Thursday, March 1, 2007

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.


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.

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