managing innovation: changing our mental...

Managing Innovation: Changing our Mental

ModelsMarian Johnson with Carol Haraden and John WhittingtonApril 14, 2016

Session Objectives

• To describe the value of an innovation process

to solve tough problems and redesign care

• To differentiate between the goals of innovation

and improvement in your organization

• To learn about different types of innovation and

IHI’s methods for innovation

Delivery System Innovation: Changing our Mental Models

Old Mental Model New Mental Model

Innovation is an event or product

Innovation is not an event

Innovation is not a product

Innovation is a process…

Moen, R. Idealized Design Process

…with many

visualizations

Our Initial Innovation Process

• Integrated into project teams

• Created great ideas from

improvement work

– Bundles

– Reliability

– ‘Move Your Dot’

• Good, but not good enough

What Was Missing

• Pace

• Staff with dedicated time

• Predictable results

• A forum for problems that needed innovation

• A reliable mechanism to transfer an idea into a

prototype or pilot test

IHI Innovation Process

• A specific challenging question to be

answered

• A network of innovators, along with

other traditional methods (literature

search, prototype testing)

• A specific timeline, in this case 90

days

• A set of recommendations at the end

of each cycle

Huston L and Sakkab N. Connect and Develop. Harvard Business Review. March 2006. pp 58-66

Components of a 90-Day Learning CycleQ

ue

stio

n Pose & refine question to be answered

Sca

n Review literature, conduct interviews, identify exemplars T

he

ory

Bu

ildin

g Identify core underlying principles & theories

Fo

cu

s &

De

sig

n Develop a new concept design for testing

Te

st

Work with one or more settings to test new concept

Using improvement science and lots of learning cycles we improved the design

From

Observation

to Proven

IdeaDevelop

a theory

(Hypothesis)

Organize and Apply Observations

Observe a Dynamic Raw Event (Phenomenon)

Transition Point

Pilot

and

Spread

Prototype test

(Find anomalies and update theory)

Validate the

theory

Changing our Mental Models


Innovation is an event or product Innovation is a Process




Innovation & improvement are separate

Improvement and Innovation

Improvement

The act of raising to a more desirable quality or condition—to make better

Refinement and extension of existing competencies, products, and paradigms exhibiting returns that are usually positive, proximate, and predictable

Mental model = elimination; remove existing system faults

Limitations: Lack time of existing staff; limited to the existing business model

Innovation

Introducing new methods, ideas, or products—to make new

Experimentation with new alternatives having returns that are often uncertain, distant, and negative

Mental model = creation; remake the system

Limitations: resources & ability to manage and execute on innovation

Why do we need delivery innovation in health care?

European Observatory, 2001

Quality Control Quality Improvement

Innovation

A Simple Innovation Map

LargeSmall

InnovationImprovement

The challenge for leadership

Burden

Time

Current

State

Future

State

Transition

State




Innovation & improvement are separate Innovation & improvement co-dependent



Innovation is an event or product Innovation is a process

Innovation & improvement are separate Innovation & improvement are co-dependent

Innovation is everyone’s job

The Critical Resource: TIME

People

Fracti

on

of

Tim

e

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Part Time Contributions from All

People

Fracti

on

of

Tim

e

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Innovation

Primary Limitation = Project Size

Full Time Contribution from a Few

People

Fracti

on

of

Tim

e

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

In

no

vati

on

Innovation with Full Timers

• Projects linked to strategy

• Resources are reliably available

• Ability to practice clean slate team design

(in a less disruptive way)

Discussion: How to free up resources?

• Catalogue your current ‘innovation’ activities to.

Look for:– Projects that are not resourced to meet goal

– Redundant activities

– Activities that are non-strategic

– High-risks that are unlikely to be met

• ‘Celebrate’ the end of some of these





Innovation is everyone’s job Innovation requires dedicated teams






Innovation ideas come from genius

Innovator’s DNA

• Associating

• Questioning

• Observing

• Experimenting

• Networking

Dyer JH, Gregersen HB, Christensen CM. Innovator’s DNA. HBR December 2009

To harvest you must go

to the fields

“Bi-Directional” Innovation…

• Cataract Surgery at Aravind

Eye Care Hospital

• ‘30 min or your money back’

– Fortis patient experience

29

Positiv

e D

evia

nts

Lead Users






Innovation happens in isolation Innovation works with operations

Innovation ideas come from genius Innovation ideas come from observation







Only disruptive innovations matter

P&G’s Four Types of Innovation

• Sustaining

• Commercial

• Transformational-sustaining

• Disruptive

34

Sustaining Innovation

• Incremental improvements to existing products– A little more cleaning

power to a laundry detergent

– A better flavor to a toothpaste

35

Brown and Anthony, How P&G Triples Its Innovation Success

Rate, Harvard Business Review, June 2011

Commercial Innovation36

• Use of creative

marketing,

packaging, and

promotional

approaches to grow

existing offerings

• P&G ads during the

2010 Olympics

– Celebrating Moms

– The campaign covered

18 brands, was viewed

repeatedly by hundreds

of millions of consumers,

and drove $100 million in

revenues



Transformational-Sustaining Innovation38

• Innovations that reframe existing categories

• These typically bring order-of-magnitude improvements and fundamental changes to a business and often lead to breakthroughs in market share, profit levels, and consumer acceptance



Disruptive Innovation

• Innovations that represent new to-the-world

business opportunities

• Typically when a company enters entirely new

businesses with radically new offerings

39



Dis

ruptive Innovatio

ns

General themes for innovation projects

Sound ideas for

improvement exist

outside of health care

Simplification of core

premises and processes

for the day-to-day care

of patients

Removal of accepted

system faults

Improving handoffs Bundles Triple Aim definition

Business case Optimizing stroke care Palliative care

Production system

design

Safe transitions for elderly

patients

Integration of behavioral

health and primary care

Transitions for health

systems

Remote monitoring of

patients

Physician Optimization

for population health

Risk resilience Antibiotic stewardship Execution Framework

High reliability systems Real-Time Demand

Capacity for Flow

Primary Care 3.0

Red=Waiting Green=Became a Program Blue=In Use in Other Programs







Only disruptive innovations matter Innovation takes many forms




Innovation & improvement separate Innovation & improvement are co-dependent

Innovation is everyone’s job Innovation is a dedicated resource


Only disruptive innovations matter Multiple types of innovation matter

Only need one innovation method

90-day Learning Cycle is great if…

• We have 90-180 days available

• The “Problem” needs primarily a research

solution

• The output of the project is a set of principles or

framework that can be tested further as part of a

prototype

But what if…

• We have 6 weeks or 3 days

• The problem needs a design solution or requires

a completely new system

• The outcome has to be a working prototype for

immediate testing

Innovation Methods Spectrum

Innovation Lab 90-day Learning Cycle(s)

With Client: Client has dedicated

time for engagement

Need a solution quickly: 6 weeks

Clarity in the problem that needs

a solution

Problem needs a design solution

Prototype is emphasized over

principle

Building and exercising

prototypes leads to learning

Produces a tailored solution

Converge to a solution

For Client: Client has limited time for

ongoing engagement

Not immediate need: 3-6 months

Problem still needs definition and

articulation

Problem needs a research solution

Principle is emphasized over

prototype

Articulating/validating theories

inspires/informs developers

Produces a broader deliverable

Converge to a theory

Start End Start End

Innovation Relay

For Client: Client has limited time but

desires engagement at all levels

Clarity in the problem that needs a

solution

Problem needs a team-based

approach to finding a solution

Prototype is emphasized over

principle

Building and exercising prototypes

leads to learning

Produces an energized set of

creative teams

Converge to a set of solutions

S E

S E

S E

S E

S ES E

S E

S E

Match the method to the question

Innovation Methods Problem

90-day Learning Cycle What does a model of population health look like

for low-income pregnant women?

Innovation Lab What is the best design for an academic training

model to improve patient care?

Innovation Relay How can you diagnose and start treatment for

mental illness before a critical event?

Idealized Design What is the idealized design of perinatal care to

eliminate adverse events that occur in labor and

delivery?







Only disruptive innovations matter Innovation takes many forms

Only need one innovation method Match innovation methods to the question

Building your innovation system

Discussion

• What is the goal of innovation for your

organization:

– Enhancing your current position in the market?

– Bringing in new revenue?

– Being seen as a leader in health care innovation?

• What are your current methods for innovation?

– For what types of problems do these methods work

well? Less well?

Where to start?

• State your aim

• Select or build an innovation method (or methods)

• Commission a small team with dedicated time (be disciplined)

• Harvest, observe, associate, question, network, experiment

• Build a learning system to review innovation methods and integrate into operations and improvement work

Building your team

Sample Innovation Project Team:

• System Designer

• Clinical subject matter experts

• Research staff

• Ethnographer

• Data Expert

• Technology Expert

• Business/Policy Expert

Where do you look “outside”

but still internal?

• Who are your natural

innovators?

• Who gets excited by new

ideas?

• Who are your natural

communicators?

• Pair “thinkers” with “doers”

What we have learned…





Innovation comes from genius Innovation comes from observation

Only disruption innovations matter Innovation takes many forms

Only need one innovation method Match the method to the question

Build a Way Forward with an Innovation System

Questions?

Thank You!

[email protected]

Marian Johnson

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