December 2019 hbr; These days, everyone working in health care is chasing innovation to thrive in this era of increased accountability for care quality and cost and (finally) truly patient-centered care. Those still pursuing business as usual are often chronically anxious: They keep hearing that innovation is essential to the transition, but they see it (often rightly) as difficult or impossible to execute in their organization, and they aren’t sure where to begin. Their anxiety is compounded by the fear of having their lunch eaten by Amazon and Walmart (new to health care but not to innovation), and by other entrants who aren’t constrained by the familiar ruts of business as usual.
Here are four observations that may help demystify the process of innovation and ensure that it actually innovates.
1. Inventions are not innovations. Many organizations define innovation as novel technologies, processes, and business models. They may regard artificial intelligence, just-in-time supply chain, or bitcoin as innovations. These things, at least in their early phases, are more accurately called “inventions” rather than innovations. Inventions are important, but they only rise to the level of innovations when they are broadly adopted to transform behavior and functioning of users or organizations or even society as a whole. In other words, innovations are inventions that have successfully scaled.
The Wright brothers’ plane, first successfully flown in 1903, was an invention. The innovation was the first scheduled commercial flight (in 1914, between St. Petersburg and Tampa), which has since scaled to 4.5 billion passengers on commercial flights last year. The polio vaccine was an invention. Its incorporation into routine medical care, resulting in the almost complete eradication of the disease, is the innovation.
Many health care providers don’t have the resources — incubators, venture funds, top researchers, and lab facilities — to generate a steady flow of inventions. As a result, they may feel like their ability to innovate is hampered. But inventing and innovating are two different skill sets. The Wright brothers invented airplanes and left it to others to innovate with the creation of airports and airlines. Jonas Salk didn’t patent the polio vaccine, enabling others to adopt public health and practice innovations to disseminate it. Inventions are everywhere, waiting for innovators to scale them, and your organization can play.
Organizations need not invent to innovate.
Similarly, an organization that pursues inventions — perhaps by setting up an incubator or a venture fund — should not assume that those efforts will automatically lead to innovations. If your innovation group isn’t making progress at changing things, despite an abundance of good ideas, maybe it is really an invention group.
2. Innovation does not automatically require radical change. Innovations can come in any size from incremental to radical. Innovating might mean adopting a new approach to an existing service — for example, starting to offer robotic surgery, a material improvement on minimally invasive techniques. Or it might mean offering a new service — for example, post-acute care, a potentially radical change that affects multiple parts of an organization and might even redefine it in some fundamental ways.
Incremental innovations are not necessarily less impactful on the quality of care than radical ones. Incorporating thorough hand washing into clinicians’ routines — once considered an innovation — is the very definition of incremental. It doesn’t take a lot of extra time or cost very much. But its impact on cutting infection rates and saving lives is incalculable. If only every innovation had that kind of payoff.
A thousand small tweaks can transform a mediocre performance into a great one. When scholars study how organizations wind up dominating their industries or fields, they often find a pattern of continuous incremental innovation over a period of years. This type of innovation enables the organization to learn which changes are working and which are not and adjust their course accordingly. Moreover, the organization’s members learn to incorporate a habit of making small changes and reaping their value, rather than treating innovation as an occasional and temporary inconvenience, after which they will return to their old patterns.
3. Radical innovation demands choreography. While any organization can embrace incremental innovations, many dread radical innovations and don’t actively pursue them. They focus on the “radical” part, recognizing that it will turn their organizations upside down in ways that inconvenience everyone to some degree. They can’t look beyond the havoc to the transformation at the other end. As a result, they often wait for radical change to find them, which increases the havoc.
A good example is the 2009 U.S. government mandate to adopt electronic health records (EHRs). While the debate over this approach to radical innovation will probably rage for another decade, two facts are indisputable. First, the health care industry as a whole had not at that point made significant progress in adopting electronic records voluntarily and left to itself might still be relying on paper folders today. And second, it was a necessary change if the health care system were ever to reap the staggering potential benefits of digital information and networks.
Some providers embraced the innovation, planned for it, and reshaped their organizations to take advantage of it. Others had it thrust upon them, treated it as primarily a burden to be endured, and reshaped their organizations reactively, to the extent they reshaped them at all. It’s no wonder that the results 10 years later are mixed. However, despite the amount of criticism directed toward EHRs, no one seriously suggests a return to paper. One hallmark of radical innovation is that it precludes going back to the way things were.
As the switch to EHRs shows, radical innovations demand “choreography” if they’re going to fulfill their promise. The changes they require may be both broad and deep, involving an intricate dance among multiple parties and facets of the organization. All will need to learn the routines, and some may need dance lessons.
EHRs required thoughtful redesign of workflows and roles at every level of a provider organization, as well as leadership, monetary and staffing resources, strategies to mitigate risk, and (maybe most important) stamina. Implemented correctly, they had the power to change an organization’s political and cultural fabric, as access to data deepened its knowledge of itself, its patients, and the services it was providing.
The choreography of radical innovation often extends outside a single institution and involves multiple complementary innovation strategies. For example, the incorporation of the polio vaccine into routine medical care required a way to manufacture large quantities of the vaccine as well as massive changes in medical education, health policy, public health resources, and public awareness. The broad adoption of telehealth will require insurance coverage parity with face-to-face care, cross-state licensure, changes in clinic workflow, and patient and provider education.
Choreographing radical innovation requires that an organization be honest with itself about its change management prowess and take steps to improve it if necessary. It also requires a way to assess and incorporate all the complementary strategies necessary to execute the innovation.
4. Sometimes we don’t need to innovate, we just need to improve. Just as we must avoid confusing invention with innovation, we must avoid confusing innovation with improvement. While all innovations should be improvements, innovation is a technique rather than a goal in itself. Sometimes tried-and-true improvement tools like process redesign are better for our immediate purpose. Revamping chaotic outpatient scheduling processes, for example, may require the boring and pedestrian focus on getting rid of stupid and wasteful work and confused accountability. It’s not going to win anyone an award for innovation, despite its dramatic potential impact on organizational performance and quality of life for staff and patients alike.
Whether we are innovating or just improving, the questions are the same: What do we need to do? What resources are required? Who will do it? How do we manage risks? And how will we know if we have been successful?
Transforming health care delivery into a system that is more value-based (where pay is based on outcomes rather than the volume of services) and patient-centric will require a commitment to change, whether it’s radical innovation, incremental innovation, or simply trying to do better. The innovation journey will be more effective if we remember that organizations don’t need to invent to innovate, that a steady stream of incremental innovations can lead to significant gains, that radical innovations require careful management, and that innovation is the means, not the end.