Innovation is increasingly becoming an important discipline for many of the country's hospitals and health systems. Leaders are dually tasked to build a culture that promotes the sharing of ideas and a willingness to learn, but they must also ensure the creative process is formalized and methodical. Here, four leaders from two of the top academic medical centers in the country share their approach to innovation.
Los Angeles-based UCLA Health System has and continues to deliver a range of innovations, from how employees answer the phone to the integration of military veterans as primary care coordinators. Molly Coye, MD, MPH, is chief innovation officer for the system and oversees the UCLA Institute for Innovation in Health. David Feinberg, MD, MBA, is president of UCLA Health System and CEO of UCLA Hospital System. Both participated in the roundtable.
The Ohio State University Wexner Medical Center in Columbus launched its IDEA Studio in Healthcare and Design in 2013. OSU's medical school also launched a new curriculum last year, and the hospital recently partnered with GE Healthcare for design thinking. Clay Marsh, MD, chief innovation officer for OSU Wexner, and CEO Steven Gabbe, MD, both participated in the roundtable, as well.
Below are excerpts of participants' responses, lightly edited for clarity.
Question: Are there any misunderstandings around innovation you'd like to address?
Dr. Coye with UCLA: There are two major things. First, a lot of people think innovation is all about technology. That's not true. Almost all innovations are enabled by technology, but the cultural change and implementation are much more critical to innovations' success than technology itself.
Secondly, I think a lot of people confuse invention with innovation. At UCLA, our scientists invent new things every day, but turning those inventions into services that can be adopted at scale and affect people's care — that's what innovation is about. I would define innovation as taking great ideas and pilots and turning them into major changes that accelerate the transformation of a health system.
Dr. Marsh with OSU: To us, innovation is a fairly specific term that implies value creation, value capture and value dissemination. We really want to be disciplined in our ability to deliver solutions in a timely way. We've created our innovation enterprise, the IDEA (Innovation, DEsign and Application) Studio in Healthcare and Design to challenge the current paradigm of healthcare. Part of design is trying to understand the greatest gaps for people and target our solutions specifically to address these problems.
Q: How formalized are innovation efforts in your organization? What does the innovation process looks like in terms of decision-making, resources and processes?
Dr. Gabbe with OSU: We have goals to understand problems people face, apply solutions to those problems and deliver those solutions. We look at this as a fairly structured process. We've agreed to a relationship with GE Healthcare for design thinking. In this world of multiple voices and choices, it becomes very noisy [and difficult] to figure out what really matters. We want structured processes in our industry.
We're trying to promote evidence-based and personalized medicine. We are one of the founding members of the P4 Medicine Institute, which stands for predictive, preventive, participatory and personalized health. We take a population and understand more precisely who needs what. As we look at design thinking, we think it blends beautifully with [this] next phase of medicine. Design thinking allows us to understand big gaps and what gaps are specific to certain populations.
Dr. Marsh with OSU: We've also had great engagement from the state. [Ohio Gov. John Kasich] brought together a group he calls the Medical Corridor, which is made up of major health systems in the state. As part of that, there's the [Choose Ohio] initiative. As major academic medical centers within the Medical Corridor, we've committed that if an innovator has an idea he or she would like to try, we will give that invention a trial in our systems.
The state also has the Ohio Third Frontier, which [funds] new inventions that can lead to new businesses and jobs. Right now, the state is interested in our neuromodulation program, which is one of the country's leading programs and led by neurosurgeon Ali Rezai, MD. We're aligned with the state and Ohio Third Frontier funds to create excellence in biotechnology and healthcare innovation to develop new treatments, businesses and technologies.
Dr. Feinberg with UCLA: There are a lot of paths into our innovation center. Some ideas come from those working directly in innovation. They might have a brand new idea or they might have seen something somewhere else that might make sense [at UCLA], so they bring it into the council. Or it could come from anyone in the workforce. We try to really be out there, looking for ideas from the frontline.
Dr. Coye with UCLA: It's our job at the Institute for Innovation to scan for innovations that can advance our organizational strategies for transformation. When we identify a potential innovation, we bring it to our innovation leadership council, which is our advisory group that includes senior leadership and program leaders.
We ultimately bring the idea to our executive group and ask them to charter it. What that means is for them to actually tell us that if this innovation is adopted at UCLA and the first pilot is successful, they will commit to deploying it at scale across the system. This ensures we don't waste our resources by piloting lots of things that will never be brought to scale.
Q: What issues is your innovation team most focused on today?
Dr. Gabbe with OSU: We have several different demographic populations and environments in which we're doing innovative pilot programs, including a depressed area of our city, an affluent suburb and [pilots] with our students. We're also doing pilot programs with families and young adults affected by autism.
Dr. Marsh with OSU: There's also drug discovery, neuromodulation and education. Neuromodulation involves putting electrical leads, or pacemakers, in people's brains to control the signals the brain receives to help with pain syndromes and movement disorders. Now it's moving into exciting areas like autism and Alzheimer's disease. The next phase of this technology is to design new devices that don't require implantation, but can be used as dental implants, helmets or other non-invasive devices.
Dr. Coye with UCLA: One innovation that was very important was our primary care innovation model. We [integrated] care coordinators, who are returned Army veterans and social workers, into primary care clinics to help physicians manage care for patients with complex chronic diseases. Oftentimes, the veterans worked in healthcare in the Army, so they have familiarity with medical terms and concepts. Secondly, they are far more organized than many people who haven't served in the Army, and thirdly, it's important to improve job opportunities for our veterans.
Dr. Feinberg with UCLA: The one most in my heart today is CI-CARE, our best example of innovation. CI-CARE is our customer service pneumonic about how you introduce yourself when you go into an inpatient room. It came from a nurse manager in a particular unit. It's our best example of an idea that gets brought in [as an innovation] and now we all live by it.
CI-CARE started around connecting with patients and introducing ourselves. Call them by Mr., Mrs. or Ms. and their last name. Ask them before you do anything for them. Respond to any questions they have and, when you exit, tell them what's coming next. Now CI-CARE [has become] the umbrella for everything we do that is patient-centered. It's morphed into everything we do at UCLA — how we answer the phone, how a security guard will walk you to your car, how we treat each other.
Q: Can you describe a healthy CEO-CIO relationship? To what degree are the two roles in direct communication? How do you support one another?
Dr. Feinberg with UCLA: Beyond her innovation role, Dr. Coye is really a key executive and the only person at UCLA who has run two state health departments. [Editor's note: Dr. Coye has overseen California and New Jersey's health departments.] She has extensive background in information technology. When she puts her innovation hat on, which she's great at, she's clear that her innovation team's role is to surface the country and world for good ideas, make sure frontline people at UCLA bring on ideas and [test] them to see if they make sense for us.
Dr. Coye with UCLA: Dr. Feinberg and I are together very frequently — easily five to 10 times per week in small group meetings. As part of the system's executive team, we're in many strategic and decision-making bodies together. I have the opportunity for curbside consults as well as direct sit-downs [with Dr. Feinberg] on key issues on a frequent basis. In addition, when I run into a barrier, I get direct support and leadership from him.
Dr. Gabbe with OSU: Clay is such a credible and accomplished clinician scientist. He led our center for critical care, which is one of our major programs, and he is a scientist well-funded by the National Institutes of Health. He had credibility as a clinician investigator, then he became our vice dean for research. People saw Clay as someone who was a servant leader in this area supporting others. When it came time to establish the IDEA Studio, Clay is well-trusted. We meet regularly and talk all the time. There isn't a day or two that goes by that we don't talk.
Dr. Marsh with OSU: Steve has been tremendous friend and leader here. There are a lot of challenges always and medicine is [undergoing] a lot of challenge, scrutiny and financial narrowing. Grant funding is also harder. But at the same time, the mission we have is to improve people's lives. Steve's personal and professional commitment to never veer from that goal — that's been the beacon.
Q: Which factors do you find most inhibitive to hospitals' innovation? 
Dr. Feinberg with UCLA: When you think about it, there was [initially] no medical school at UCLA. We're only 60 years old. [Editor's note: UCLA's Geffen School of Medicine was established in 1951 and UCLA Medical Center opened in 1955.] Now we're one of the top five hospitals in the country. We've been the best in the West for 25 years, according to U.S. News & World Report. We're among the elite academic medical centers. [UCLA physicians perform] more organ transplants than any hospital in the United States.
To go from the starting line to competing with Mayo Clinic and Cleveland Clinic, which have been around for 100 years, [took] entrepreneurial innovation. [People] saw this as a place where nobody would ever say, 'Oh, well we don't do it this way at UCLA.' That's not who we are. We like risk-taking and pushing the envelope.
There's sometimes friction, and I think we've gotten better at this, in the handoff between innovation and operations. People in operations have full-time jobs. Then a new innovation comes up. We prove it makes sense and then it needs to be passed off. The people you're passing it off to don't have a lot of extra time, and they need to get up to speed on something the innovation people [have gotten] used to for past six months.
Dr. Coye with UCLA: I think some of the barriers are common in all health systems and others are particular to an academic institution. Common barriers are issues like bandwidth. Everybody is working so hard at keeping up with patient demand and trying to reorganize for health reform and all the other impending changes that sheer bandwidth is a major issue. In an academic environment, this is sometimes exacerbated by conflicts between research, teaching responsibilities and the redesign of patient care; these make our organizational structures unwieldy when we're trying to bring about transformation.
Dr. Marsh with OSU: One of the challenges of medicine in general, and academic medical centers specifically, is [the amount] of tradition and culture. How we train physicians is relatively static, for example. But [some traditions] target only one approach for all. People really want things [in healthcare to resemble things] we have in other areas, like the airplane industry for safety. Another sector that may foreshadow what will happen in healthcare is banking. For most of us to make a bank transaction, we rarely go to see the teller at the bank. We go to the cash machine if you need cash. Medicine is evolving in this way, and eventually, perhaps telemedicine or computer-driven medicine may take the place of routinely seeing the doctor in person.
Q: How do you weigh an innovation's financial implications? How do you approach a project that may not have large financial returns?
Dr. Gabbe with OSU: It depends on how you want to quantify your return on investment. When you start a new curriculum, like ours, that's an investment of millions of dollars, but the short-term ROI is the quality of the students you recruit to your school. [Editor's note: OSU's College of Medicine took five years to develop a new three-part, four-year curriculum, which went into effect with the medical school's class of 2012.]
We've seen a dramatic increase in our applications. Long term, it's how those students [trained here] progress through their medical careers and contribute to their communities. There will be different metrics. None of these are a quick fix; these projects will go on for years. We're willing to put resources in and stay in this for the long haul to see these outcomes.
Dr. Feinberg with UCLA: We've undertaken major innovations that are actually harmful to our bottom line, under the old business model for healthcare. Our purpose is to heal humankind. We do that by alleviating suffering, promoting health and delivering acts of kindness. That's what we measure things against. If we take care of people — and I want them cared for like they're my mom — I don't want them in the hospital if they don't need to be.
We've put a primary care medical home in almost all [of our] primary care physician clinics. The PCMH has care coordinators, behavioral health professionals and pharmacists all supporting the PCP office. It's been remarkably successful in decreasing readmissions and ER visits, and hugely successful in supporting patient, family and provider satisfaction. We're doing the wrong thing from a business standpoint. We've decreased unnecessary hospitalizations and ER visits — those are things that make money — but [decreasing them] makes sense for the patient.
Q: How do you keep innovation from becoming insulated within your organization?
Dr. Coye with UCLA: We have joined collaborations organized by the Association of American Medical Colleges, the Institute for Healthcare Improvement and the Innovation Learning Network, among others. This gives a chance to pool ideas and compare our progress on a regular basis. We also started a Los Angeles Innovators Forum, in which representatives of health systems serving the 14 million people in our country meet every other month to share our work, test ideas and make sure we're not too insular.
Dr. Marsh with OSU: It's an interesting paradigm in some ways. We want people's input, but not so much input that we can't make decisions. I'm really drawn to Apple in that [their team] created elegant, amazingly functional and beautiful machines, but they also did it [with a focus on] simplicity. Steve Jobs' litmus test was to create the technology that he, his friends and family would want to use — this is a very interesting paradigm for medicine of today and for any innovations we offer others.
The key issue is that we constantly have to focus on editing to amplify and create things that are foundational and important. [We don't want to] present solutions that amplify the noise and confusion people encounter in medicine today. The key is to continuously edit our own ideas to address the critical gaps our customers articulate. Finding experts in other sectors to embrace the elements of design, delivery and iteration of these products or solutions is critical for us to create medicine that meets our goal of improving people's lives and realizing value innovation — lower cost, higher quality — in healthcare.
Dr. Feinberg with UCLA: We [involve] patients in everything we do, so we have the voice of the patient institutionalized in all decision-making. If there are a few gaps, we're working on those. In all of our quality decisions and innovations, we have formalized a how means of including the voice of the patient.
We also won't do anything without going around the country and seeing who else, if anyone, is doing it. We don't want to reinvent the wheel. That goes from how we answer the phone to how we talk to patients about prostate cancer.
We started a new innovation in July. We now answer the phone as, 'This is UCLA Health. Would you like to be seen today?' This is [something we started] by listening to our patients. Emotionally, [patients] need us to be completely accessible. Cleveland Clinic has been [answering phones] this way for years. We want to make that model [specific to UCLA] but also say, 'Hey look, we're humble. We didn't come up with this on our own.'
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