There is no shortage of innovation in the healthcare industry. Alongside dramatic advances in medicine, there have been many recent innovations in healthcare delivery, such as telemedicine, eye camps, hyper-acute stroke units, and community health workers. Such innovations offer the potential for dramatic improvements in quality of life for patients. For example, two-thirds of strokes caused by an irregular heartbeat can be avoided; cataract blindness can now be cured faster and at a fraction of the cost compared to ten years ago.
What remains a great paradox is that despite these many innovations in healthcare delivery, only a small fraction of the patients who could potentially benefit from them actually are doing so. Why so? The speed and extent to which even remarkable healthcare delivery innovations have been adopted is highly variable.
Kamalini Ramdas, Professor of Management Science and Operations at London Business School, is a specialist in innovation and addresses fundamental flaws in healthcare. “There are pockets of excellence all over the world,” she says.
“There are individuals and organisations doing amazing things, but these value-adding innovations, in different parts of the world, are not spreading.”
The slow diffusion of innovation is a classic problem, and it is seen in many industries, not just in healthcare. Research has shown that it’s not enough just to have a better technology or way of working – you have to also find a way of changing the habits and beliefs of the people who are responsible for implementing the innovation.
This challenge – how to roll out more effectively existing delivery innovations – was at the heart of the recent Driving Innovation in Healthcare Delivery conference led by Professor Ramdas at London Business School, attended by close to two hundred leading professionals, consultants and researchers. Speakers identified a number of the key barriers to adoption and provided examples of ways to overcome them.
All large organisations have functional silos based around particular bodies of knowledge, and the healthcare industry, with its strong emphasis on science and professional expertise is no exception. Take the UK’s NHS, which employs 1.3 million people and deals with one million patients a day, but operates with 212 clinical commissioning groups; 250 health trusts; 8,000 GP practices and 600,000 nurses.
For Sir Malcolm Grant, Chairman of NHS England, a major priority is to transcend these structural barriers. “Our concentration now is on removing silos between primary and secondary care. When responsibility for care is transferred from one provider to another – across a series of stepping-stones – data, communication and appropriate care can be damaged.”
Michael Standing, a senior partner in Deloitte’s Life Science and Healthcare Practice, recently helped the UK Government design a programme to accelerate the adoption of innovation in healthcare. “Improving co-operation is a key opportunity” he observed, “Other industries, like communications, software and defence, innovate very effectively – it’s the structure of their models that bring about co-operation.”
The Cleveland Clinic in Ohio is proof that vast improvements in sharing knowledge are possible. Its CEO, Dr. Toby Cosgrove described some of the innovations he has put in place over the last fifteen years. For example, he broke down the traditional specialty-based units and replaced them with cross-disciplinary groups so that cardiac surgeons and cardiologists, neurologists and psychologists work more closely together.
The Cleveland Clinic also has professionals whose official job is to spread delivery adoption. For example, one promising recent innovation is the notion of “shared medical appointments” where several patients with similar conditions see a doctor at the same time. Each receives a one-on-one consultation while others in the group listen in. This approach has proven to be highly effective, but physicians and patients alike are often wary of it at first. Dr. Cosgrove has appointed Dr. Marianne Sumego, an expert in shared medical appointments, to spearhead their adoption across the Cleveland Clinic system.
The healthcare industry creates and consumes vast amounts of data, but getting that data to the right people in a timely way is still an enormous challenge. “In this era of digitalisation, the vast number of disparate data pools that exist around the whole healthcare system is a barrier,” noted Stuart Fletcher, CEO of Bupa. His business employs 80,000 people and last year provided care to 29 million patients in 190 countries.
One of the major opportunities in healthcare delivery is therefore to increase the fluidity of medical information. This is partly about building databases that cut across different healthcare providers, so that all the historical data about patients is accessible immediately when they visit a doctor or a hospital. It is also about getting real-time data on patients with current medical issues. Consider for example the fast-growing California based startup, HealthLoop. Its business model is based on bringing contextual and actionable information to providers and patients via mobile phones. Founder and CEO, Jordan Shlain, commented at the conference that asking a remote patient the simple question, “Do you feel the same, better or worse than you did yesterday?” on a daily basis after a face-to-face interaction can be incredibly informative. It helps to pick up on those few patients who are getting worse, perhaps because the original prescription hadn’t worked as intended. And it is also popular with patients – a digital extension of the clinician’s empathy through a pre-scripted email.
A recurring theme during the conference was the need to overcome the “not invented here” syndrome. “Innovation isn’t a eureka moment,” said Deloitte’s Mike Standing. “It’s about incremental improvements; people building on other people’s ideas.” He recalled a research project by the Department of Defence in the US to demonstrate. “It looked at the 500 most significant innovations in defence technology in the last 20 years, and 495 of them involved people stealing somebody else’s idea.”/p>
There are plenty of examples from other industries of leading innovators adopting the ideas of others. Jack Ma, founder and CEO of online retailer Alibaba, took the idea of eBay to the Chinese market with Taobao. Steve Jobs famously said in 1996: “Picasso had a saying: 'Good artists copy; great artists steal' and we have always been shameless about stealing great ideas.”
But getting people to ‘adapt with pride’ takes a shift in mindset. Again, the Cleveland Clinic shows what can be done, with its emphasis on delivery ahead of creativity. Across the globe in India, the Aravind Eye Care System, the largest and amongst the most renowned eye care providers in the world, is now adapting the concept of shared medical appointments for glaucoma, a long term disease that results in irreversible blindness when untreated. Adapting ideas from elsewhere requires a culture of openness, creativity and experimentation.
Encouraging people to adopt new delivery methods sounds straightforward in principle, but it often takes time, and a few failures along the way, before the adopted innovation is a success. This puts a heavy burden on the leaders of the organisation to become more tolerant when things don’t work out. “I think failure is a tremendous teacher,” said Toby Cosgrove of the Cleveland Clinic. “As a leader, there’s a certain amount of willingness to experiment, and with that goes some humility. You have to be comfortable with trying something that has six reasons to fail.”
The Cleveland Clinic celebrates innovation with a cash award for the innovator of the year and it encourages people to look as broadly as possible for ideas. Small cost-saving innovations, such as centralising courier services, are taken very seriously. More radical innovations, such as no visiting hours, open medical records and shared appointments, also count, as do cutting-edge technologies, such as HealthSpot, a virtual walk-in kiosk, which offers patients convenient options to access healthcare./p>
A final theme that came out of the conference, cutting across the others, was the need for researchers to get closer to the world of practice. Kamalini Ramdas argued that academics need to take the next step beyond publishing their research, and to find ways of getting their ideas adopted in the real world. “The biggest barrier of all,” she observed, “is how innovations, wherever they are in the world, work in practice”.
One way forward, she argued, is to take the notion of experimentation seriously. Most ideas can be tried out in low-risk ways at first. Indeed, researchers have a lot to bring to the table in terms of designing these types of interventions, and there are some examples out there of effective collaborations between academics and practitioners in the healthcare sector. Jérémie Gallien, Professor of Management Science and Operations at London Business School, is an expert in logistics and distribution. He has applied his research at big brand retailers including Zara and Amazon, and is now working to improve healthcare delivery in Ghana using community health workers to supplement physicians.
Radical innovation is not a leap of faith, not if you know how to experiment quickly and cheaply.
Professor of Management Science and Operations