To innovate, be prepared to fail

BOSTON—When startups’ “fail fast” philosophy is obstructed by healthcare organizations’ “can’t fail’ culture, innovation falls by the wayside, according to speakers at the 2014 AMDIS Fall Symposium.

But there are risks when healthcare organizations fail to act—they may get left behind, lose stakeholder investment and compromise patient care and safety, said Narath Carlile, MD, MPH and CMIO at ACT.md.

In fact, healthcare organizations should establish a baseline failure rate and assume not all innovative projects will work as intended. If “courageous” companies begin sharing their percentage of failures, someday a baseline failure rate could be established for industry guidance, he said.

A number of areas exist that are ripe for innovation, especially where reliable care is not occurring. Startups offer a number of advantages for healthcare organizations that wish to close gaps in care, according to YiDing Yu, MD, internal medicine physician at Brigham and Women’s Hospital and co-founder of Twiage, a startup that provides emergency telemedicine solutions to first responders.

While some companies may be hesitant to work with young companies, these companies offer lean and focused interventions that can be rapidly delivered at a cost lower than solutions offered by larger vendors, she said.

“Much more often when organizations need a sleek, streamlined solution, startups are a better fit,” she said. “They are ready to deploy very quickly."

Yu listed four specific keys which she feels are ripe for innovation: pharmaceuticals; medical devices; care delivery; and digital health. She elaborated on four specific hotspots in the category of digital health—an area of “tremendous innovation”:

1. Patient engagement (high-risk populations, reducing readmissions, patient satisfaction)
2. Communication + Teaming = team communication (secure messaging, digital care thread for care teams, transitions of care)
3. Population health management (physician dashboards)
4. Health monitoring (remote telemetry, user collected data, predictive analytics)

But a number of challenges confront would-be innovators in the healthcare industry: stressed resources, regulatory hurdles and organizational barriers. To create a space for innovation to flourish, Yu outlined three approaches organizations may follow to foster innovation: incubate; dedicate; and translate.

The incubate approach is an in-house incubator that connects clinical investigators with resources and transforms the end product into a financial viable business venture. She cited Cleveland Clinic, iHub of Brigham and Women's and CIMIT as examples of this model.

The dedicate approach entails teams implementing and evaluating specific innovations throughout an organization. She referred to Massachusetts General Hospital, which used a team to rapidly deploy telemedicine programs.

The translate approach is when innovation centers establish a culture and pathway for external entities for innovation translation and dissemination. She cited the Mayo Clinic, Penn Medicine and Intermountain Healthcare as organizations following this model.

Any way an organization chooses to go, its leadership must outwardly value innovation and align resources around that forward-facing vision.  

The bigger the company, the less interest there is in customizing products, said Carlile. “The key challenge is showing that IT is a benefit, not a burden.”

Carlile offered 10 features of organizations that innovate well (as gleaned from his experiences as well as a 2008 Geisinger paper on continuous innovation):

1. Alignment around healthcare value
2. Identification of specific targets for redesign
3. Highly collaborative groups
4. Pursuit of innovations to answer specific questions
5. Use design teams to redesign care process
6. The creation of a clinical business case
7. Ability to build incentives with clinical enterprise
8. Application of improvement methodology
9. The building of an innovation architecture
10. The establishment of an innovation index

These 10 concepts, as well as a willingness to let projects fail fast and learn from mistakes, cultivate the innovative culture needed for change to happen.