How to Build a Culture of Innovation From the Inside Out

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“How do you inspire and enable innovation in a large organization?”

That’s the question I grapple with daily as director of Kaiser Permanente’s health care innovation center. I’ve observed that it isn’t sufficient to have a dedicated Innovation Center, an Innovation & Advanced Technology Group, or in-house Innovation Consultancy design group – all of which Kaiser Permanente has. The real question to solve is: “How do you create a culture that enables innovation throughout an organization?”

To explore answers to that, this week I am joining with physicians, nurses and design thinking, quality and innovation experts from the United Kingdom’s National Health Service and Kaiser Permanente for three days in South Devon, England, at the NHS Horizon Centre for Innovation, Education & Research in Healthcare, to share successful failures and best practices in innovation.

One contribution the NHS already has shared with the extended health care innovation community is a guide that helps leaders enhance the conditions for innovation: “Creating a Culture of Innovation.” Given that organizational leaders’ behaviors have a disproportionate influence on creating a culture that either hinders or aids innovation, Lynn Maher and Helen Bevan of the NHS Institute for Innovation and Improvement and Paul Plsek distilled the organizational research on innovation into a helpful “how to” guide outlining the seven dimensions of culture that support innovation. These principles, summarized below, can be applied to any organization.

So how can you begin building your own innovative culture — and how have we used these principles at Kaiser Permanente?

Risk-taking: Establish a climate in which people feel OK trying out new ideas by not shutting down ideas before they’ve been vetted. Leaders should demonstrate they are more interested in learning from failure than punishing people for it.

To foster innovative thinking at Kaiser Permanente, our Information Technology leadership created an Innovation Fund, an internal program that provides seed funding and support to teams of doctors and employees to facilitate the rapid prototyping of novel IT ideas and diffusion of successful innovations. Leadership also created iLabs, an innovation lab that serves as a technology research, advisory and software prototyping group that works with Kaiser Permanente innovators to help develop technology solutions for health care.

Resources: Resources are meant in the broadest sense of the term here. The traditional definition signifies an organizational commitment to innovation, but resources need not always be concrete. Time, permission and autonomy to innovate may be what is needed. For example, Kaiser Permanente’s Innovation Fund not only provides seed funding, but access to mentors and tools to jumpstart innovation.

Knowledge: There must be free-flowing information inside and outside your organization on what’s effective, what is not effective, and what others are working on. It is particularly helpful to see what industries outside of your own are doing because knowledge from dissimilar organizations helps you see new connections between concepts. In that vein, I’ve brought innovation teams from Kaiser Permanente to visit innovation labs at McDonald’s and Bank of America; our learnings from those visits most inspired the design of our Sidney R. Garfield Center Health Care Innovation Center.

That’s also why my team visited the Mayo Clinic Center for Innovation in March and why this week we’re visiting the NHS Horizon Innovation Centre at Torbay Hospital in South Devon, England, where we’re learning how the NHS has enhanced the recovery process after colorectal surgery and how virtual reality surgical simulators are used for training in ophthalmology and inner ear surgery.

As the experts from the NHS remind us, consumer giants outside the health care industry recognize this. That’s why Procter & Gamble has a stretch goal that 50 percent of its new product ideas must be inspired from the outside. That’s why research of scientists’ notebooks has shown that the most creative scientists are the ones who get inspired from a broad array of external sources.

Goals: When aspirational goals are clearly defined, leaders signal that innovation is important. These goals clarify why concepts are important but how they should be implemented. An overarching Kaiser Permanente goal is to help shape the future of health care – and we look to our employees to figure out how we will do that.

Rewards: Rewards for innovation are symbols and rituals whose main purpose is to recognize innovative behavior. They signal how much value is given, or not, to the efforts of individuals and teams who come up with new ways to help an organization achieve its strategic goals, Maher, Bevan and Plsek explain in their guide. But be aware that monetary incentives are not the primary drivers for innovative thinkers. Two proven incentives that drive innovation are more autonomy to innovate, and professional development opportunities that support an innovator’s career path.

Recognition: Giving innovators a chance to present their innovations in a larger group is a powerful form of recognition. Kaiser Permanente created an internal innovation-sharing group called the Garfield Innovation Network so employees can present their projects and feel recognized for their efforts.

Tools: Give people a set of tools with which they can innovate. At Kaiser Permanente, our Garfield Health Care Innovation Center is a tool. Other tools are the IDEO-inspired human-centered design methodology and the Institute for Healthcare Improvement metrics methodology used by Kaiser Permanente’s Innovation Consultancy. (IDEO is a design group that pioneered a human-centered design process involving observation, storytelling, synthesis, brainstorming, prototyping and field-testing.)

Relationships: The final characteristic of an innovative culture is relationships among people. Research shows innovation is rarely the product of a lone genius – instead it comes from enabling diverse and divergent opinions to come together to holistically solve problems. That is something we do really well at our Garfield Center by encouraging networking among innovators both within and beyond Kaiser Permanente.

Once you’ve built your innovative culture with the building blocks above, you will likely create surprising projects to improve health care in new ways you did not think possible.

For example, here are three Kaiser Permanente projects born from innovative thinking on the front lines of clinical care:

– Text messages sent to members reminding them of upcoming appointments has led to a decrease in no-shows and gives members the information they need in the format they want

-A human-centered design program that equips nurses with neon-yellow, non-interruption wear and a sacred process and space for drawing medications has significantly reduced medication administration errors

– A technology-enabled Microclinic being rolled out in shopping centers and suburbs was designed in part by patients with foam boards, plywood and electrical tape acting out scenarios in a low-fidelity, rough mock-up prototype model.

To learn more, go to www.kp.org/innovationcenter.

To join a network of innovative health care organizations, check out the Innovation Learning Network, a non-profit sharing the joy and pain of innovating in heath care.


And to hear what we learned this week about inspiring innovation with NHS at our “Innovation Summit” in South Devon, England, follow the dialogue on Twitter at #kp&nhs and stay tuned for a video interview on THCB coming in early June.

Jennifer Ruzek Liebermann is the director of the Kaiser Permanente Sidney R. Garfield Health Care Innovation Center. She has been involved with the Garfield Center since January 2005, when several Kaiser Permanente leaders asked the question, “How might we create a ‘Unit of the Future’ at Kaiser Permanente in which we can test how new technologies impact our front-line staff?” Jennifer led the cross-functional team to develop, fund, and launch what is now the Garfield Center with a multidisciplinary focus that also includes testing Kaiser Permanente’s new facility designs.

Suggested Additional Reading

BBC News Online: “Could US Firm Hold the Key to Health Reform?”
Wired Magazine: “The Good Enough Revolution: When Cheap and Simple Is Just Fine”
Fast Company: Most Innovative Companies (Healthcare)

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11 replies »

  1. Dear Jennifer,
    Great post. This I believe is the need of the day for most hospitals or medical practices (to keep it simple) in this era of new healthcare IT wave introduced through the federal push for nationwide EHR implementation.
    I agree that the practices should be more willing to take calculated risks, with sufficient knowledge about the system which they are adopting.
    I think today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment.
    Do you all agree with me ?

  2. As a retired management consultant and a cancer patient who has undergone more than half a dozen procedures requiring hospitalization in the last two years, I have viewed a number of opportunities for improvements and gains in efficacy and improved patient outcomes.
    Most that come to mind are relatively low cost/no cost and don’t involve redesigning of “monuments” nor do they require drastic innovation. They do require alterations in human behavior, from the top of the organization to floor and lab personnel.
    Improved EMR and other technologies may be desirable but I have had physicians tell me how the new EMR has denied then access to all the “jotting” and “notes” they had written about their patient that were instrumental in understanding the patient’s condition and determing the best course of treatment. Immersive information that is of meaning to the writer is difficult to retract from a flat screen.
    And until we improve the behavior and performance of staff and redo the outmoded systems and processes they depend upon, little real permanent progress in patient outcomes will be difficult to achieve. The amount of low lying fruit in terms of improvements that are available that I have personally witnessed are considerable. Wasted motion, poor work flow, failure to follow basic protocols all offer significant opportunities.
    Varied and complex staff hours among floor personnel which confound rather than aid good communications and handoff of patient data from one staff member to another is a clear example of a setting ripe for error.
    During my hospitalization’s I have often wondered “who’s in charge?”. My experience has taught me that I need a health care advocate in my corner to protect me from the potential of decisions and treatments that may not be in my best interest or consistent with the risk elements that one is willing to entertain.
    John W. Burns

  3. Dear Jennifer,
    Thanks for the detailed post.
    In my opinion, you have to look at innovation from a strategic point of view. Any organization basically enables its resources to fulfill the needs of its customers, thus creating value. Innovation is not just technological in nature it is also novel ways of delivering existing technical solutions. All this is unique to the environment where care is delivered – regulatory, financial, availability of technology, geographical, demographic etc.
    One of the ways by which some organizations, Intuit springs to my mind, innovate and create value is by making two things:
    1. Make every employee and customer a owner in the organization by making them feel so much part of the organization that they start looking the organization as their own. This spurns innovation as they both look at ways to identify and imagine how better services can be provided that is needed and relevant.
    2. Bring employees, who deliver services, closer to customers and empower them to innovate and create value by letting them implement small-scale changes. This closeness is important to identify needs of customers better and also to innovate within the environment.
    Most of Intuit’s innovation in developing Quicken comes from customer support staff as they are closer to the customers.
    I feel the separate ‘innovation center’ is a good idea to foster innovative technical solutions but may not be adequate to innovate service-oriented solutions. e.g. In some regions the non-availability of parking space close to the OPD may be the reason for the particularly high no-show rates and front-line service staff would be able to identify this need for say valet parking as a solution to improve waiting times and ultimately better outcomes due to better follow-up. These things would never be picked up by the ‘innovation center’. You may need to balance both approaches to innovate in a service-oriented organization. You may have to effectively widen the ‘innovation center’ to encompass everyone in the organization. No mean task!
    If you are worried about more ’empowered’ employees breaking the rules and bringing disrepute, create a complimentary ‘boundary’ system to identify and prevent such breaks from happening.
    Developing a learning organization that systematically creates evidence by its work and uses this evidence to identify better ways to serve and create value (for health care organizations it is better outcomes) is the key to develop sustainable innovation and value creation.

  4. This is a very useful guide for an industry that is in desperate need of organizational reform, from doctor’s offices to large health plans. As far as the rewards go, however, it is unclear to me how “professional development opportunities” are defined tangibly. It is also difficult to think that internal financial incentives would not greatly aid in your efforts, despite your insistence that they are less important.
    Please visit my blog on the business of health care in America:

  5. “The key is employee satisfaction that is built from within – this includes recognition, participation and empowerment.”
    This quotation from the first commenter is accurate. Buzzwords and “programs” from organizational re-invention types do nothing positive in almost all cases, although concepts behind the programs generally have validity and therefore it is potentially useful for management at all levels and average workers to have a decent awareness of and understanding of the concepts.
    Unfortunately the very nature of large organizations – even of many small organizations – is such that innovation is almost always discouraged. The reason for that is the same as that underlying the saying that “no good deed goes unpunished”.
    Conformity, pretense, flattery towards those above and so on are the behaviors that large organizations encourage by dint of being large organizations.
    Good for Ms. Liebermann to try to encourage innovation, but she is moving against a stream of opposition far stronger than she.

  6. Jennifer, thank you so much for your post. Not every day you can find such a detailed info/tips on the subject. I’m bookmarking this website, will be back for more.

  7. Jennifer, thanks for your post. I guess the challenge for KP is as much external as it is internal. While the KP model holds great promise as a fundamental underpinning to preserving and improving high quality, efficient healthcare delivery, it has yet to capture the imagination of a broader base of consumers across the US. KP needs to better highlight how its innovation is leading to equal or better clinical outcomes, more effective population health management, and efficient delivery of care. This innovation has to result in annualized medical trend of low single digits which can in turn be merchandised to employers who still control the purchase of healthcare for over 180M Americans.
    Building a culture of innovation through empowerment, recognition and relationships also requires aligned incentives. This is easier to achieve in a closed integrated system bit is difficult across multi-specialty siloed institutions.
    The great question is whether KP is a regional phenomena or a model whose time has finally come? I am biased in believing KP’s model and delivery system will be enabled by reform as Medicare and Medicaid cuts impact providers and hospitals.
    Can your internal innovation drive efficiencies that allow you to operate under Medicaid type levels of reimbursement and still maintain the culture that seems to drive these values? We know rationed reimbursement is coming. The NHS is operating in a system that manages public spend within 7% of GDP. We have a ways to go to get there. Will our docs be as chipper or engaged when incomes inevitably get cut ?
    It seems physicians are more inclined to sell their practices to the larger PHOs and hospital systems that are gobbling up independent practitioners at an alarming rate. How can Kaiser’s innovation and culture of creativity translate into brand value that can attract and retain those providers and in turn, the patients who trust them?
    Personally, my mother in law was treated over the last year through Kaiser for Stage 3 breast cancer and was delighted with her oncologists, surgeons and the collaborative culture allowing her and her providers to work together to determine the best courses of treatment.
    As for the NHS, they have a long way to go. However, they have already inverted the delivery pyramid with many more primary care providers and increasingly limited specialty and tertiary care. The US pyramid is about to invert over the next decade. The question is whether your care model will be compromised by this fundamental shift and go more the way of the UK as reimbursement is rationed – or will KP help the NHS graduate from rationed access and triage medicine to improved access, outcomes and population health.

  8. Hello,
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  9. We had many “consultants” come to our entity to help us “reinvent” and “redesign”, etc. – I’ll let you pick the term. What I found is that our little dept. was doing more for innovation then any of these consultants. The key is employee satisfaction that is built from within – this includes recognition, participation and empowerment. Once these are in place, innovation takes care of itself.