Computers in Healthcare

Solutions: Top-Down or Bottom-Up?

Guest Editorial

The healthcare industry does not have a rich culture of innovation.

While regulatory burdens, enterprise developers, and even generation gaps have taken heat for causing grief over the course of the Meaningful Use program (RIP), there is a legacy of change-resistance in medicine that goes much further than the last ten years.

As the focus on technology integration morphs into scrutiny over processes and patient satisfaction, institutions are looking to their administrators and leadership for better solutions. Rightly so: this next stage of transformation is cultural.

Consider, for instance, how clinicians are educated. The medical school model, in its current form (if not the particulars of the entire curriculum) is rooted in 19th century sensibilities.

The overwhelming focus on clinical outcomes may not be misguided, but it certainly shifts attention far from the center of gravity in healthcare; the next generation of care, after all, will be provided by the next generation of practitioners.

This requires innovative thinking among current educators, care providers, and administrators to better pave the way for a new paradigm in medicine. Doing this successfully will ingrain new practitioners not just with a resilient skill set for the modern century, but with a knack for managing change and thinking in innovative terms.

On the clinical side, the Henry Ford Health System is a bit of an outlier in terms of just how much focus it puts on innovation. Like many of the leading Silicon Valley start-ups, the culture at these institutions treats every member of staff as a potential source for The Next Big Idea. That is, innovative thinking occurs all along the continuum of care, not just at the top.

Ideas are submitted for review, with higher marks given for those that are actionable. Leadership at HFHS isn’t just demanding its workforce to be creative—they are taking good ideas and looking for ways to realize them.

Of course, the promise of $10,000 in prizes to submissions judged to truly lead the pack is a nice supplement to a culture that values and prioritizes innovation, but the cultural factor is what makes HFHS’s commitment impressive.

This approach demonstrates, on a small scale, what is possible. But getting that kind of engagement and cultural retrofitting to replicate across the country is more than a little optimistic.

On the academic side, thought-leaders are taking a similarly start-up minded approach to the problem of inertia in the medical curricula, and giving innovation a more foundational presence in the minds of future clinicians.

Arizona State University, already a pioneer in higher education under the restless leadership of president Michael Crow, has taken up a partnership with the Mayo Clinic to bring cross-disciplinary instruction to the Clinic’s student doctors.

The idea is that, in addition to their medical school curriculum, participating students will have the opportunity to double-major in other areas like bioengineering, business, or even law.

“What we have now, in my view, is that we have industrialized medicine, being implemented by technical specialists in a model that’s largely early-20th century, and we’ve got to go back and in a sense pull out the wires, think about where we want to end up, and then reconfigure,” Crow said of the partnership.

Rather than emphasizing the need for specialists, Crow sees the partnership as driving medical students toward thinking more broadly, having the capacity to integrate with other professionals, and develop more sophisticated problem-solving skills. Students at the Mayo Clinic can connect to the full assembly of faculty at ASU through the university’s online degree programs, completing their medical training on schedule while simultaneously delving into other, non-medical areas of study.

With medicine on its own path to greater integration—via EHRs, value-driven collaborative care, and a growing reliance on technology to connect patients and patients and professionals remotely—preparing future doctors to think laterally may well prevent the bottleneck that MU encountered. As with HFHS, this approach to education makes innovative thinking a cultural priority.

Changes to culture don’t happen overnight—in isolated organizations, or across an entire industry as big as healthcare. But by leaders at the top and bottom of the industry tackling the core issues of how people think, and how institutions respond to innovation, healthcare in America just may be on a path to slow transformation.

Edgar Wilson is an Oregon-based independent consultant who writes on trends in education, healthcare, and public policy.

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