Building an innovation system can yield improvement ideas that reshape health care practices, but this rarely happen seamlessly. The following excerpt from the IHI Innovation System white paper presents five types of challenges inherent in most innovation systems and what IHI has learned about overcoming them.
The most significant harvesting challenge for IHI is not the observation of ideas, problems, or possible solutions, but rather creating strong mechanisms for capturing and cataloguing them. Ideas come from many sources, both solicited and unsolicited, including from IHI senior leaders, faculty, and staff who are often in the field making observations. A major challenge is creating a mechanism that allows for documenting these observations in a centralized system that informs decision making for selecting potential innovation projects.
When a member of the IHI innovation team conducts a site visit with the intent to observe a new idea in its local context, there is a reliable process to document what was learned. However, when there is another intent for such observation, or the observation is not made by an innovation team member, IHI struggles to capture what was learned in a consistent, timely, and reliable way. The current solution, while not perfect, is to set aside time during key internal meetings for IHI senior leaders, who are often traveling and observing new ideas out in the field, to verbally share their learnings. The discussion is broad, not focused on any one topic, and free flowing. The innovation team listens, learns, and documents ideas for current or future use.
Testing New Ideas
Because IHI is not embedded within a health care system, we do not have options readily available to test innovations in clinical environments. Testing new ideas often means relying on health systems, communities, or providers who are willing to try out unproven ideas. IHI is continuously seeking health systems and providers who have the time, experience, and willingness to test some of our early innovations. Key to overcoming this challenge is to demonstrate flexibility: to adapt the size and scope of the test to something that health system partners can do fairly easily, and from which both IHI and the testing organization can learn together.
Moving an Idea from One Stage of Development to the Next
As IHI gains confidence in an idea through the innovation process, the level of testing increases, gradually moving from early proof of concept, to theory validation, alpha and beta testing, prototype testing, pilot testing, and scale-up. In the majority of IHI innovation projects, several of these steps (except for scale-up) are managed by the innovation team. Different skills, testing sites, and resources are required at each level. Given that the innovation team is excited by what they learn, becoming enamored with the research and versed in the topic (i.e., preoccupied with “admiring the problem”) instead of working toward an accessible and actionable output can be a challenge.
As a small innovation team with limited resources, we are challenged by managing the transition of an innovation project from one stage of development to the next, which requires deliberate focus on simplification and ensuring the innovation can be effectively translated at the next level of scale. Prototype testing is time consuming and resource intensive; therefore, IHI needs to have a high degree of confidence in the ideas we pursue to the next stage of development.
Moving ideas out of the innovation system and into IHI’s programs and project work can also be challenging. This transition requires the innovation project lead to hand off the work to others for the innovation to be appropriately modified for implementation in a broader context. This transition also requires the implementation team to accept a new idea that was created outside of their team. The best transition is one where there is a gradual shift in involvement and leadership of the idea, moving from the innovation project team to the implementation team. Clear documentation of the innovation, including detailed specifications for how the innovation should be implemented and possible adaptation, can ease the transition.
Example: One IHI innovation project focused on creating a new approach to managing cost and quality at the front lines of clinical care. This method, called “continuous value improvement,” was developed via the IHI innovation system and then tested in the NHS Scotland. As the innovation project achieved initial 12 to 15 percent cost savings, it moved quickly from prototyping to spread, scale-up, and replication at other sites around the world. IHI innovation team members worked with IHI project staff to recruit additional coaches and faculty to implement the model elsewhere with additional customers. Innovation team members continued to serve in two primary roles: as coaches to those learning the methods, and as learners to continuously refine and improve the methods and the model that was originally created.
Integrating Operations and Innovation
Innovation and operations have fundamentally different, but complementary, purposes, structures, cultures, competencies, and drivers. And appropriately, the individuals who are drawn to these two systems have different skills, styles, and even personalities. Both systems are necessary for success and, more importantly, both systems need to be optimized simultaneously for optimal performance.
Without an internal process whereby operations and innovation continuously learn from each other, leaders within the organization will:
- Generate tension (and possibly competition) between innovation and operations;
- Fail to realize the potential of an innovation by suboptimizing the output;
- Fail to harvest and implement new ideas from operations; and
- Decrease joy in work across both systems.
Fostering a healthy interaction between operations and innovation is the responsibility of leadership. It requires recognition of the value both groups contribute, from senior leaders and staff throughout the organization. Whenever possible, it is best to publicly celebrate and champion both systems together. Innovation may be celebrated when the innovation team first explains or publishes the development of a new idea. Operations may be celebrated when the idea is embedded as ongoing practice in the organization and producing results. However, because of the time gap between idea creation and broader implementation, innovation and operations are rarely recognized simultaneously, as two equal parts that have contributed to the whole.
New ideas may also be developed by operations, or both innovation and operations may be working on different aspects of the same problem. When this is the case, it is best to map where the two intersect, to reduce complexity and barriers to those intersections. Frequent communication, written project charters with agreed-upon aims, and leadership’s acknowledgment of shared ideas and support for ongoing collaboration between innovation and operations are important to prevent rivalry, challenges of attribution, and competition for recognition.
In their December 2014 Harvard Business Review article, Nathan Furr and Jeffrey Dyer synthesized the key role of leaders in innovation: “What the great leaders we’ve studied know is that when competing on innovation, sustainable advantage comes not from the superiority of any particular invention, but from the superior ability of leaders to foster an organization that can learn from mistakes faster, more efficiently, and more consistently than competitors do.”
The success of an innovation system relies on an organization’s senior leadership to understand the structures that need to be in place to embed innovation within the organization and to connect innovation to organizational priorities. Senior leaders can get started with establishing their organizations’ innovation systems by learning from a few simple, but powerful lessons from IHI’s experience, observation, success, and failure:
- Set expectations for the innovation system; don’t specify the outcomes. Trust the creativity of your innovation and operational leadership to identify new ways to meet the challenges they face. Over-specifying the outcome of the innovation system artificially constrains the teams’ thinking as they try to give you what you want, not what the customer needs.
- Whenever there is conflict or uncertainty, try to develop a limited, rapid-cycle test to explore the question rather than make an executive decision. Leaders can play an important role in helping to identify individuals, organizations, and opportunities to test ideas where there is ambiguity, to help the organization gain confidence in the theory.
- Prepare the organization for new ideas by creating an internal learning process. Leaders can help staff recognize that, if the organization is seeking different results, it cannot conduct “business as usual.” A learning process might include virtual, online, or face-to-face opportunities to explore the key questions and challenges faced by the organization and enables stakeholders to agree on the need to innovate, surface new ideas for change, and identify problem areas that need disruption. Such a process can also improve the transfer of knowledge and discovery from innovation to operations.
The role of innovation in an organization can be exciting; new ideas are enticing and may easily gain attention at the expense of ongoing operations, which will be responsible for integrating the end result of the innovation into everyday practice. Leaders need to generate excitement for the new idea by demonstrating its relative advantage, while also ensuring they do not dismiss or diminish the ongoing operations work that maintains the current state. It is natural for staff to feel threatened when a new idea comes into their domain; leaders must neutralize this fear and bring everyone (not just the innovators) on board with operationalizing the innovation to become everyday work.
IHI developed an innovation system within our own improvement organization because we believe that both improvement and innovation are needed in today’s health care environment. To optimize both health and health care, health system leaders must motivate continuous improvement in daily care delivery while also working to meet the future needs of patients and families with fundamentally transformed systems.
To learn more about how to create an innovation system that meets the needs of your own organization, please download the IHI Innovation System white paper.