In Innovation; Emphasize the Big Idea: Readings on Innovation from The Daily Drucker (HarperBusiness, 2004)

Prologue: Here Peter Drucker speaks of making a list of your three best ideas and acting upon them. What are the three big ideas in health care innovation?

My top three are:

1) learning from health care consumers—through focus groups, satisfaction surveys, and clinical experiments -- what they want and quickly delivering it;

2) engaging caregivers on the front lines of care, asking them what works best, and implementing necessary changes;

3) seeking effective, systematic, and understandable ways to educate patients at the points of care at which they need the information the most and filling in the gaps.

Others have loftier goals – universal coverage, ubiquitous information systems, unified collaboration. I applaud their efforts. My innovations are more modest – but more doable. One man’s frog eggs are another man’s full-grown frogs.


In Innovation, Emphasize the Big Idea

Innovative ideas are like frogs’ eggs: out of a thousand hatched, only one or two reach maturity

The innovative organization understands that innovation starts with an idea. Ideas are somewhat like babies – they are born small, immature, and shapeless. They are promise rather than fulfillment. In the innovative organization executives do not say, ”This is a damn fool idea.” Instead they ask, “What would be needed to make this embryonic, half-baked, foolish idea into something that makes sense, that is feasible, that is an opportunity for us?”

But an innovative organization also knows that the great majority of ideas will not turn out to make sense. Executives in innovative organizations therefore demand that people with ideas think through the work needed to turn an idea into a product, a process, a business, or a technology. They ask, “What work should we have to do and what would we have to found out and learn before we can commit the company to this idea od\v your?” These executives know that is as difficult and risk to convert a small idea into successful reality as it is to make a major innovation. They do not aim at “improvements” or “modifications” in products or technology. They aim at innovating a new business.

ACTION POINT: Make a list of your best three ideas. Then make a list of the key pieces of information you need to know and the major work that needs to be done before these ideas can blossom into a new business. Now pursue the best idea, or if none is practical, start again.

Clinical innovation - Information Prescription: A Primary Care E-Mail Innovation from America’s Heartland

Scarcely a day passes without another commonsensical innovation coming from a doctor who’s been there and done that and who knows what doctors can deliver and what patients want.

In this case, that doctor is Charles Smith, MD, 57, a practicing family physician in Little Rock, Arkansas, who wears three hats:

• founder in 1998 of EDocAmerica.com,
• associate dean of the University Of Arkansas Medical Sciences College Of Medicine (UAMS) in Little Rock,
• teacher and attending physician at UAMS.

Dr. Smith is also the Executive Associate Dean for Clinical Affairs at the University of Arkansas for Medical Sciences (UAMS) and is a Professor in the Department of Family and Community Medicine there, where he has been working since 1989.

In his role at the University Of Arkansas Medical Sciences College Of Medicine, he also serves as the Medical Director for UAMS Medical Center and as Physician Director of Medical informatics. He is responsible for initiating and implementing software programs to assist physicians to provide care at UAMS and for overseeing quality of medical care at UAMS. Dr. Smith is clearly a man of all seasons for all the right reasons.

Dr. Smith has long been a leader in American Academy of Family Physicians circles. In his own company, EDocAmerica, Inc, he has gathered together 12 primary care national leaders – 10 family physicians, 1 internist, and one psychologist – to answer emails from concerned patients on a secure website, eDocamerica.com. In his career as a family doc, Charlie has learned about ½ of patients don’t really need to come to the office to be seen – what they want and need is more information about treatment and doctor options.

Employee groups who desire to provide another health benefit for employees are the source of EDocAmerica patients. Employers pay a per use per month access fee, which usually averages less than $1 per use. EDocamerica.com has 350,000 eligible users – more than 1 million including family members, who are eligible to use the service.

Dr. Smith and his team are discriminating about what they can and cannot do. What they can do is “prescribe information” – give information, tell patients where to go to find information, link them to other relevant information websites, and tell them where to seek second opinions. What they cannot do is make diagnoses and prescribe drugs. Dr. Smith and his primary care crew say many patients visit their site on multiple occasions, and follow-up visits are welcomed.

Dr. Smith says the whole experience of communicating with patients from these employer groups has been gratifying. Because of email’s anonymity, patients share information they would not tell their personal doctors. Also, and this is a crucial point, employer groups and patients say the service saves money. A recent study of 1.2 million claims of those using the service against those who did not and found a 16 % reduction in fees, about $89 per claim, in users versus non-users.

Smith and his group have a partnership with revolutionhealth.com, and Smith’s blog can be found there in the list of Revolution Health bloggers who share insights to revolutionhealth.com visitors. You can also visit his blog at edocamerica.blogspot.com,

To conclude:

There once was a family physician named Smith,
Who sought to serve others through e-mail pith.
So he gathered one dozen primary care buddies,
Who were not stick-in-the-mud fuddy-duddies,
And they dispensed information forthwith.

HIMSS - HIMSS-07 Hangover

As everybody who is anybody in health care knows, the Health Information and Management Systems Society (HIMSS) supplies unparalleled leadership in health care for managing technology and information through its publications, educational opportunities, and advocacy – but first and foremost, through its annual meeting and exhibition gala.

That said: Hello out there, you health care IT crazies, those of you with a HIMSS-07 gala hangover. A hangover means either suffering from excess or carry-over knowledge from an earlier experience. HIMSS certainly had an excess of IT information, too much for an ordinary mortal like you to absorb.

But you loved it. As Oscar Wilde so famously said, “Nothing succeeds like excess.” This is especially true in health care information technology. And you will, no doubt, retain lessons learned from your week-long, in-depth immersion into IT health care at HIMSS-07. For the geeks, nerds, and technophiles among us, this was an exciting – perhaps over stimulating - event.

Wildly Successful

All reports indicate HIMSS07 was wildly successful, albeit overwhelming. I congratulate its organizers, who, in addition to transmitting the message that IT will go a long way towards saving health care, helped to resuscitate tourism in New Orleans.

More than 25,000 of you gathered in New Orleans the last week of February to hear hundreds of speakers, to meet thousands of contacts, and to view more than 900 exhibits. The advance slogan on the exhibits was,

“Innovations will happen. ‘What if?’ shakes hands with, ‘We can do that.’ And something new is born. Imagine that that happening hundreds of times day all around you.”

Sounds like an Innovator’s Dream to me.

Cyber Uber Alles

By now, in your hangover phase, you might think health care IT has the hardware, software, and brainware to make thousands of health care fixes, to repair and bridge most faults in our health system. and to coordinate it all, seamlessly, of course. Why not? Let’s face it. In many respects, you have just seen and heard the computer glorified as a cure-all of health care.

The Big Dogs

The big dogs – Steve Ballmer, CEO, of Microsoft, now on an acquisition binge to become the number #1 player in the health care space, General Colin Powell, USA (ret), a board member of Revolution Health, Inc., Michael Leavitt, Secretary of HHS, dedicated to the proposition of a national IT structure, Newt Gingrich, everyone’s alternative for President and self-styled IT health care guru, and Dr. Stephen Covey, everyman’s motivational speaker and author of Seven Habits of Highly Effective People – were there.

A Wild Idea --IT More About Cultivation of Ideas Than Technology

What a time you had! Garry Baldwin and Jim Molpus, reporting for Healthleadersmedia.com immediately after the conference, report the highpoint for them was a crazy idea – that effective health care IT might be more about ideas than technology.

“Thursday morning Harry Lukens, CIO of Lehigh Valley Health Network in Allentown, Pa., described how the community health system reaches out to the staff to develop new ideas. As Lukens pointed out, the session was not about technology, but rather the cultivation of ideas. For the last few years, Lukens has chaired a group called the “Wild Idea Team.” It sports a rotating membership of 18-25 people, representing all areas—and levels—of the organization.”

“Staff members bring ideas about ways to use technology to improve operations. The only rule for the discussion, Lukens said, was ‘no snickering.’ It’s a way to encourage participation. Ideas are vetted through a series of steps including informal evaluation, research, formal evaluation, and test. Most ideas do not make it to actual implementation. Nevertheless, the meetings are a way for the IS staff to stay in touch with their internal customers.”

“Lukens’ punched up his talk by using an interactive audience response system. Using a small handheld device, we were asked to vote on various questions, with the results tabulated and presented on his PowerPoint. Most in the audience had no formal manner of deriving technology ideas from the staff. Lukens uses the same technology at senior staff meetings to solicit feedback on strategic planning proposals. Allowing people to vote anonymously on ideas encourages more honest responses, he pointed out.”

Luken’s "Wild Idea" Team Should Surprise No One

Luken’s “wild idea” is engaging people in the front lines of the organization to submit ideas, and inviting feedback and haggling with them may be just as important, or more so, than deploying technology to improve the system.

That this wild and crazy approach works should surprise no one. After all, it’s just a swing back to Naisbitt’s High Tech/High Touch megatrend prediction – for every technologic advance there’s a counter-balancing human response.

It didn’t surprise me. In my February 25 blog, “Disruptive Innovation at Work: One Solo Doc, One Internet, One Room, One Year Later,” I described how one “Wild and Crazy” family physician, Gordon Moore of Rochester, New York, used the Internet to transform his practice into a highly cost-effective, quality-driven, patient pleasing operation.

Nor would it surprise Tom Peters, the Wild and Crazy management guru of “Ready Fire Aim! “ fame. Ever since Tom Peters and Bob Waterman burst onto the scene with their book Search of Excellence in 1982, Peters has become the guru on innovation.

Focus on People

In the management world, Peters and Waterman are known for setting forth these practices of successful companies – IT and non-IT, all focusing on people.

1. A bias for active decision making –“getting on with it.”
2. Close to the customer – learning from people served by the business.
3. Autonomy and entrepreneurship – fostering innovation and nurturing “champions.”
4. Productivity through people – treating rank and file employees as a source of quality.
5. Hands-on, value-driven – management philosophy that guides everyday practice—management shows its commitment.
6. Stick to the knitting – stay with the business you know
7. Simple lean staff –some of best companies have lean HQ staff.
8. Simultaneous loose-tight – autonomy in shop floor activities plus centralized values.

Peters’ Principles

Here are 26 of Peters’ current health care beliefs on how to fix the health care system. It’s a bit of a rant, but effective.

1. Fully utilize Physician's Assistants to do routine work in a timely fashion. ("Doc in a Kiosk" at Wal*Mart is great!)
2. Maximize Outpatient Services!
3. Short hospital stays work!
4.Support home care to the max. (E.g., "Declaration of Independents"—Beacon Hill/Boston)
5. STOP THE 100K+ NEEDLESS DEATHS—much/most of the "quality stuff" is eminently fixable. (Don Berwick for President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!)
6. FLIP HC 177 DEGREES TO EMPHASIZE PREVENTION & WELLNESS. ("Steps" are being taken but not enough. Med schools: Awful! Insurers: Little better. Support for appropriate-proven alternative therapies is an important part.) (HUGE INCENTIVES FOR EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)
7. "Boomers" will determine HC's (very different?) future. (They are from a different & demanding planet compared to yesterday's Oldsters.)
8. "Focus on Women." (It's my generic—and correct—rallying cry, and it applies to HC in spades, women-as-patients-with different-woes-than-men; women-as-HC decision makers at the "consumer"—and commercial—level.)
9. "Patient/Consumer-driven" may be a buzz phrase bandied about all to easily ... but it is true. (And changes the game.)
10. Reduce incentives for unnecessary tests. (Malpractice caps would help, though the issue is complex. Insurers-HMOs doing so-so on this.)
11. OUTCOME-BASED MEDICINE IS A MUST! (There is a long, long way to go!) (Measure until you're blue in the face!)
12. Science-based medicine is a terrific idea!! (Many-most "therapies" unproven scientifically, uneven in application when proven.)
13. Over the next 5-25 years, the Life Sciences Revolution will make the likes of the "info revolution" look like small beer. (Get ready.)
14. Radical increase in "best practices" utilization—inculcate in Med school!
15. Med school "revolution" imperative—outcome-based medicine, abiding emphasis on Wellness & Prevention, etc.
16. Get info to Patients! (HIPAA mostly good.—"I wanna see my records!") (Detailed hospital-by-hospital, disease-by-disease, doc-by-doc success records a must—despite controversy.)
17. Upgrade IS-IT in the entire system, starting with acute-care nstitutions. (Current grade: D-.) (Winners include: Indiana Heart Hospital; Inova Fairfax Heart Institute.)
18. Healtheon WebMD-like (if it had worked) mega-, integrated-info network will-should emerge. (A healthcare Google+?)
19. MOVE HEAVEN & EARTH TO IMPLEMENT ELECTRONIC MEDICAL RECORDS. NOW.
20. By hook or by crook, something approximating basic universal care , starting with kids—50 state partial experiments is a help; some are quite far along. ("Market-based" as much as possible—but this is far from a "perfect market.")
21. Deal with the enormous HMO "I want my doc" perception problem. (Fact: MARCUS WELBY, STATISTICALLY, AIN'T THAT GREAT A HEALER IN TODAY'S "HIGH SCIENCE" WORLD! Incidentally, same perception problem re Congress, schools. "My Congressman is great, Congress has 434 other crook-clowns." "My kids' school is good, the system is awful.")
22. Blitzkrieg of Patient/Customer/Citizen education (e.g., re "outcomes-based health care ," "Get the most for your health care dollar"). (Corporate cuts should motivate this.)
23. "Healing-centric"care supported. (E.g., Planetree model—reduces future problems.)
24. Emphasize front-to-back "customer care " practices—cuts waaaaay down on malpractice claims among other things.
25. Specialization in acute care works wonders, regardless of howls! (E.g., Shouldice/hernia repair.)
26. Shorten the FDA approval process. (Tom , age 63, wants the good new stuff and will accept associated risk; so will most boomers-geezers.)
From Peters to Reece to Bullets
As you can plainly see, Peters stresses IT as it applies to people. Here’s my take on what he said.
• Delegate people other than doctors to deliver care.
• Serve patients in decentralized outpatient and home settings.
• Cater to women and baby boomers.
• Measure providers’ performance.
• Use specialists in hospitals.
• Cover people’s every insurance need.
• Engage and educate patients at every level.
• Ease, facilitate, and shorten patient care.

No Reason to Go On

I could go on.

But I don’t need to. You’ve been to HIMSS-07, and you’ve heard it all.

This year HIMSS was wild and crazy.

Just wait until next year!

Clinial innovation - Life Line Screening: An Example of an Innovation that the Public Wants and Will Pay For

In my last blog, I cited Peter F. Drucker’s comment that the key to a successful innovation is one that customers want and will pay for. This will become increasingly important in consumer-driven health care. In this new environment, patients will pay more out of pocket, will take more responsibility for their health, and will seek moe value for their dollar.

No Better Example

I can think of no better example of a successful innovative company in the health care field than Life Line Screening, headquartered in Cleveland, Ohio. It operates in 48 states and has teams of nurse and other professionals riding in more than 100 mobile vans to conduct screening clinics. These clinics feature two basic technologies: non-invasive ultrasound to screen for carotid artery disease, abdominal aneurysms, peripheral vascular disease, and osteoporosis; and blood tests to screen for diabetes and coronary risk (lipid panels and C-reactive protein).

Marketing

Life Line Screening markets their services by local and national media and sets up appointments for screening sessions in local neighborhoods, places of worship, and community and senior centers. The charge is $129 for four ultrasound vascular screening and $45 or less for the blood tests. Groups of well-qualified bck-up physicians interpret results, help contact patients, and refer them to local physicians should something abnormal occur. The company continues to grow each year.

Patient Satisfaction

In my own circle of friends, I know of at least half a dozen who get screened each year and who consider the screening an annual not-to-miss ritual well worth the price.

Why is Life Line Screening so successful? I think the reasons are quite simple.

• It’s personal -- Who among us hasn’t known of someone who died or been incapacitated by a sudden and unexpected stroke, heart attack, ruptured abdominal aneurysm, fractured hip, or has suffered the ravages of diabetes?
• There’s something magical about directly visualizing a vascular lesion in time to so something about it.
• It answers the fundamental question asked by admirers of innovation: “Now why didn’t I think of that?”

clinical innovations, Drucker, Readings on Innovation from The Daily Drucker (HarperBusiness, 2004)

Prologue: From time to time, I will reprint a daily entry from Peter Drucker’s book, The Daily Drucker. These entries may serve as an agenda item for physician entrepreneurs who seek to create a new company or introduce a new service. In his March 2 entry, Drucker makes this salient point about a successful innovation,, “Do customers want it and will they pay for it?” In tomorrow’s blog, I will give an example such an innovation.

Test of Innovation

2 March

Measure innovations by what they contribute to market and customer.

The test of an innovation is whether it creates value. Innovation means the creation of new value and new satisfaction for the customer. Yet, again and again, managements decide to innovate for no other reason than they were bored with doing the same thing or making the same product day in and day out. The test of an innovation, as well as the test of “quality” is not “Do we like it?” It is “Do customers want it and will they pay for it?”

Organizations measure innovations not by their scientific or technological importance but by what they contribute to market and customer. They consider social innovation to be as important as technological innovation. Installment selling may have had a greater impact on economics and markets than most of the great scientific advances in this century.

ACTION POINT: Identify innovations in your organization that are novelties versus those that are creating value. Did you launch the novelties because you were bored with doing the right thing? If so, make sure your next new product or service meets your customers’ needs.

Clinical innovation - Seven Sources of Innovation: A Devastatingly Brief Review with Concrete Examples

There are seven fundamental sources of innovation,
of which practicing physicians should have knowledge.
These innovations offer a reference framework
that may lead to a better and more balanced life
for doctors, patients, and the health system too.
There is always a better way to do things.
It is never too late
to innovate.

First is the unexpected --
The unexpected success,
The unexpected failure,
The unexpected outside event.
This innovation may be something as simple
As your patients spreading by word of mouth
that you see patients on time,
or they get their money back.
Or it may be giving patients access
to interactive online videos
to have and to hold,
to download and review again and again,
and to share with their families too.
The videos explain exactly what to expect
ror a surgical procedure or devices, techniques,
and methods to control your chronic disease.

The unexpected may be something as simple,
as patients giving their personal histories online.
When guided by a well-designed clinical algorithm,
patients tell their own stories on their own time
from their own uniquely personal point of view.
No one knows their symptoms better than they.
All patients need is a little guidance and direction
to channel their story into a coherent narrative.
by so doing doctors can document the exchange.
and save time and create a record,
reference letter and a claim document
for themselves, payers, and patients.

Second is the incongruity
Between realities as it actually is,
and reality as it assumed to be or “ought to be.”
Call this ‘disruptive innovation,” if you wish.
Maybe all things “ought to be done” in hospitals.
The incongruity is patients prefer things be done
in free-standing ambulatory care centers,
maternity centers, geriatric centers,
or better yet in their own doctor’s office,
with more time with their doctor,
with nothing between them and him or her,
but a feeling of a deep personal relationship,
or best yet in the comfort of their homes,
far removed and remote from hospitals.
Homebound patients prefer to have
vital signs, weight, and complications
monitored from distant audio-visual devices,
initiated abd controlled by themselves
from to their own beds in their own home,
rather than traveling to
some distant ER, office, or hospital.


Third is the recognition of process need.
There often needs to be changes in how we do things.
Examples of this innovation are rapid access scheduling,
seeing patients on the day that they call,
or rapid methods of patient evaluation,
as practiced by California Emergency Physicians,
or by consolidating receptionists, secretaries,
registration clerks, paraprofessionals, specialists,
laboratories, physician therapy units, pharmacies,
and high tech imaging and treatment devices
into one building separate from the hospital
in a facility known as a Big Box,
owned by docs, hospitals, and investors.

Fourth are changes in industry or market structure.
A prime example of this is managed care.
Managed care is negative for most practicing doctors.
It makes them quasi-employees and mere technicians,
subject to repeated review for utilization patterns,
to systematic reimbursement reductions,
to humiliating, frustrating, and costly claims rejections.
For other doctors with business ambitions,
managed care is a positive, fateful event,
a chance to become overlings in the suprastructure,
rather than underlings in the infrastructure,
to be the hammer rather than the nail.
It prods some doctors to seek greener pastures.
Managed care jobs prompt them to form
and to lead integrated groups and hospitals.
Doctors become a hybrid that has crossed
the Great Divide called physician executives,
who creates guidelines, best practices,
and quality indicators.
to maximize health
and minimize disease.

Fifth is demographics or population changes.
Who would have dreamed demanding baby boomers,
would have sought to stay and look young forever:
would have striven to have their knees and hips done
in middle age to compete as weekend warriors;
would have insisted on having Botox injections,
tummy tucks, face lifts, eyelid lifts,
nose jobs, neck smoothing, and collagen injections
to hide the relentless advances of aging and living;
would have undergone a barbaric procedure
known euphemistically as liposuction.
Who would have thought a movement
Deemed consumer-driven health care,
would give health consumers freedom, choice,
and incentives to rate hospitals and doctors?

Sixth are changes in perception, mood, and meaning.
Who would have imagined disease management
would transmigrate quickly into wellness management,
that smoking would be verboten everywhere,
in offices, bars, public places, inside cars and homes,
transfats, whatever they are, would be banned
every café, restaurant, and eating establishment,
obesity would make you an employee non grata.
chubbiness would replace smoking as a social No-No.
fatness would be the leading cause of diabetes,
and be held responsible for a host of other diseases,
and would be tied to poverty.
and even to the fate of the human race,
and decline of Western civilization?

Seventh is new knowledge, scientific and nonscientific.
Who would have thought that someday, somehow,
medicine would replace every organ save the brain:
would deploy stem cells to regrow spinal cords,
brain cells, Islets of Langerhans, and
even repair damaged hearts, and may be cure disease:
would use drugs would inflate a certain organ:
would personalize cancer treatment in such a way,
as to turn it into just another manageable disease:
would “virtually” view your bronchial tree or GI tract,
spotting those tumors without intrusive orifice probing?
Who would have thought that someday holistic support -
meditation, hypnosis, prayer, laying on of hands,
vitamins, herbs, roots, spices, and weird concoctions,
would be as important to patients as scientific advances?
Who would have thought patients would need gurus and poets,
just as badly the rest of us need nerds, geeks, and techies?

But how do you tap these seven sources of innovation
First, form an innovation team inside your practice.
Second, have your team meet frequently.
Third, name a nurse as Chief Innovation Officer.
Four, ask: How can we do things better?
Five, ask: How can I, the doctor, do things better?
Never, never, get discouraged or distraught.
There is always gloom for improvement.
And always remember.
Even come December,
it is never too late
to innovate.

References

1. Drucker, Peter, Innovation and Entrepreneurship, Practice and Principles, Harper and Row, 1986

2. Reece, Richard, Innovation-Driven Health Care; 34 Key Concepts for Transformation, Jones and Bartlett, 2007.