December 16, 2019

3 ways to solve health care's innovation crisis, according to Harvard Business Review

Daily Briefing

    Health care is abuzz with innovative clinical discoveries, yet observers often "lament" the industry's "lack of innovation" in care delivery, Penn Medicine CEO Kevin Mahoney and colleagues write in Harvard Business Review. 

    Checklist: Get started with digital innovation at your organization

    Mahoney's co-authors include David Asch, a professor at the University of Pennsylvania's Perelman School of Medicine and the Wharton School, and Roy Rosin, chief innovation officer of Penn Medicine.

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    3 ways to foster innovation

    In health care, resistance to change typically appears in the form of "thoughtful professionals trying to avoid mistakes in a setting that is expensive, regulated, and high stakes," Asch and colleagues write.

    But while resistance is understandable, innovation is essential in health care, the authors contend.

    For innovation to happen in health care, the authors write, there must be "laboratories where experimentation is encouraged and can proceed safely." As such, Asch and colleagues share three strategies that they have found can "help support this essential kind of experiment."

    1. Wait before seeking consensus

    "Highly-specialized expertise and narrow licensing and credentialing make health care organizations so matrixed that it seems anyone can say no, and no one can say yes," the authors write.

    As a result, it's important to make sure that "leadership's first exposure" to a new initiative "is in the form of promising results from initial tests," as opposed to the initial idea.

    When this happens, "conversations focus … on to how to work out kinks, make it part of the regular business process, and scale it up" rather than coordination with various clinical and administrative services that could delay and potentially doom a program from the start, the authors write.

    2. Make exceptions (but test them first)

    Oftentimes, trying out initiatives that make exceptions to existing protocol can invoke "concerns about setting new precedents," the authors write. However, if the new initiative is tried as an experiment with an automatic end date, those concerns can be abated.

    For example, the authors write that guidelines recommend early post-partum visits with any women with pre-eclampsia to monitor their hypertension. The authors write that at their health system, protocol calls for four forms of patient communication: face-to-face, telephone, mail, or email through a portal that required a login. "None seemed likely to work, and none did," they write.

    Some argued that the health system should consider allowing texting as an acceptable form of patient communication, but others raised concerns that texting is insecure. To gain approval, the proponents of texting pitched it as a short-term pilot.

    "Changing the request form 'Can we text patients?' to 'Can we try it, for a limited time, in a limited population' made it safer by bounding it in an experiment with an automatic sunset," the authors write. Ultimately, the program more than doubled the rate of post-partum blood pressure measurement, according to the authors.

    3. 'Free the data'

    Health providers "will always be ahead of the EHR vendors," the authors write, as providers work on the front lines of health care and are thus more aware of current problems. That means providers will be "frustrated by standardized information systems whose upgrades solve for what most people needed in the past but not for what leading organizations need now," the authors write.

    To remedy this, the authors advise "creating platforms and extensions that sit between the EHR and clinicians, allowing data manipulation and presentation in new interfaces outside of the locked down systems."

    For example, the authors write that their health system struggled with identifying medical inpatients who needed behavioral health support, and often found them "too late." This led to "high use of restraints, the need for 1:1 coverage by staff, longer hospital stays, and incomplete or delayed care," the authors write.

    To fix this, "the language within clinical notes was ported outside the EHR to quickly design and test algorithms for early patient identification, with automated communications to interdisciplinary behavioral health teams," the authors write.

    As a result, clinicians "were able to identify eight times as many patients with needs, deliver behavioral health consultations on day one of their stay instead of day five, decrease hours in restraints by 30%, reduce 1:1s, safety events, and patients leaving against medical advice, and cut a day from the average length of stay," according to the authors. 

    The authors write, "Successful innovation requires experimentation—following many of the same pathways of the successful science that has brought us CAR T-cell therapy and CRISPR." They conclude, "But health care change requires we tinker with the health care system we depend on, affecting critical resources organizations understandably protect. To support the people determined to drive change quickly, we need to find ways to bend institutional norms safely" (Asch et al., Harvard Business Review, 10/28).

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