either, not enough product offerings.  Most likely it’s a health delivery concept that hasn’t reached the masses yet, like the medical home or micro practice.

Regardless of what it actually is, the concept of neighborhood health care delivery is much more desireable than the mass production of a primary care clinic attached to a super hospital.

Jen McCabe Gorman passed along a link to a video via Twitter Tuesday.  It’s a Modern Healthcare highlight reel of the Rocky Mountain Roundtable 2008.  The theme of the short footage is generally about bettering wellness prevention and chronic disease management.

Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group, emphasized community solutions, especially community-based health centers for all patients.

Dr. Tuckson’s talk focused on a four-step approach to improving prevention efforts and disease management:

1. Better leadership

2. Better strategic planning

3. Support research

4. Integrate prevention into clinical care through IT

All good points.  However, his quote about step two is bothersome.  Dr. Tuckson said, “We gotta get better strategic planning, we play around with prevention. ‘I heard a good idea the other day, let’s try that.’  That’s foolishness.  We need data, information that’s locally specific that says ‘here are the problems in our zip code and here are things we need to get at.’”

If trying new ideas is foolishness, fools are what we should aspire to be.

Granted, planning around prevention would improve through locally gathered data.  It would tell us a community’s greatest needs and then we would apply proven methods to address them.  That’s fantastic.  And some day it may work like that.

But varying needs will require solutions of many different feathers.  How do we find such solutions?  When researchers, doctors, public health officials, citizens, patients, etc. say, “I heard a good idea the other day, let’s try that.”

Tom Peters:

If Randomness Rules then your only defense is the so-called “law of large numbers”—that is, success follows from tryin’ enough stuff so that the odds of doin’ something right tilt your way; in my speeches I declare that the only thing I’ve truly learned “for sure” in the last 40 years is “Try more stuff than the other guy”—there is no poetic license here, I mean it.

You have to try stuff to find winners.

It’s wonderful to hear an executive from a private insurer pushing these ideas.  But throwing out the engine (good ideas) that will create innovative solutions to solve our oppressing health care issues is unwise.

Dr. Richard Reece on vertical vs. lateral health care thinkers (via Kevin MD):

Vertical thinkers dig deeper and deeper holes across the health care landscape. At the bottom of each hole, you will find a world class expert. The only problem is the various vertical holes don’t connect. One specialist may not know what the other specialist is doing and may have no means of communicating with him/her colleagues or hospitals.

The lateral thinker, on other hand, roams the countryside looking for connections, seeking ways to put things together into an integrated whole, searching for a system blending relationships and eliminating care gaps, and hunting for self-organizing information platforms and disruptive innovations that lower costs and that work outside traditional specialty silos.

Read his very interesting (and spot-on) post.  It’s amazing how many of our problems we could solve with a proper focus on primary care.

Another story of a frustrated primary care physician forced to experiment with the trials and tribulations of going solo.

This doctor’s decision was driven, in part, by a sabbatical in Sweden.  Imagine these requirements in American medicine:

The Swedish doctors were equally worried about his American ways. The clinic chief swiftly laid down the rules. Oldenburg was to take a half-hour morning coffee break, like everyone else, and then a lunch break from noon to 1 p.m. and another half-hour afternoon coffee break. During these breaks, he was to socialize with his co-workers, including lab and cleaning staff, and there was to be no shop talk.

I know, I can’t either.

A terrific article in The Boston Globe over the weekend on health care as a campaign issue:

Healthcare is the sharp end of the stick of nearly every issue in the presidential campaign. And it has been for almost two decades.

Much of the health care debate focuses on the uninsured.  But increasingly the insured are having issues as well:

But what of the people who are insured, the ones who are trying to navigate through the red tape and the bureaucracy, the ones who fill out the forms and check all the boxes and scope out which providers are covered under which plans, the people whom the healthcare wonks call “the worried well”? For many of them, healthcare also means gasoline as well as pills, a T schedule as well as a prescription.

Widespread transformation efforts will begin when the majority of people in this country begin to realize that their health care system is on shaky ground.  Until then it’s a macro problem affecting everyone else.

The need for connection in health care (via Ted Eytan, MD):

In recent years, I had thought it would be nice — but not essential — to dash off an e-mail to my physician if I had a question about a minor medical condition like a sore throat.

Escalate the medical condition — whether it’s an emergency or chronic care — and you begin understand why it becomes important for the many pieces of the unconnected medical community to get better connected.

The scariness of connection in health care (via Noah Brier):

Strike two came when I was waiting for the doctor in the examination room. The nurse first came in and logged into the GE medical history software (the actual machine was already logged in, didn’t check to see if it was logged in as administrator but I bet you anything it was/is). Then she left the room. Left the room with the software that contained every medical record of probably every Beth Israel patient logged in. At this point I was a little freaked out, but was happy to see that at least it timed out after 5 minutes of inactivity and logged the nurse out. Oh that and the computer in the room was totally unlocked, I had full physical access to the machine for a good 15 minutes totally unattended. I could have done anything to that machine.

Private health information slips out easily enough when people are careful, let alone when privacy is blatantly ignored.  Connectivity is a key to health care transformation, but we need to make data secure all-of-the-time (read: every millisecond of every second) (and more HIPPA-like policies are not the answer).

Fries at the bottom of the bag: Speaking of The Barbarians, they’re responsible for the branding of Hello Health, which launched this week (check this out, talk about accomplishing a task).  Good luck to Jay and company.  Also, Likemind is Friday morning, so if you’re up early enough go check it out.

Taken in sum, our health care system is one big mess.

A closer look reveals a series of problems that together create it.

Looking microscopically we find the root causes of those problems.

These microscopic problems are only tiny in view of the big mess.  Microscopic problems are where individuals, small teams, and organizations can have significant impact on positive health care transformation.

It’s the sheer power of crowds.  A lot of people working on a lot of problems create a lot of solutions.

Easier said than done.  That’s why we need an agenda.  That’s why we give rewards for demonstrating success.

The New York Times reported on such an idea.  InnoCentive is an open source solution finder.  The platform brings together seekers and solvers.  Seekers post problems.  Solvers solve them for a cash prize.

From the article:

That specificity is crucial to InnoCentive’s operation, people who have studied the company say. “If you say, ‘find me a cure for cancer’ it may not work,” Dr. Lakhani said. But if problems can be “decomposed” into what he called modular questions, like “find me a biomarker for this condition, these questions may be more tractable.”

InnoCentive has a global health category.  One seeker has broadly asked for “improvements to the United States health care system.”  That won’t work.

A dedicated platform should be created that focuses on specific improvements to the health care system.  Strategies to increase care coordination.  Communication improvements on medication directions.  Measures to better the process of medication reconciliation.

The list is endless.  But taken together, the power of the solutions would make a significant positive impact.

Collaborative networks created to improve care delivery are growing.

Here is the most recent example from Fierce Healthcare (and another example of “getting it“):

A group of nineteen New England hospitals have joined together in a network allowing them to share information about clinical practices and boost their quality improvement efforts. The hospitals are starting by focusing on preventing and reducing the incidence of pressure ulcers. The hospitals will share this information through a “Rapid Adoption Network” sponsored by VHA Inc. The hospitals will be using VHA’s clinical blueprint to mount their pressure ulcer reduction efforts.

Collaboration!

We seek tax advice from accountants. We seek financial advice from financial planners. We seek health care advice from…well, doctors.

At least that’s the way it should be. But an overburdened system with underfunding in important high-advice areas like primary care, combined with misplaced financial incentives, make a physician’s time an especially scarce resource.

This usually means short visits with a provider for patients who are passive during appointments.

The internet, of course, is changing all of this through the emergence of Health 2.0.

We now can complete our tax returns online. We can invest using online services. Health care, however, has been slower to adapt. It still lacks the “killer-app” to make the internet truly industry altering.

The complexities of health care delivery are the reason for this slow adaptation—which is good. It allows for the opportunity to do it right, something especially important in this industry.

There are vasts amounts of information available on everything medicine. But it can be daunting for a patient not familiar with the intricacies of the industry. That should be okay, because a patient can search for information, collect and gather, and show up to an appointment armed with questions for a physician.

The breakdown in this Xanadu comes at the appointment. Physicians just don’t have the time to spend 30+ minutes with each patient. Fifteen minutes is pushing it.

But patients want to be informed. Read this post at Health Management Rx for an enlightening example.  Jen has written about the “middle eighty,” the constituency of patients in the middle.  The theory, adapted from sales, goes something like this: ten percent of patients are super-involved in their health care, ten percent of patients are completely passive, and the middle eighty percent is awaiting online tools to help them become more involved, but only after those tools have proved their value.

Targeting the “middle eighty” is where health care online will transform the industry.

The Associated Press wrote last week about a new service cropping up in health care to serve the “middle eighty,” albeit primarily offline.

In the vein of tax and financial advisory, health care advisers are beginning to solve patients’ health care headaches like finding a doctor and negotiating payment.  Organizations have been the primary purchasers of services thus far, mostly in an attempt to lower their health care coverage burden.

The recent trends in health care, including reduced employer support of health insurance and Medicare complexities, have forced the burden of managing health upon the “middle eighty.”  They’re being forced to become proactive in their health decisions.  And they’re looking for help.

The current service offering by these health care advisers is just a start. Once this industry moves to the online world with all that it has to offer–content, community, commerce and advisory to help a patient make sense of it all (coherence)–will it truly be industry altering.  Jen et al. call it Health 4.0. I call it health care transformed.