I’ve been thinking a great deal about the newly formed Center for Medicare and Medicaid Innovation. (CMI). This entity was established as a result of the Affordable Care Act (the new healthcare reform legislation) and its purpose is to “research, develop, test and expand innovative payment and service delivery models that will improve the quality and reduce the costs of care for” patients covered by CMS-related programs. The legislation gives this entity over $10 billion dollars initially and broad authority to figure out new ways of doing things better and differently than before. What is great about CMI is that they have the authority to run their programs much more like a business would without many historical governmental constraints. That’s great news for innovation, which is sorely needed in the U.S. healthcare system.
Among the key objectives that the administration has discussed is how to transition the collective mindset from one of healthcare to one of health. In other words, if a person is healthy, they do not need health CARE. This is a very important distinction; it puts the emphasis on prevention and wellness as opposed to what you do when somebody is already sick. In order to affect such a transition, there must be an emphasis on innovation to change the way we have traditionally looked at the healthcare world.
This is an interesting challenge and one that requires a great deal of thoughtfulness in how to approach the universe of innovation opportunities. As venture capitalists, I and my colleagues vet, select and monitor deals and specifically focus on how we pick winners and avoid losers. It’s a little like being asked to handicap who’s going to win the World Series, but then again, that is pretty much our job as VCs: to act like Billy Beane and pick those most likely to succeed in a capital efficient way based on detailed analysis of trends and meaningful data, not solely based on experience.Continue reading…
“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.
All eyes are on Toyota’s recall of 8.5 million vehicles due to faulty gas pedals and brakes. The recall has sparked congressional hearings, a probe by the U.S. Department of Transportation, possible criminal charges stemming from a federal grand jury investigation and numerous civil lawsuits, all in the name of driver safety.
This aggressive response to Toyota’s mistakes is appropriate, even though the human toll from its miscues has been, thankfully, relatively modest – 34 alleged deaths and a few hundred injuries. Not to downplay this misery, but in stunning contrast, consider this: More than 100,000 Americans die annually in U.S. hospitals because of avoidable medical errors, according to the Institute of Medicine (IOM), which also says that medical errors rank as America’s eighth leading cause of death. This is higher than auto accidents (about 45,000) and breast cancer (about 43,000). And the problems don’t end here. Studies show that approximately 19% of medications administered in hospitals are done so in error, injuring about 1.3 million each year, according to the FDA.
Our healthcare system is now facing a problem that has plagued business leaders for years: how do you balance consistency and innovation?
The drive for consistency in healthcare is based upon the fundamental observation that physicians across the country treat similar medical conditions in dramatically different fashions. Sometimes, these different approaches are costly, such as using a more expensive treatment when a less expensive approach might be as effective. In other cases, these practice variations are dangerous – failing to provide patients with treatment the evidence suggests is best.
Standardizing the delivery of care — identifying “best practices,” and then insisting physicians follow these guidelines – could, in theory, save money while improving quality, and is the basis of Obama’s healthcare proposal.Continue reading…
Most biomedical research is framed by an outdated view of disease, a linear mind-set that focuses on simple causes rather than complex relationships within dynamic systems. If we are to achieve President Obama’s audacious goal of “a cure for cancer in our time,” we must radically alter the way we think about biology and disease.
Physicians and medical researchers are traditionally taught to consider disease in terms of simple causes and isolated linear pathways. This one-gene-one-disease approach also informs the way most animal models of disease are developed. Technology readily enables researchers to engineer mice with specific molecular defects in one or a small number of genes as an experimental proxy for human disease. While some of these models are informative and reasonably predictive, most are not.
The limitations of animal models are highlighted by results emerging from powerful genomic studies of human diseases ranging from Type 2 diabetes to pancreatic cancer. For these and many other conditions, the cause is not a single defect, or even a handful of defects, but rather, combinations of hundreds of possible defects, each contributing slightly to the overall risk of disease.