When Health and Human Services Secretary Sylvia Burwell announced an aggressive timeline for the transition from volume- to value-based payment earlier this year, it was the equivalent of reading healthcare the riot act: The status quo in healthcare is now the enemy.
One way that leading-edge healthcare organizations are responding to the mandate for change is through the development of innovation centers where ideas to improve healthcare delivery can be rapidly designed, tested and implemented.
As chief innovation officer of the Penn Medicine Center for Health Care Innovation, Philadelphia, Roy Rosin, MBA, is three years into the initiative. The former innovation officer at the software company Intuit describes healthcare as “target-rich” and its practitioners as “passionate.”
In addition to addressing institutional targets, the center distributes innovation grants to applicants across the institution and then guides them through the innovation process with the objective of scaling those ideas that show promise for measurable impact in the areas of health outcomes, patient experience and new revenue streams.
“Healthcare is so interesting to me because there are all of these really passionate individuals on the front line, and they are lacking time and resources,” he observes. “I think a lot of times, their ideas just don’t go anywhere.”
Rosin acknowledges the barrier of conservatism in healthcare that may not exist in the world of software development, but he also points to a law of nature: inertia. Partner Voice talked with Rosin about how health care organizations can jumpstart their own version of change.
Most of the principles of change that Rosin and colleagues are applying at Penn have to do with overcoming inertia: How do you get started? How do you actually get something done?
“The biggest change in innovation over the last 15 years or so has been the methods of how quickly you can test ideas,” he explains, “ways to generate some data and evidence, not at the level of proof of an idea, but just to get it started.”
Those methods boil down to an essential four principles:
- Quickly get some contextual, observational insight. “Go and walk in other people’s shoes and really see for yourselves the problem in the context in which the problem happens,” he urges. “That principle of having to see not what other people say is going on, but what actually is going on is critical.”
- Problem definition. “The problem is so often defined in a way that either limits innovation or, frankly, it makes you literally solve the wrong problem,” he explains.
- Divergence. Based on empirical work by innovation scientists, the first idea is rarely the one that succeeds, Rosin says. Innovation thrives with multiple iterations and hence the need for divergence and the use of concepts like analogy, where you imagine how different industries would handle the problem.
- Super rapid-cycle innovation. “If you don’t have a lot of time and resources and you want to see if there is anything valuable residing in these ideas, you need a way to get off the mark a lot faster, and there are techniques for doing it way, way faster,” Rosin says.
Solving the right problem
Properly defining the problem is a critical task, Rosin explains. In his recent talk at the Health Information Management Systems Society, he shared a story about being asked to solve a problem around time-of-day discharge that illustrates just how fraught with potential error this initial step can be.
Upon hearing the problem of discharge happening later and later in the day, most people would assume that the solution was moving the metric to an earlier time in the day.
Through contextual observation (or storytelling), he learned that there were 50 liquid oncology patients and 10 beds. The real need was to get some people out in order to intake others, and in Rosin’s mind, the problem changed from time-of-day discharge, to length of stay.
He pressed on, asking why a shorter length of stay was desired. As soon as he asked that, he realized that the goal was the time it took to get a bed. When he was told that patients needed a bed so that they could receive their chemotherapy, the problem definition changed again.
“So, it’s not time-of-day discharge, and it’s not length of stay, and it’s not time to bed, it’s actually time to treatment,” he says. The new definition of the problem changed the potential solutions dramatically, including outpatient clinics and other ways