Monday, August 6, 2007

Clinical Innovations - Wild, Crazy, and Creative Doctors

As editor for 11 years of Physician Practice Options, a monthly newsletter devoted to improving patient care through increased practice efficiency, I’ve noted many practices succeed by innovating rather than strictly through blocking and tackling and paying attention to management details.

It sometimes pays to be wild, crazy, and creative rather than hidebound. I believe in creative, innovative, and entrepreneurial doctors – individually and collectively – to make a difference. I believe we control our destinies. I believe physicians are the central decision makers in health care, and we must keep open to new possibilities. We are closest to patients, and we know what they need – and want.

Here are a few samples of the power of new ideas.

•A family physician in California comes up with the idea of “Be seen on time, or your money back.” He and his staff made sure the practice could deliver on the promise, and business boomed.

•Two Seattle internists, Garrison Bliss and Mitchell Karton, start a “concierge” practice, based on the idea patients will willingly pay for 24 hour access, more time spent with doctors, health counseling, and help navigating through the medical maze.

•Eugene Stead, MD, professor of medicine at Duke, seeing Vietnam medics come back with skills but no work, launches physician assistants movement.

•Marshall Zaslove, MD, a physician productivity expert, advises doctors to have a nurse follow them around on the office and then to turn to the nurse often and ask, ”How could I do this better?” Zaslove says this simple idea enhances productivity enormously.

•Practices begin creating the position of Chief Innovation Officer. The officer may be themselves, a nurse, the practice manager.

•Allen Wenner, MD, a Columbia, South Carolina FP, creates the Instant Medical History, software containing clinical algorithms allowing patients to create their own histories before seeing the doctor.. The software saves 6-8 minutes in each patient encounter and creates room for 5 new patients each day.

•Susan Baker, a patient satisfaction consultant, says patient satisfaction soars when doctors train themselves and staff to meet patient satisfactions during 15 “moments of truth” that occur in every patient encounter.

•Robert Berry, MD, A family physician in Greenville, Tennessee, an area with many uninsured patients, starts a “cash only” practice and lists his prices in his front office. The uninsured, who can’t afford to pay health premiums, flock to his office for care they can now afford.

•Harry Lukens, chief information offer at Lehigh Valley Health Network, conceives a “Wild Idea Team.” He put together a team of frontline people and to have them suggest “wild ideas” to improve care and please people. It has a rotating membership of 18 to 25 people, at all levels of the organization. Meetings, open to all new ideas, not matter how wild, had only one rule” “No snickering.”

Within five years, I predict health care organizations of all sizes, shapes, and functions – health plans, hospitals, practices, support groups, consultants, and supply chain vendors, health care associations, consumer groups -- will select a Chief Innovation Officer.

The Chief Innovation Officer will generate ideas, sift through them, pick winners, and lead organizations towards a future geared to productive change.

The CIO’s chief functions are to stimulate, generate, and instigate ideas, principally from below – from managers, employees, people on clinical front lines, patients, staffs in medical offices, from consumers and the public at large. Most workable new ideas generally do not come from the top rungs of an organization, but from service and interactive personnel on the front lines of care.

The CIO’s job is to keep ideas flowing and to try them out, again and again, failing again and again, then starting out again. My favorite definition at the moment for “innovation” is this one, which I read in the March 20 New York Times.

Innovation is a constant process of trial and error. You need the willingness to fail all the time. You have to generate many ideas and then you have to work very hard only to discover they don’t work. And you keep doing that over and over until you find one that does

What does a chief information officer do? Jonathan Lord, MD, chief innovation officer of Humana since 2002, says,

The CIO becomes the spiritual leader within the enterprise. His basic role to bring new ideas into health care and to find talented people who can handle ambiguity and who have passion for change – people who have comfort with new ideas, who can align beliefs, and who can co-create.

The CIO, in short, constantly co-generates idea, keeps the ideas flowing, and tests them out to see if they work or fail. Be your own CIO.


1. Marshall O Zaslove, The Successful Physician: A Productivity Handbook for Practitioners, An Aspen Publication.1998,

2. Susan Keane Baker, Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients, Jossey-Bass, 1998.

3. Richard L. Reece, Innovation-Driven Health Care: 34 Key Concepts for Transformation, Jones and Bartlett, 2007.


Unknown said...

Innovation is important in medicine. I thought it interesting however, that many of the examples you proposed would potentially be generated by another position: The Chief Experience Officer (CXO).

Innovation in medicine has 3 pillars: cost, quality, and service. Most patients are unable to differentiate service quality-- and docs would need to benchmark against other practices to understand differences.

That leaves consumer-driven innovation starting points of cost and service. A CXO-- walking through points of care from a patient's perspective-- can highlight areas needing innovation due to service not meeting office standards or where patients feel pricing is too high relative to the benefit.

The CXO approach can be a bit more focused on items that will drive patient referrals to the office, providing an alternate approach to innovation.

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