Are Health Systems Ready For Innovation?
By Lauren Cheung, Senior Director of Strategy & Operations, Center for Digital Health, Stanford Medicine and Sumbul Desai, Vice Chairman of Strategy & Innovation, Department of Medicine, and Executive Director, Center for Digital Health, Stanford Medicine
When thinking of innovation in healthcare, many think implementation of a new technology is the goal. Technologies like Watson, telemedicine platforms, and electronic medical records (EMRs) have the ability to assist providers with clinical decision making, improve access, and boost efficiency. Organizations spend considerable effort in evaluating and implementing these new technologies. Once implemented, they then measure success by how well a technology functions. In healthcare, however, success often relies on the non-technical aspects of implementation. Many technology-centered innovation initiatives fail unless resources are dedicated to aligning the technology with proper organizational structure and culture, operations, reimbursement, and provider adoption.
Even when innovative new care delivery models are successfully implemented, organizational challenges to scaling often appear within traditional health systems. This is due to non-technical difficulties including operations, competing priorities, organizational structure, reimbursement, and clinical staffing.
Traditional health systems have well-established standard operating procedures and processes to support their clinical models. These standard operating procedures often break down when new models arise. For instance, the use of a call center may function well in a traditional clinical setting, but, when encouraging patients to interact with a system differently (e.g., through virtual means), the call center’s role must be re-examined. Do you teach the call center to describe and prescribe a telemedicine visit to patients or will they revert to scheduling in-person visits because it is what they know? Likewise, workflows and the metrics used to evaluate initiatives must be redesigned to address new modalities of care.
Even when innovative new care delivery models are successfully implemented, organizational challenges to scaling often appear within traditional health systems
Finally, the space a traditional care model uses may not be conducive to tech-enabled models of care and should be redesigned from the ground up rather than pieced together from what already exists, creating new privacy and patient experience challenges.
Redesigning an organization’s operations requires substantial investment. However, competing priorities and current reimbursement models often prevent organizations from investing sufficient resources into new models. It is difficult to invest in new care delivery models (that are often value-based) when traditional models continue to bring in revenue. Why invest large amounts of resources into a pilot project if it hasn’t scaled and the ROI is unclear? And yet, without resources, pilot projects often cannot scale because they are not designed to.
Traditional health systems often have very siloed organizational structures which must be broken down to foster innovation. Often multiple parties are involved in bringing innovative programs to life, including IT, Operations, and clinicians, and each party has its own mandates and priorities. Aligning and breaking down this chain of command and power structure in traditional settings can be near impossible unless everyone in the organization believes in and values true change. Without strong and aligned leadership, scaling innovation is often limited.
Finally, innovation requires provider adoption. We must encourage providers to move beyond traditional provider-centric practice patterns and must hire providers who are excited to practice differently. Providers must understand the benefits of adopting new technologies, a challenging feat as research is often slow to prove the effectiveness of new models of care. In the interim, physicians must be comfortable with ambiguity and iteration, which is challenging in itself.
Despite the challenges to innovating in healthcare, opportunities exist to create exciting and successful patient-centered care delivery models. To realize these opportunities, traditional health systems must rethink their approach to innovation. Organizational structure should be examined to find ways to incentivize innovation. Aligning and breaking down silos and fostering collaboration and teamwork will lead to support among stakeholders and hospital boards. Funds should be allocated directly towards innovation. And providers and their operational teams must be retrained.
The work to achieve all this is daunting. Nevertheless, the time for change in healthcare is upon us, which begs the question: can we change traditional systems enough to get the results we desire or must we first build a new system to change our traditional thinking?