Profile In Leadership | Boston Children’s Hospital’s Innovation Team Serves As ‘Dream Sherpas’

Naomi A. Fried, PhD, chief innovation officer at Boston Children's Hospital, leads the organization's Innovation Acceleration Program. In addition to launching a range of unique programs at Boston Children's, she helps other facilities focus on innovation and is a recognized speaker on the topic. Every hospital can benefit from innovation, she says.

What is your role as chief innovation officer?

Naomi Fried, PHD, Chief Innovation Officer, Boston Children's Hospital, Boston

I was hired to develop an innovation program. Innovation refers to the process of trying out new ideas. There is no guarantee of success when innovating; in fact, risk and uncertainty are inherent. Innovation is often fraught with failure. While our team is not tasked with coming up with the novel ideas, our role is to accelerate internal innovation by providing resources and support. Our distributed model of supporting everyone across the organization works because our small team can reach thousands of people at Boston Children's. We consider ourselves "dream sherpas" as we facilitate new ideas.

What are some of the ways you facilitate innovation?

Innovation can be a very isolating activity. Organizations can build communities to support innovators so they have peers and colleagues with whom to work and from whom to learn.

At Boston Children's, we have a monthly forum in which innovators present and share their work with the community. Recent forum presenters included a pediatric urologist sharing his work on developing an artificial kidney and a cardiac fellow who presented her work to develop a light-activated adhesive glue that can be used to close holes in babies' hearts. Someone from the hospital's parking team shared efforts to help return valet parked cars back to patients more quickly.

We also established a virtual community called SPARC—a social networking platform that allows innovators to collaborate and make connections. The internal platform supports blogs, videos and virtual conversations to keep innovators connected and enhance efficiency.  

Additionally, we offer the "FastTrack Innovation in Technology" (FIT) award in which winners get software developer time. One innovator used this opportunity to create digital smartboard technology to replace the white grease boards traditionally used to track patients and clinicians. The project involved collecting information from the EMR and the bed management system to keep the digital board updated in real-time. Now, clinicians can track patients electronically from any location in the hospital. The new board has been very well received by the nurses, and Boston Children's has scaled this new innovation across the hospital.

We're also working on an innovation boot camp designed to teach folks about the innovation process and to introduce the resources available. Part of the boot camp includes hearing the war stories from experienced innovators.

To celebrate our innovators, we held our first Innovation Day last February.

What are some of the most effective innovations at Boston Children's?

In addition to the new digital white boards, MyPassport is a project moving from ideation to prototype. This patient passport tool offers digital resources for admitted patients to access their test and lab results through a user-friendly interface. Patients also can view pictures of their care team members as well as have a place to make notes about questions for their physicians. This project was built to focus on enhancing the patient experience while here. As shown with this example, our innovation team is not limited to efforts that save time and money.

How can smaller organizations implement innovation efforts?

Leadership needs to express their support and be open to innovation and risk. There are several things that leaders can do for little or no money. For example, recognizing and teaching folks about the innovation process are easy efforts for any hospital. Creating a safe environment for innovators doesn't cost money.   

Smaller hospitals need leadership to make innovation a priority. While a chief innovation officer is not required, he or she can be useful to have someone to drive the process and educate the organization on why risk and failure are an acceptable part of the innovation process.

It can be very beneficial for hospitals to have innovation programs, as it can help hospitals achieve their strategic goals such as cost savings, increased efficiency and enhanced patient experience

Anyone can be an innovator. Nurses often call their innovations "work-arounds," but they have, in fact, often developed great ideas which could be broadly shared. Boston Children's has always fostered a culture of innovation in part because the tools and technology needed to care for children are often not available on the market. Innovators are often driven by the problems they want to solve.

What do you see happening in healthcare innovation over the next few years?

More and more chief innovation officer positions are being created. In the future, we'll see more organizations provide dedicated resources to innovation because there is growing recognition of the terrific impact of these types of programs.

At Boston Children's, our program is dedicated to supporting grassroots efforts. The proliferation of mobile devices has gotten people excited about building clinical applications (apps)  on these platforms. We have a mobile apps working group, where innovators can learn from each other. Recent efforts to build mobile apps for our environment include an app to access the cafeteria menus, a wayfinding app for navigation in the hospital, and a tool to help autistic children better communicate.

Telehealth is a field that is going to grow exponentially. It represents a paradigm shift in care delivery from the doctor's office to the home. There's a real interest in shifting to the lowest cost venue which can include the home. Telehealth technology is now mature enough that its cost and reliability are no longer barriers to the implantation of telehealth.

6 Steps of the Innovation Lifecycle

Step 1 Initiation: This step is important but not difficult. Innovators identify a problem and envision a solution. This can happen at a grassroots level or a more strategic, institution-wide level. Step 2 Ideation: People often confuse ideation with innovation but ideation is part of the lifecycle. There are many ways to ideate, including brainstorming new ideas. But, Fried points out that innovators can borrow ideas from other industries and competitors. "You don't always have to solve a problem from scratch." For example, a nurse at Boston Children's wanted to find a better way to warm babies after cardiac surgery. The nurse wanted to create a hat for the babies since humans lose 40 percent of their body heat through their heads. While watching the Boston Marathon, she noticed the runners receiving Mylar blankets at the finish line. Now, the hospital is using a Mylar hat that lies flat on the operating table and is put on the patient, secured with Velcro, right after surgery. The hospital has filed for a patent for the hat. Step 3 Pilot: This is when innovators test a new idea or build a prototype. If the idea is going to fail, this is when, she says. However, failure at this stage is a form of success. Fried cites an example from when she was the vice president of innovation at Kaiser Permanente. They were trying to come up with a new way to conduct medication administration. They tried adding medication drawers to the computers on wheels already in use. However, the drawers and medications made the carts too heavy to maneuver. "We quickly found out that what was a great idea in the conference room was not a good idea on a hospital floor. But, had we not gone through the process of building a functional mock-up, we might have bought the materials, deployed the system throughout our hospitals and spent millions on equipment that didn't work." After the pilot, ideally the innovation is adopted by others and translated to broad operations. But, "who lives in that ideal world where people adopt new ideas with no resistance? In the real world, it's hard to make that transition." Fried calls that challenge the "operationalization gap" or "o-gap." The o-gap is primarily found in large organizations or networks with diffuse leadership. To close the o-gap, "get leadership re-engaged," she advises. Look for resources, including education, change management tools and communication programs. The most important thing an innovator can do to solve the o-gap is recognize and plan for it." Step 4 Operationalization: This happens once the organization recognizes the full value of the innovation, but it's not the last step. Step 5 Optimization: The innovation has been broadly distributed and the end user is able to make small changes and localized innovations to the new idea. Step 6 Obsolete:No lifecycle goes on forever and no innovation lasts forever, Fried cautions. Needs change, workflows change and new technologies come along. You have to determine that an innovation has become obsolete and begin again, which can be tricky. Four "Rs" to Support Innovation Speaking during a webinar presented by the Institute for Health Technology Tranformation, Fried discussed the four "Rs" needed to build an internal culture of innovation. 1. Recognize the process. Understanding the innovation lifecycle is important and a valuable organizing framework to help organizations determine where to apply resources. The innovation lifecycle can help innovators understand where they are and what to expect. 2. Resources for innovators. They need space, money, support and time. 3. Risk taking. Innovation is inherently risky and uncertain. "An organization needs to accept that there will be failure. How it deals with failure is critical to creating a culture that supports innovation." Failure should be treated as a learning opportunity, not a time to punish people. "Organizations must create a safe environment that fosters the learning that comes from sometimes having failures." 4. Reward and appreciate. "Innovation is hard. Lots of ideas don't work out," Fried said.  A Children's physician working on injectable microbubbles that deliver oxygen to the bloodstream had to iterate the idea over 300 times. "It's important to acknowledge innovators and recognize their efforts, so they have the energy to keep on trying."