Based on a talk for the Southern Ohio branch of the Project Management Institute (Healthcare group). Many thanks to PMI for their sponsorship.
Healthcare innovation has been led by technology providers, almost entirely, over the period we consider relevant to “innovation” (1970’s – current). Innovation has been a supply-side approach, led by information technology (EMRs and Health IT platforms) and medical devices (ranging from user-controllable diffusion pumps to CAT machines). Only recently have clinical services become the focus of innovation, ranging from patient-centered care to new practice models (the ACO and PCMH) and business models.
Yet even service innovations emerge from the supply side – just supply-side from inside the hospital instead of industry vendors. The hospital remains a highly hierarchical entity, managed as a top-down coordination of patient bodies in space and time. The patient’s individual desires and personal circles of care are not elicited for service innovation – they are surveyed for “patient satisfaction” with these service improvements. That’s a huge difference.
Internal innovation programs typically develop service proposals as process improvements, from a quality management perspective, and based on real knowledge of clinical concerns. Regardless of as opposed to external customer (demand-side) drivers. After all, healthcare innovation centers are new entities within the institution, and are cost-centres and therefore probationary, so they are not going to break radically with organizational tradition. They are and will be staffed by internal staff, primarily those with deep process improvement (Quality, Six Sigma and Lean) experience and knowledge. While these may be effective and even much more productive PI shops, as innovation shops they are likely to miss the mark, the real opportunity over the long run.
Demand-side innovation requires entrepreneurial risk-taking and field-level human-centred research. The problem is that a true demand is never obvious within the institutional setting. There is never a “single source of demand” from patient profiles or past history and there are no perfect “typical cases” from which to invent demand for service. Innovation for care as service requires a creative synthesis bridging patient needs, clinical modes and workflows, and information sharing. Changing workflows and modes of care to meet the real concerns of people in a local population may inspire a radical organizational shift. However, as care organizations continue to promote the optimization of current clinical processes (e.g., Lean practices) they will only continue to strengthen today’s current service offerings, reinforcing supply-side of care.
Large healthcare institutions often manage service innovation as multidisciplinary research program – which leads to publications and prestige, but not necessarily the results of population health outcomes or other “external demands.” If they have no platform for commercialization or scaling to the healthcare system level (as in Canada) these projects remain internal at best. Project managers in these organizations should develop meaningful guidelines for balancing innovation (transformation) goals with organizational objectives, as current norms and practices can significantly diminish the impact of innovation proposals. Program leaders must advocate the acceptance of risk and the possibility of failure iterations, to accomplish innovation outcomes.
While design leadership can play a significant guiding role, even more so we need executive guidance to reinvent business models and approaches to meeting health seekers where they love. Externally-focused innovation should be 3-5 years ahead of current strategy, and not in the mainstream of process optimization. The presentation (PDF) offers an approach based on Porter’s value-based care model, with a starter kit of design guidelines.
