Innovation: Reframe the problem to find the best solution

BOSTON—Change doesn't just happen. “Leaders have to change. Every company has to change. Large groups have to change and do the heavy lifting,” said Roy Rosin, chief innovation officer, Penn Medicine, speaking at the National Healthcare Innovation Summit on May 15.

With change management, “the reality is you have to do intentional things to get people to change behavior," he said. "You need a burning platform and then reiterate it all the time. People have to believe in it. The stories you tell all the time are the ones people start to believe.”

Companies that will be successful into the future think about both their core business as well as what they can do to maintain their viability with new business. They also have to set up their innovation program properly, Rosin said, by methodically identifying and eliminating friction points. “Watch when someone does something new, see where they get stuck, study those. How get through these sticking points?" The solution might be changing the reward system for functional partners. In areas such as risk management and privacy, for example, teams can't only be rewarded for on zero incidents. "The best way to have no bad stuff is to have no stuff," Rosin said.

Penn Medicine focused on innovation by signing on with DreamIt Ventures, a health startup accelerator that runs four-month incubator sessions in various regions across the country, when Rosin came on board. The results have been impressive, resulting in the launch of 10 new startups within the past year.

One was Biomeme, which produces accurate lab results in minutes using just an iPhone. The company has contracted with the Department of Defense to detect anthrax and other biohazards. There are 33 million new infections of sexually transmitted disease per year, but current tests have low sensitivity and take up to five days. That has led to overtreatment, which is expensive and contributes to antibiotic resistance. “Having a rapid test made a lot of sense.” A year later the test is in use in Penn’s hallways. “The toughest thing about innovation in healthcare is access.” Talking to lab workers didn’t always go well because they were talking about something that might replace them.

Teledermatology is another area in which Penn Medicine made some headway through DreamIt. Rosin cited a group of dermatologists that knew the importance of teledermatology but didn’t pursue it because of the lack of reimbursement. Administrative leaders voted down a project because there is no business model. “I said, ‘that’s exactly why we should do this—we have to discover the business model.’”

And that’s why Penn did the partnership with DreamIt—“we could look at our top trading partners and build collaboration.”

Successful innovation requires the ability to see what other people have missed, he said. He cited the shipping industry. In the 1950s, everyone said the industry was going to die because of airplanes. They looked at ways to innovate the processes that occurred on the water. In reality, it wasn’t the crossing where there was room for innovation, it was the week the ships sat idle in the port. By switching to shipping containers—which dramatically increased the time to load and unload ships--the cost of shipping went down by more than 90 percent.

Innovation fails often, Rosin said, so organizations need to build a culture that enables diverse ideas and rapid experimentation. “The lower the time between iterations, the increased chances of success,” he said.

Innovation also calls for divergence, he said, or unlocking people from the first solution. “Generally, the first idea is not the best idea. The probability that you’ll get it right the first time out of the gate is very low.” To compensate, instead of making a couple big bets, make tons of little bets, he advised. “Don’t spread yourself too thin but innovate in a way that will produce evidence quickly.”

Rosin cited an issue Penn Medicine faced with the time of day of discharge getting later and later. They did a “sprint” problem-solving effort and found that much of the problem linked to oncology. More people needed a bed than were available. Reframing the problem, however, showed that the issue was not length of stay but time to a bed. Another look showed that the issue wasn’t time to a bed but time to treatment. The bottleneck was due to people waiting for their chemotherapy and actually had nothing to do with a bed.

Penn also looked into online scheduling via an innovation tournament to get people engaged. Everyone was asking for online scheduling primarily for new patient access. In reality, “the only thing that would happen is that it would be easier to see how long the wait is for an appointment. That doesn’t solve the wait problem.” In the end, they redirected 147 new patients to different practices over seven weeks, reducing wait times from as long as three months to three days. They also built two new practices.

The organization also has learned that more messaging doesn’t change behavior. They introduced simple leader boards that were highly visible and showed which providers were meeting the Meaningful Use Stage 2 requirement of at least 5 percent of patients using messaging. After the boards were installed, the number of patients using messaging more than doubled. That was due to the physicians seeing others’ scores and talking to each other about how they achieved those results. That shows that “there are different ways to think about things other than sending more email,” Rosin said.