How Cleveland Clinic, UPMC and Rush executives foster a culture of innovation

Rasu Shrestha, Shafiq Rab and William Morris

Healthcare innovation, though often elusive and at times overwhelming, is what will drive hospitals and providers toward increased value and better outcomes.

It should be a steady and consistent goal to adequately fund innovations not just for the sake of patients but for physicians and other staff as well. But how do you encourage the cutting-edge within your own healthcare organization?

We interviewed three thought leaders: Cleveland Clinic Associate CIO Will Morris, MD, UPMC Chief Innovation Officer Rasu Shrestha, MD and Rush University Medical Center CIO Shafiq Rab about their foundational philosophy to innovation and the areas most ripe for disruption.

Morris, Shrestha and Rab shared their best advice about establishing and fostering an ecosystem of innovation in the hospital environment.

Identify innovators

Here's a not-so-secret nugget to keep in mind: Prospective innovators are not limited to people working in IT or clinical roles.

"An innovator to me is someone who is perpetually dissatisfied with the status quo," Morris said. "They aren't the one to come up with the spark of the solution. To me they are the one who can articulate and understand the core problem. Anyone is and can and should be an innovator."

A key component of that is understanding the culture of your organization, Shrestha said. That means trying to weave innovation efforts into that existing culture to create a foundation on which to take it all to the next level.
 

Rab agreed that innovation is an enterprise-wide capability and everyone has something to contribute.

"We believe that every employee, staff, doctor, and nurse has an idea," Rab said. "We believe in our people, that they have ideas and those ideas are valuable."

Crowdsourcing that wisdom will naturally require you to think strategically.

Focus on purpose-built tech

Technology for technology's sake? Nevermind that. A purpose-driven approach to innovation is a must. Don't innovate to be able to say you did, or because you are driven by one or two use cases or an individual that wants to get something done around a specific pain point.

Shrestha said to go the distance in innovation, you can't get lured into the compelling nature of the shiny objects that are out there or even the lure of undertaking innovation. You have to have a strategy for addressing the challenges of making it sustainable, scalable and sticky.

Really understanding the core skill sets, attributes and strengths of your particular health system is another absolute must.

"What's the special sauce that you bring to the table? Do you have expertise in a specific area that distinguishes you?" said Shrestha. "Understanding that is important."

Likewise, it's critical to grasp a range of big opportunities for improvement and not overlook the ones perhaps less glitzy than that new app everyone is clamoring to download.

Embrace the unsexy: back office operations

Yes, there is an "unsexy side" of healthcare innovation.

That is, three quarters of innovation especially in healthcare delivery is operational on the backend, rather than clinical, Morris said. He pointed to billing, supply chain, HR and procurement as opportunities lying in wait, hoping to be discovered for all their potential as a breeding ground for transformative developments.

It's not just the new widget, device or artificial intelligence -- though those are noble pursuits in their own right -- innovation can come from something as staid as predicting bed utilization or days in accounts receivable.

"I don't think that gets showcased enough," Morris said. "And I think it's the majority of the opportunity. It is a veritable goldmine to disrupt the back office functions."

That's not to say every attempt targeting the operational side will automatically be a success. You still have to choose wisely which projects to pursue into a proof-of-concept, pilot test, wider production and live across the enterprise.

Self-protect by investing incrementally

Regardless of which hospital department you are developing technology for, it pays to create a selection criteria around discerning the good ideas, what to invest in and how much money.

Rab recommended investing smaller amounts first.

"If you spend $200 million on a project and it fails what do you do now?" Rab said. "You have nothing have left."

Rab continued that another key is to decide at the outset what the problem is you are trying to solve and what the value is of that problem. Is it money, time, productivity, efficiency and outcomes or value to staff and patients?

Once you have clear picture of that, the innovative part becomes easier to do, sell, implement, and get buy-in on. And you must also examine whether that problem is common among other hospitals or areas. That gives you scale, Rab said.  

"These are the mechanisms by which you self-protect," Rab said. "You don't have to invent yourself but you can invite other people to use your space as a collaboratory. From that you can profit and benefit."

Engage end-users

You've heard this one chanted so frequently it would almost go without saying -- if not for the countless app and enterprise software implementations that trudge forward without ever taking actual users into account.

Ask any doctor who dislikes her EHR whether she kicked the tires or even saw the interface before logging into the live production version for the first time, and good luck finding many to answer in the affirmative.

Right. That's because problem areas are usually articulated in the workflow where a given product's actual work happens, not in the design stage.

It's also important to have a process around prioritizing what you focus in on. Create the right teams, do some brainstorming and design thinking exercises and plot a project in terms of how to do it with a level of purpose that drives longevity in your innovation pursuit.

From there, make sure the people who will be using the product you build are part of the process right from the beginning as opposed to after the tool is already created. That takes having the right set of parameters in place to keep them engaged throughout the development lifecycle such that they become the champions on the ground that inspire others to use the app or device, Shrestha added.

"It's easy to start off with a big splash," Shrestha said. "But the first time you hit a roadblock, hiccup or failure, if you're not thinking long-term then chances are that project is going to get scrapped."

Make workflow a key component

Of course it is. And that holds true whether in the backoffice, clinical front lines, or patient-facing apps.

You have to understand the problem and ensure the solution compliments a workflow and a process. It sounds so simple but to do that, front line staff are the most crucial element driving the innovation and it's success or failure.

"Often we see really cool widgets or devices or things. But if they aren't integrated in a meaningful workflow they'll never be adopted," Morris said. "The front line people are so key. They are the first mile and the last mile of innovation. They are the ones who see the reality, who are actually going to adopt it and use it and show value."

Which is exactly why innovation agents have to involve front line people, otherwise known in IT circles as users, early in the tech development process.

Look outside your IT shop and the healthcare industry

Innovation also requires the ability to ask: has this problem already been solved in other verticals?

Be pragmatic and bring in these solutions and try to make them compliment the clinical workflow and setting. There is a lot to learn from industries outside of healthcare.

"Be inquisitive and be a sponge for reading and looking outside of healthcare. Question a lot and look outside the industry for inspiration," Morris said. "When you open up your apertures, the world is a ripe place for disruption and healthcare can be a tremendous benefactor."

Allow people time to develop their ideas and from there, partner and collaborate with outside companies. They have thoughts too and you can work together with them to minimize risk. If you are investing in a good product that your system can make something of, don't be afraid to take on co-investors so you don't have to fully fund a project yourself.

"If you don't believe in it -- forget about it," Rab said. "Nothing will happen."

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com