MyRapidMD is a cell phone service that allows first responders access to all of your important medical information in an emergency situation.  It seems like a great idea.  Here’s an article all about the service at the Los Angeles Times.

But the service is plagued by a problem common amongst health care innovation: slow adoption.

This is what’s holding MyRapidMD back according to the LAT: “The company has to persuade first responders across the country to check cellphones as a matter of policy.”

EMRs.  Checklists.  Innovation culture.  All plagued by slow adoption for various reasons.

An oft-used sports analogy has athletes, coaches, and reporters speaking of “getting over the hump,” a moment when the worst is over and success is imminent.

It’s not too simplistic to reduce the problems of health care innovation to slow adoption—whether it’s steep implementation costs, over regulation, or the organization’s culture (etc.).

The new idea isn’t the tough part of the process.  Getting over the hump is the true obstacle.

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.

The environment matters.  Innovation centers are the new “to do” in health care (thankfully!).

Combine the two for this: an innovation center to improve the nursing work environment.  From the Kansas City Star:

McEniry said nurses working in hospitals and long-term care facilities would be invited to present ideas on improving their work environments to management teams. Hospital or facility executives then would submit proposals to the center.

Nurses whose ideas were selected would get training to make changes happen, and their institutions would get financing, she said.

The center is not a brick-and-mortar project, but rather a “regional think tank for innovative ideas and implementation strategies, all focused on improving patient outcomes for the most vulnerable patients,” McEniry said.

Are generational differences in the workplace becoming a problem?

Steve Baker (writer at Business Week) at Blogspotting posted responses to such a question.  It’s an interesting thought worth further exploration.  Very interesting thoughts from the Twittersphere.

The tweets uncovered a gem of a story, too.  A gem that could provide a model for health care delivery innovation exploration.

Nick Eaton and seven of his young colleagues at the Spokane Spokesman-Review have been given the task by their editor (Steve) to “reinvent how a newspaper functions.”

We are charged to take a blank sheet of paper and come up with a way to make the Spokesman newsroom efficient while completing all if its objectives. The eight of us are meeting every day, often for several hours at a time, to work through this process.

A few guidelines and limitations have been laid out, but their remarkable task is fundamentally unpolluted.

Here’s the gist:

Our goal, as I understand it, is to come to Steve with a report by 5 p.m. July 10. He may or may not eventually implement our recommendations (we can have many), but he has promised to take them seriously.

Lots of work.  Lots of ideas I’m sure.  Very, very intriguing approach.

Interesting dialog:

There is skepticism and fear in the newsroom, of course. Many veteran Spokesman employees don’t like that Steve has selected eight young journalists and put some responsibility of the future of the newspaper into our hands. We don’t have the experience, they say. Steve sees it the opposite: We don’t have a stake in how newspapers have operated for 150 years, we don’t have a stake in who is in what editor position, we don’t really even have a stake in how the newsroom is currently structured.

Could a similar approach be used in health care?  Yes.  Could it be useful and productive and spark needed delivery innovation?  Yes.  It seems a perfect model for a hospital innovation center.

Tom Peters summarizes a Wall Street Journal article saying “[t]here are, more or less, two flavors of companies”:

The first sort, focused on avoiding downsides, treats customers “only as data,” “manages risk through analysis,” “places big bets, slowly,” and frequently fails in new situations; alas, its rigidity and fearfulness increases through time in a vicious circle.

The second sort sees life as a “journey of learning.” It treats customers “as people”—and constantly seeks new input through direct contact with those customers. The Type Two group “places small bets, quickly” and manages risk through hustle and an abiding bias for test-try-adjust-action. It is relatively more successful in novel situations—which in turn creates a virtuous circle through which a “growth mindset” becomes the raison d’être of the firm itself.

My struggle: rationalizing why any health care organization, given the choice, would choose the former.  And my best reckoning indicates it most definitely is a choice.

It’s a brave new world requiring innovation, innovation, innovation (psst…innovation goes beyond new medical technology, new pharmaceuticals, and electronic medical record keeping).

Innovation is a continuous learning process that necessitates failure.  The key, however, is how the organization reacts to that failure.  Is it punished?  Or applauded and used as a tool for learning?  The answer to that question goes a long way to revealing the ideals of the organization.

Money quote from the article (article summarizes research by Sean Carr, Drs. Jeanne Liedtka, Robert Rosen, and Robert Wiltbank):

Indeed, interviews with the growth leaders revealed little frustration about the corporate hierarchy. Instead, they were experts at avoiding corporate interference as they executed their initiatives. They found supportive bosses who provided cover as they skirted restrictive budgeting processes, purchasing policies and hiring procedures.

The managers tended to ask for forgiveness afterward instead of permission before.

Aha! Rogue bandits get it done! Solution: people.  Put the people in place to make the organization willing to endeavor upon a “journey of learning.”

Lots of cool stuff going on at SSM St. Clare Health Center.

Namely, question asking:

Building from the ground up, SSM officials sought to streamline the health care delivery process through a facility that maximizes patient and practitioner efficiency. They started by turning inward, scrutinizing processes like outpatient admissions and emergency department procedures and soliciting opinions from staff, physicians and patients.

“It’s asking each one of us who deliver health care in today’s current state to really broaden our horizons, challenge the way we do things, ask ‘why’ a million times and then figure out what’s the right way,” said Brobst, a clinical director at St. Joseph.

YES!

And a commitment to delivery innovation:

Brobst oversees a unique 22-bed medical and surgical pilot unit that mimics conditions at the soon-to-open St. Clare. Housed in a medical office building connected to St. Joseph, the pilot unit allows nurses and physicians to implement new procedures and processes in real-world conditions.

The health system also spent more than $110,000 on a full-scale mock-up of a patient’s room at the new hospital. More than 150 St. Joseph employees have walked through the prototype in the last two years, providing feedback that resulted in changes ranging from the creation of individual nurse alcoves outside each room to wall-length safety bars leading from the bed to the bathroom.

YES!

Forward thinking hospitals. It’s cool to see good ideas in action.

Comarow on Quality has a post titled “What Medicine Can Learn from Business.” Waiting rooms (in which patients incur long waits) have long been a part of what we do.  But new perspecitives bring new insight. Mr. Comarow shares a story of Virginia Mason’s implementation of the Toyota Production System:

During the visit, a team led by Virginia Mason’s chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.

“Who waits there?” the sensei asked.

“Patients,” said the chief of medicine.

“What are they waiting for?”

“The doctor.”

The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.

“You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?” He paused and let the question hang in the air. “Aren’t you ashamed?”

The discoveries just keep getting better. First, this place earlier in the week. And now this press release from Allina in Minnesota:

Allina Hospitals & Clinics today announced it is creating a new, $100 million Center for Health Care Innovation to support innovations in both clinical and population health research that can be translated to improved health for patients and the wider community.

Areas of focus for the new Center include:

• new models of care and coverage for populations currently underserved
• investment in innovative community health initiatives
• developing new approaches to care and disseminating that knowledge
• supporting and expanding clinical research throughout Allina to improve patient care.

Not only is Allina making a concerted (and concentrated) effort at health care innovation, they are also working on improving the health of the communities they serve—a public health role that hospitals should be pursuing.

More on innovation:

To examine the potential for change, BusinessWeek has joined with the Chicago-based innovation consulting firm Doblin (a member of consultancy Monitor Group). Larry Keeley, co-founder and president of Doblin, has pioneered a tool, Innovation Portraits, that reveals patterns of innovation in a specific industry. Of the many possibilities, we examine eight that are fermenting swiftly and hold high promise for transforming health care. They were chosen because of their intensity, measured by the number of innovations in a specific area, and their importance, determined by the impact the innovations could have on the practice of medicine.

The eight ideas all have something to do with delivery.  Although none of the ideas are new, few have been implemented well—or at all.  Opportunities abound.

Here is what is awful: rejecting retail health care because “a patient shouldn’t purchase health care at the same place they buy groceries/supplies/incidentals as the quality can’t be as good” or rejecting direct practice because “there is no way medical care can be delivered over the internet” or rejecting medical tourism because “there is no way that a consequential number of Americans will ever want to receive care overseas.”

Rejection because “it’s something new” is awful.

For whatever reason (precedent mostly), the health care industry is averse to new ways of doing things. If a new way of performing a task is accepted, it is definitely not without significant debate—and even then it’s not implemented everywhere.

We need a lot of things to happen to get us out of our health care mess. In traditional health care organizations, innovation needs to start at finding new and better ways to deliver care.

Why do we have such an aversion to innovation in health care?  And how do we go about changing that?

Here are some thoughts and possibilities (feel to add/subtract as you feel necessary, but only if your argument sounds nothing like the first paragraph of this post):

1. Let your patients participate in design. Really, ask them what they want. Ask them to design around their needs. As Max Chafkin in this INC. article writes, “The companies that win will be the ones that listen.” What does that mean? Focus groups. Interviews. Questionnaires. “Overhearing” conversations in the hallways or in the cafeteria. Blog. Twitter. Facebook. It sounds crazy, but “user innovation” is possible. From the same article:

This idea goes against a basic principle that has been taught in business schools since the invention of mass production: Employees make stuff, and customers buy it. But this notion seems anachronistic in a marketplace of ever-narrowing niches and nearly unlimited consumer choices. Meanwhile, a generation of so-called Web 2.0 companies has succeeded by encouraging customers to contribute to, and in some cases create, the product being sold. Not only do we have instantaneous access to countless television programs though video websites, but anyone with a YouTube account and a digital camera can create a show of his or her own. Professionally edited, dead-tree newspapers are besieged by digital news sites that are produced and edited by their readers. The 240-year-old Encyclopaedia Britannica finds itself eclipsed — at least in terms of readership — by Wikipedia.com, which pays its writers nothing and requires that they possess no expertise at all.

2. Create a department that !only! pursues delivery innovations. Kaiser Permanente’s Sidney R. Garfield Innovation Center “is a living laboratory where ideas are tested and solutions are developed in a hands-on, mocked-up clinical environment. Many aspects of delivering healthcare can be innovated and examined at the Center using real-world scenarios and activities, such as simulations, technology testing, prototyping, product evaluations, and training.”

It’s important to have a centralized figure collecting ideas and making the necessary connections that turn an invention into innovation. Ram Charan says in a Fast Company interview:

Let me explain some simple things. First, as Thomas Edison said, an idea is called invention. Converting an idea into revenues and profits or something a customer uses is innovation. Today, in the Internet society, you can buy ideas. You can have ideas flow to you from outside your department and outside your company. Innovation is selecting an idea and converting it to the production of a product, service, or new business model that creates growth and profit. The conversion of an idea for most companies, if not all, requires more than one person to make it happen. And that is why it is a social process.

And sums up his thoughts like this:

Necessity is the mother of invention. Those companies that are not getting top line growth organically, they are absolutely pressed to figure out how to create these collaborative changes for innovation. This is the era of the renaissance of innovation. If you don’t do innovation, cost cutting is not enough. You will be left behind.

3. Stop waiting on the government. CMS regulations handed down (and then copied by private insurers) are ruthlessly tearing through your organization. Preventing hospital acquired infections should have been a top priority before payers stopped paying for them. As we all know CMS is constantly looking for reasons not to pay your organization. Why not make it about constant improvement instead of constant reaction?

4. Waiting to hear from you…

I know we’ll figure it out. Crisis produces innovation. But wouldn’t you rather make a proactive decision?

Will any of this work? I’m sure of it. Will all of it work? Not likely. But here is the message: continuing to criticize delivery innovations as pie-in-the-sky developments is dangerous. It’s even more dangerous to stand by and do nothing. Let us be p-r-o-a-c-t-i-v-e, I’m begging…