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digital innovation is a priority. That same percentage of leaders at hospitals with more than 400 beds are planning to open some form of innovation center.

Some CEOs have gone further to tie innovation into culture.

“We intentionally changed our values or added one more val­ ue—innovation—just to force us to think differently and act different­ ly,” says Michael Ugwueke, CEO of Methodist Le Bonheur Healthcare in Memphis, Tennessee.

Hospitals have some disadvan­ tages when it comes to innovation: Start with large staffs of doctors and nurses trained to care for people, not to create new products. It is a

5 REASONS INNOVATION FAILS What leaders must do first is reset and retrain. Building an innovative healthcare organization takes time and a new look at skills.

By Jim Molpus

nnovation isn’t just an industry buzzword anymore. It’s become an essential component for hospitals looking to compete in a more demand­ ing consumer market, and to com­ pete against a sea of entrepreneurs convinced they know how to fix healthcare better than hospitals do.

A 2017 American Hospital As­ sociation Survey found that 75% of hospital leaders surveyed say

healthleadersmedla.com ■ July/August 2018 27

5 Reasons Innovation Fails

“WE INTENTIONALLY CHANGED OUR VALUES OR ADDED ONE MORE V A L U E - INNOVATION-JUST TO FORCE US TO THINK DIFFERENTLY AND ACT DIFFERENTLY.”

heavily regulated industry. These tides pull against the ability to create ideas, build working mod­ els, and fold them into the care process.

But there are advantages. Hos­ pitals have scale to model solutions to solve real gaps in care, not just chase technology that looks cool. An innovation that comes through the crucible of a major hospital has applications in provider settings anywhere.

What leaders must do first is reset and retrain. Building an innovative healthcare organiza­ tion takes time and a new look at skills.

Why your innovations aren’t working Population health is the ultimate proving ground for health system innovation. Ever since the first rum­ blings of the Triple Aim began to appear in the liter­ ature, healthcare leaders have discussed, planned, and executed thousands of initiatives meant to funda­ mentally redesign care delivery from volume to value. Many succeeded. Most have failed.

So why have so many programs not worked? Were they just bad ideas? Not necessarily. Many programs designed to drive quality, reduce cost, and improve the overall health of the community may have failed for internal reasons.

In a recent session of the HealthLeaders Media Population Health Exchange, a panel of leaders in the diverse clinical, executive, and information technolo­ gy sectors responsible for innovation discussed why success can sometimes be elusive.

WHY YOUR INNOVATIONS DON’T SUCCEED Fear of risk

Innovating for the wrong audience

Scale is all wrong

You’re a sucker for myths

Poor timing

1. Fear of risk Hospitals have been inundated with change for years now. You might expect that at this point, the clinical and executive teams would be skilled at nurturing innovation and bringing it into workflow. But there are always barriers, because with change there is always risk, and fear of risk is a human reaction on an organizational scale.

Other factors heighten the fear of embracing risk: regulatory un­ certainty, softer operating margins, and pressures to measure every hospital process.

“You can’t be so risk-averse and worried about your operational cash flow that you never take risk,” says Parinda Khatri, PhD, chief clinical officer at Cherokee Health Systems, a comprehensive commu­ nity healthcare organization with 25 sites in East Tennessee. “For us, frankly, it’s actually much more ex­ pensive not to take risk.”

The leadership team must set innovation as an expectation, she says. “It’s a paradigm shift. You must have leadership that says, ‘Sure, go ahead; you don’t get in trouble here for failing. You get in trouble for not trying. The status quo is not acceptable.’ ”

Changing the overall risk tolerance of the organization is not a switch that can be turned on instantly, cautions David Stowers, RN, PhD, vice president of enter­ prise care management, at four- hospital Covenant Health Partners in Lubbock, Texas.

“One of the first things I learned in this business is no one wants to change,” Stowers says. “Everybody likes their own comfortable way of doing things. So the first thing we did at Covenant was to set up a pilot for four different processes, each with relatively low risk, under­ standing that some may fail. Some did, and others, like care navigators in primary care, did not. But the medical staff at Covenant and the administration could see that by

2 8 healthleadersmedia.com ■ July/August 2018

putting in small processes, we were impacting little things, and that would grow to bigger things.”

2. Innovating for the wrong audience How often have you come across an improvement initiative that was sold as “internal process improvement” but didn’t turn out to be internal at all? In the healthcare business, all work eventually goes downstream to the pa­ tient, and that is where innovation will be judged.

Monty Duke II, MD, senior vice president and chief physician execu­ tive of Lancaster (Pennsylvania) Gen­ eral Health, a 663-licensed-bed not- for-profit health system, says thinking outside the organization is a challenge that his leadership team recognized and took steps to change.

“We had become very insular in our efforts to innovate by simply keep­ ing it all in the organization,” Duke says. “We didn’t have partnerships outside the organization. That is a must-have to be able to integrate what other people are thinking.”

The danger was that innovation would go off in a direction that did not match the pain points of the patient base, Duke says. “What are the things we’re not providing service for now? What is the customer telling us? We have our physician comments post­ ed online. It’s not so much just about getting the comments. It’s about un­ derstanding where the opportunities are out there so that it’s not taking potential customers and fitting them into our paradigm, but thinking about the paradigm that they potentially would like.”

One essential skill of innovation is observation, Khatri says. “Apple didn’t ask people, ‘Do you want an iPad?’ No. They watched people. So, we observe. We watch our patients. We watch our providers and then we try to think of different ways of doing things in a very Socratic, experimen­ tal way, with no investment in one certain way of doing things. We end up being very solutions-agnostic.”

INNOVATION EVENT

Health system innovators will gather at NEXT Hospital Innovation in Dallas, October 7-9, to learn how the nation’s leading systems have brought applications and tools to market, and gain insights into how to jump-start their own ideas.

Cohosted by Baylor Scott & White Health and HealthLeaders Media at the new Baylor Scott & White Sports Therapy and Research facility with presenting sponsor GE Healthcare.

To register for the event, visit store.healthleodersmedia.com/ NEXT18

“IT’S A PARADIGM SHIFT. YOU MUST

HAVE LEADERSHIP THAT SAYS, ‘SURE, GO

AHEAD; YOU DON’T GET IN TROUBLE HERE

FOR FAILING. YOU GET IN TROUBLE FOR

NOT TRYING. THE STATUS QUO IS NOT

ACCEPTABLE.’ ”

3. Scale is all wrong Some innovations may meet a cus­ tomer need and be right for the or­ ganization, but might fail because they were either too small to work across the organization, or were rushed to growth too fast.

“Innovation doesn’t all have to be lightning bolts out of the sky,” Duke says. The healthcare indus­ try is perhaps “too steeped in the culture of rolling big things out.” Instead, Duke says he and the team at Lancaster have adopted a “design thinking” approach that emphasizes small pilots.

“You don’t have to innovate across the organization. You can do small things. If you fail, you fail early and cheaply. If it doesn’t work, you can adapt. I think there’s a playful element to this too. You can have some fun and do things differently. If you can do targeted, pilot areas, that becomes a lot more deployable than perfecting it for the whole institution.”

Mark Wager, president of Her­ itage Medical Systems, an affiliate of the Heritage Provider Network, which serves over 1 million pa­ tients in integrated care programs,

healthleadersmedia.com ■ July/August 2018 29

5 Reasons Innovation Fails

ft W s

f

“APPLE DIDN’T ASK PEOPLE, ‘DO YOU WANT

AN IPAD?’ NO. THEY WATCHED PEOPLE.

says his organization started a pro­ gram they call “3-3-3” to generate interest in pilot programs.

“At our practice sites, we’ll put up $3,000 for three weeks if you have at least three people who want to talk about something different that they observe could be done,” Wagar says. “It’s simple, not real expensive, and people get excited about it. There might be 10 pilots going on, and seven of them miss, but three of them hit. You applaud them all. They’re not so large that they would break any one site’s performance, but you get people thinking and active about change. That helps when you bring a bigger change to them. They’re used to the idea of trying something new.”

SO, WE OBSERVE. WE WATCH OUR PATIENTS. WE WATCH OUR PROVIDERS AND THEN WE TRY TO THINK OF DIFFERENT WAYS

OF DOING THINGS IN A VERY SOCRATIC, EXPERIMENTAL WAY,

WITH NO INVESTMENT IN ONE CERTAIN WAY OF DOING THINGS.”

4. Sucker for myths In an industry built largely of scientists who trust only data, a surprising number of innova­ tions may halt because of myths or other self-generated barriers to change. One of the most common myths that may kill innovation before it starts is the proposition that innovation is destructive, not merely disruptive.

3 0 h e a lth le a d e r s m e d ia .c o m • J u ly /A u g u s t 2018

A leadership team might not in­ novate out of fear that, by doing so, they might lose a revenue stream, even one that may have question­ able efficiency or sustainability.

“If the leadership is not willing to force the business portion of the organization to adapt to the various innovations, it won’t move forward,” says David Battinelli, MD, chief med­ ical officer for Northwell Health, the largest employer in New York state with 22 hospitals and 3,900 em­ ployed physicians. “The operating budget issue is simply an excuse and a myth used to protect the status quo. Like the bogeyman, it doesn’t really exist. Because there are few examples of how useful innovation disrupts and harms the operating budget. That’s a myth that just con­ tinues to get propagated.”

Other myths might simply be popular misconceptions that are

outdated or not supported by data. “The myth is that the patient will only be satisfied

if they see the doctor. Well, th at’s not true,” Battinelli says. “They want to get their problem taken care of. It can be done in 100 different ways. Sometimes, yes, they do want to see the doctor. If you don’t get past some of those things, you’re never going to make advances.”

5. Poor timing, again There is no such thing as a successful innovation being ahead of its time. Only when customers, organizations, or technology are ready for the change will an inno­ vation take hold. But just because a change was tried earlier and failed doesn’t mean the idea was wrong.

Luis Saldana, MD, chief medical informatics offi­ cer for Arlington, Texas-based Texas Health Resources (THR), with 24 hospitals and more than 3,800 licensed beds, says THR tried a program recently to reach out to emergency department (ED) patients to prevent ED return visits.

“We applied some resources towards it, but we found that it was resource-intensive to get the data because they weren’t just coming to our EDs,” Saldana says. “They’re

going to other EDs, and it was too dif­ ficult to collect that data.”

But what was not as available just a few short years ago was rel­ atively inexpensive and convenient access to telehealth. So THR tried the idea again.

“Our ED group took the ini­ tiative to give every patient who comes to the ED access to a tele­ health visit within seven days,” Saldana says. “We find out what the issues are, like why didn’t they get the prescription filled. Maybe they could not afford it, so we can make a substitute. Some didn’t take advantage. But overall, it seems to be working very, very well on reducing patients returning to the ED.” Cl

Jim M o Ipus is the editor in chief and leadership programs director for Health Leaders Media. He can be contacted at [email protected].

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