Monday, March 17, 2008

Clinical innovations, systems thinking - Short Take on Disseminating Innovation

What - Dr. Lyle Berkowitz, a practicing internist, chief medical information office of 120 person primary care group at Northwestern Memorial Hospital in Chicago, and program director at Szollus Innovation at Northwestern, called to discuss status of medical innovation in the U.S. – how to spot it, encourage it, spread it, teach it, embed it.

Why – If U.S. health care is to improve, cost less, and get better outcomes, it must innovate to crawl out of its present rut and fixed ways of looking at things.

When - It’s happening fast now as we seek ways and as innovation centers spring up to “fix” the “broken system,” or “mess,” whichever term you prefer.

How – To spread, innovations must be perceived as benefit with risks outweighing risks; must be compatible with values, beliefs, past histories, and current needs of doctors; must be relatively simple; must find ways to test validity; and be observed and tried out by early adopters.

Where -. Innovation centers have been set up at Kaiser, Virginia Mason, Northwestern, Cleveland Clinic, Minnesota state government, Mayo, and University of Pittsburgh – and no doubt others.

Who – Personalities who spread the word and make it stick include : 1) innovators (venturesome, risk tolerant, novelty seekers, who are willing to venture outside to learn); 2) early adopters (those who see the opportunity and seize it early); 3) the early majority (who see the light shed by innovators and early adopters and climb on the bandwagon); 4) the late majority (who see the success stories and view change as inevitable); 5) the laggards (who refuse to change under any circumstances and are chained to the past by social, organizational, or political constraints)

To make innovation work , rules are:

1) Find a sound innovation.

2) Support innovation.

3) Invest in early adopters.

4) Make early adopters’ activities observable.

5) Trust and enable those who want to modify or reinvent original innovation.

6) Give those who fail some slack time to re-energize their risk-taking zeal.

7) Lead by example,

8) Read Donald Berwick, MD, MPP, “Disseminating Innovation in Health Care,” JAMA, volume 289, pages 1969 -1975, 2003, for details.

9. Never, never, never give up.


kevinh76 said...

thanks for this article. However, I don't like your new how, what, where, when style, especially since the entries don't always fit the category. eg. Your what in this article was actually a who. Otherwise, I love your blog and read it frequently.

Sarah Fraser said...

I agree with the need to crawl out of the present rut and this goes for the most of Europe as well.

However, there is significant evidence about how good practice doesn't spread and to some extent the old Roger's theories are no longer relevant in our twenty-first century. I have written about this in "Undressing the elephant; why good practice doesn't spread in healthcare"

One of the issues that came out of the research was "pilotitis". How projects created by early adopters were not taken up by others because they were inherently designed in different contexts resulting in solutions that were not designed for the norm. This is a feature that is well known outside healthcare. In healthcare we are one of the few industries where we take one practice developed by one group and expect all the others to adopt it almost unchanged (like guidelines).

There are many other issues like this.

If the spread of good practice was simple, then it would have happened a long time ago in healthcare.

NurseDan said...

This article really hit home. I am currently getting my Masters In Healthcare Innovation at Arizona State University. Tim Porter O'Grady is my program director and the diffusion of innovation in healthcare is our focus. Your article provided a great summary of the issues surrounding healthcare innovation. The challenge really is providing the context for the late majority and laggards so that they will eventually adopt it. Sometimes, it is appropriate to cut the head of the snake off and drag those laggards along for the ride... If the world changes around them, eventually they will have to adapt or die!