Is Your Organization Ripe to Implement Innovation?

Before embarking on the quest for change, an organization’s whole system—its greater purpose, leadership and culture—requires scrutiny.  

In my course, “Successfully Implementing Healthcare Innovations” at the University of Pittsburgh School of Pharmacy, I teach my students an Innovation Model, which entails a condition analysis to determine whether the organization is at good or poor risk for implementing an innovation.

Specifically, I instruct my students to examine levers, or components of a system, so that when they apply energy or focus to them it will more likely move the system in a predicted manner or direction.

Levers come from complex adaptive systems theory. When people teach process improvement, they in essence teach it so that when you change one thing, a clear cascading set of planned, predictable changes results. However, in a complex adaptive system, when you change one thing it ignites a butterfly effect and changes many things within the system. And, the system transforms in some ways that you can predict and in other ways you cannot.

Leadership, learning, performance measurement and the clinical/operational model are all levers. You can study an organization’s levers and convert that information into a personality profile for a particular system. From there, you can fashion recommendations to that system.

The Assessment

If you are implementing a simple innovation, you can do an organizational leadership assessment in a week’s time if you have access to leaders at all levels of the organization. Also, you can conduct a current condition analysis, which looks at the way work is done and where there are problem areas against the greater purpose.

Then you can sit down and think about innovations. You must consider the resources and ability within that system given the leadership culture and the degree to which they are working in synchronicity. Then you can probably come up with a suitable innovation or state-of-the-art, evidence-based practice to implement at the organization.

Once you implement the innovation, there must be a continuous process and it has to be fairly systematic. When you apply an innovation, in an unrelenting manner you must constantly measure whether it is moving in the right direction and make course corrections when need be.

Unfortunately, people don’t do that part. For example, if you spread an innovation among a number of organizations, 10 percent are going to adopt the innovation. These organizations are the ones who tend toward excellence, and they know how to piece it all together.

The rest of the organizations will start, but then the environment and situation will intervene and they’ll give up. The whole innovation won’t go anywhere.

The most indispensable ingredient necessary to foster change is a greater purpose that can be articulated by all levels of an organization’s staff. The greater purpose supersedes the leadership; when you combine the two, you don’t have gasoline, you have jet fuel and that will move the system forward. It’s completely essential.

Good leadership makes people feel comfortable with the change because it reinforces what the change does in meeting a greater purpose and it celebrates when the change brings them in closer proximity to the greater purpose. Then you get folks in organizations that embrace change, or are actually excited about it because it is safe to do it and reinforced when things move in the right direction.

Implementing innovation is not insurmountable. Success is about changing your idea of ways to do things. If you spend 40 hours a week doing a job, you might as well focus on an understanding of how you can move to your greater purpose.

If you go to organizations that are functionally very well and ask them why they are doing so well, they all articulate a greater purpose. That well-articulated greater purpose becomes the lens through which you look at everything. If somebody is pulling you away from that, it’s waste.

Case Studies

In a study I conducted with approximately 240 Rite Aid pharmacies in western and central Pennsylvania, we taught staff in 117 intervention stores how to do screening and brief interventions of patients who were at risk for poor medication adherence. The remaining stores were control stores. The project took place from 2010 to mid-2012.

We started off with a greater purpose or vision. We did a current condition analysis at the stores. We followed everything in the model. Per our implementation principles, we constantly provided feedback and within two months there was the stable uptake of the process of administrating patient screens and providing appropriate patients with brief interventions.

The key to the success of the intervention was not the brief intervention, it was the implementation process. We proved that brief interventions significantly improved medication adherence for very common medications used to treat chronic illnesses and that we significantly reduced overall healthcare costs mostly via reduced hospital and emergency department use. However, these results would not have been realized without using the Innovation Model components as we did.

In another study, we collaboratively implemented behavioral health screening and brief interventions aimed at reducing alcohol and drug use among patients in an urban emergency department. We used the same Innovation Model principles in this project as are taught in my course. Thanks to persistence over time, and even with little resources and funding, we are providing screening and interventions at levels that are similar to those in emergency departments that have received six figures in federal funding.

Most important is that the healthcare sites with which we are working have begun to achieve stable changes in their organizational culture and the leadership for consistent change. Binding all of these projects together is a commitment to a greater purpose of improving healthcare for every patient.