2. Promoting novel approaches to process improvement

Historically, efforts to innovate in healthcare have targeted the creation of new products, such as biopharmaceuticals and devices. Moving forward, the industry must develop similar capabilities with respect to continuous process improvement.

A. Recognizing the importance of process improvement:

Healthcare leaders must recognize the significant potential of process improvement to increase value in healthcare. Read more

B. Creating incentives to engage in improvement:

All parties, including providers and patients, must be incentivized to engage in improvement efforts. Read more

C. Framing failure as an important part of success:

“Failure” must be viewed not as an obstacle to progress, but as a critical component to the success of continuous improvement. Read more

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A. Recognizing the importance of process improvement

Healthcare leaders must recognize the significant potential of process improvement to increase value in healthcare.

In his keynote address, Berwick drew upon the work of quality management expert Noriaki Kano, who described three forms of improvement. Berwick referred to these as Kano 1, 2, and 3. Kano 1 is “defect reduction.” Kano 2 involves removing unnecessary cost from production, while fully meeting the needs of customers. Kano 3 adds new features and products and addresses the consumer appeal of a given project. Berwick noted that Kano 2 improvement merits special attention from the healthcare industry at this time, even while it continues to pursue, as it must, the other two types.

Fig 2.1: Opportunities for Innovation

Insight 2A - opportunities for innovation

“A Kano 2 improvement is quite different and not at all understood in healthcare,” said Berwick. “That is, reduce the cost of production without hurting the customer… by making production simpler, taking a step out, doing something with different materials… figuring out a way to do the same thing—or even something better—for the customer, while reducing your cost of production. Then you can use the money or return it. That’s the kind of Kano 2 improvement we need in healthcare.”

The survey echoed Berwick’s sentiment. While it exposed a surprising lack of confidence in the innovative power of traditional areas of focus, such as “basic medical research” and “pharmaceuticals,” it also revealed an intriguing confidence in an area of innovation typically associated with non-healthcare industries: process improvement. When asked to rank eleven areas of innovation by their potential impact over the next five years, participants identified “process improvements in care delivery” as the number one opportunity for both improving quality and controlling the cost of care, with approximately 60 percent expressing “very high” or “somewhat high” confidence in its power.

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B. Creating incentives to engage in improvement

All parties, including providers and patients, must be incentivized to engage in improvement efforts.

Reisman noted that a key to Aetna’s approach for enhancing value is the integration of multiple elements into a model centered on “accountable care.” Within this model, providers are enabled with advanced technologies that help them communicate with and engage healthcare consumers. Consumers are subsequently empowered with information, which, in turn, aligns their behaviors with actions that contribute to improved care. “We are enabling providers and consumers with tools and incentives to make fundamental change,” Reisman said.

Michael A. Mussallem, Chairman and CEO of Edwards Lifesciences, addressed collaboration among innovators themselves, stressing the necessity of creating the appropriate environment for innovation. “One of the things we know is that there’s nothing like the collaboration of physicians, bright engineers, and scientists to solve problems,” Mussallem said. “Somehow, we need to have the transparency and openness that allows and encourages rather than discourages it.”

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C. Framing failure as an important part of success

“Failure” must be viewed not as an obstacle to progress, but as a critical component to the success of continuous improvement.

To innovate successfully, healthcare leaders need a process for continuous improvement that can accommodate what we prefer to avoid: failure. Both panelists and participants challenged the prevailing fear of failure that handicapped the exploration of new ideas. They largely agreed that the healthcare system would be better served by acknowledging failures as the necessary by-product of innovative progress.

Tackling the issue from the perspective of process design, Tim Brown, CEO and President of IDEO, a leading design firm, believed it was important to accelerate the cycle of testing, failing, and learning. “We’re not very smart,” he said. “So we have to learn very fast. Failure is an extremely efficient form of learning. The principle we operate under is to put yourself in the place where you can fail as fast as possible and figure that you get to learn faster.”

“Failure is an extremely efficient form of learning... put yourself in the place where you can fail as fast as possible.”

– Tim Brown

President and CEO of IDEO

“Failure often contains the seeds of success,” said Lander. “If you are willing to look hard at a failure, you can ask why it failed. But if you just keep it internally, you don’t. If you’re willing to expose it to others, you may learn a lot.” Terrance G. McGuire, Co-founder and Managing General Partner of Polaris, Partners concurred, noting that Polaris had learned from the digital world “where failure is not a bad thing; it’s something to be learned from and brought forward.” Perhaps ironically, the opinion expressed by many at the conference was that being “successful at failure” planted the crucial seeds of experimentation required for meaningful improvement.

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