Iadh innovation in healthcare r4


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  • Innovate vs invent problem solving or appreciative inquiry developed @ Cleveland Clinic practiced at Harvard Business SchoolMedicine as science
  • G. Timothy Johnson (born 1936) is an Americanacademic, pastor, physician, television journalist and writer who, as "Dr. Tim Johnson", is best known to television viewers as the longtime chief medical correspondent for ABC News on the ABCtelevision network.For many years he has been a member of the faculty of the Harvard Medical School at Harvard University and on the staff of Massachusetts General Hospital, a teaching hospital of the Harvard Medical School and a biomedical research facility in Boston, Massachusetts.
  • The gene partnership Dietrich Stephan
  • Images are from 3Dscience.com If you are Ok with the images we need to secure authorized copies
  • Richard Gilfillian of Geisinger to lead CMI Center for medicare and Medicaid Innovation
  • Six months after centralised stroke services were opened in the capital, figures show that more Londoners are being given life-saving drugs to quickly restore blood-flow to the brain after a stroke. This treatment is proven to reduce lasting disabilities and could save hundreds of lives every year. Since centralising stroke care in eight Hyper Acute Stroke Units (HASU) rather than in most hospitals, London has seen: More patients being given clot-busting thrombolytic drugs than anywhere else in the UK or other large cities around the world; Patients taken from home to HASU by London Ambulance in under 15 minutes on average; Patients recovering quicker from a stroke, spending on average four days less in hospital.
  • An operating room that is also a laboratoryA laboratory that is also an operating roomPopulated with state of the art equipmentNIH funded.Not under pressure to be profitable“The principle is one of disruption. Agents are forced out of their habitual patterns and, individually or in small groups, build new relationships and behaviors that are more productive or adaptive” G. Eoyang
  • Proving ground Risk is focused tool up for innovation
  • Academic Medical Centers are comprised of three major areas: Patient Care, Medical Education and Research & Development. Within these areas, are a variety of critical components, a “kit of parts.” These parts can be physically independent of one another, and function independently, too. This has been the standard approach for years.
  • Vertical organization can work very well, because the proximities are there. This is where the actual design is so important. It’s a matter of designing support, circulation and amenity spaces to foster interaction among patients, clinicians and researchers and enhance knowledge transferFirst Generation “Bench to Bedside”Center of Excellence “Silos”Focus on Single Disease / OrganIntradisciplinary Integration Second Generation Multiple “Silos”Multiple SpecialtiesInterdisciplinary IntegrationShared Core ResourcesThird Generation “Translational”Transdisciplinary IntegrationCo-located Core ResourcesOther challenges inherent in a vertical building, are maintaining correct flows with vertical circulation and aligning the structural grid and infrastructure for clinic, office and labs.
  • As much as we need to invent tomorrow’s technology, we need to take the technology that exists today and as Apple has done so well, create a coreplatform for innovation leading to “meaningful use”
  • Iadh innovation in healthcare r4

    1. 1. Health Improvement through Innovation<br />Session 4: Research-based Design: An Evaluation Tool for Improving Healthcare <br />7th World Congress <br />
    2. 2. A<br />The Promise of Innovation <br />How Facilities Impact Innovation <br />Lessons from HDR’s Translational Health Science Initiative<br />
    3. 3. Introduction:<br />in·no·vate<br />[in-uh-veyt]     verb<br />to introduce something new; make changes in anything established.<br />generally refers to the creation or improvement of products, technologies, or ideas <br />“Appreciative Inquiry (AI) as a systematic discovery of what gives life to a living system (ie. in our case an organisation) when it is most alive, effective and constructively capable.” D. Cooperrider<br />“We can’t solve problems by using the same kind of thinking we used to create them”<br />-A. Einstein<br />“medicine is not a science: it is the clinical practice of healing the given individual”<br />-Wikipedia<br />
    4. 4. Innovation Opportunities<br /><ul><li>Evolving science leading to new medicines and predictive and personalized solutions
    5. 5. HIM pervasive use in development of Best Practice - EBM - Comparative Effectiveness
    6. 6. Transition from the primacy of the Patient - Physician relationship via Care Extenders
    7. 7. “Reorganization of Primary Care as Disruptive Innovation: From Molecules to Practice - HIT and the Medical Home” CIMIT</li></ul>4<br />
    8. 8. The Threat of Innovation – Dr Tim Johnson <br />The Theory of Translation<br />The View<br />Friday Nov. 5th 2010<br />“The biggest threat to our Healthcare industry is the blatant introduction of expensive unproven technologies”<br />“If we don’t bend the cost curve we’ll be bankrupt in 8 years”<br />
    9. 9. 100%<br /> I<br />H<br />E<br />A<br />L<br />T<br />H<br />S<br />T<br />ATUS<br /> I<br />0%<br />Birth Projected human life span 120 Years<br />
    10. 10. The Square Wave Life Curve<br />100%<br /> I<br />H<br />E<br />A<br />L<br />T<br />H<br />S<br />T<br />ATUS<br />Jeanne Louise Calment Photo by N'geenTien-Gamma Liasion  <br /> I<br />0%<br />Birth Projected human life span 120 Years<br />
    11. 11. TGP’s Value Proposition: The Patient<br />Personalized Medicine<br />Partners<br />Patients<br />Researchers<br />Predisposition analysis with behavior modification and exposure avoidance<br />Achieve a molecular diagnosis<br />4<br />1<br />Parental carrier screening and reproductive decisions for monogenic disease<br />2<br />Ongoing research results returned to clinical practice to improve patient care<br />5<br />Ongoing relationship that will improve decision heuristics and improve care<br />6<br />Earlier and more appropriate interventions<br />3<br />CHB Catchment Age Impact (Ages 0 – 21)<br />DNA Sequencing, Initial Results Return, Conduct Research, Ongoing Results and Patient Re-engagement, Impact Practice of Clinical Care<br />CHB Ongoing Care Impact (Ages 21 and over)<br />Conduct Research, Ongoing Results Return, Family Re-engagement, Impact Practice of Clinical Care<br />Diagnosis and Familial Carrier Status<br />Post-Disease Management<br />Predisposition, Environment, and Pediatric Care Management<br />Interaction with Primary Care Provider<br />Interventions and Adult Care Management<br />
    12. 12. Patient Care Paradigm<br />Whole Body<br />Organs and Systems<br />Cells and Tissue<br />Genes and Molecules<br />
    13. 13. b<br />How Facilities Impact Innovation<br />Medical Arts<br />Intuitive Medicine<br />Multidisciplinary<br />Specialists<br />Experience<br />Evidence - Based<br />Medicine<br />Knowledge<br />Technologists<br />Precision Medicine<br />Medical Science<br />
    14. 14. Disruptive Technologies to Meaningful Use<br />The Theory of Translation<br />Device<br />Data Transmission<br />Steam<br />Engine<br />Medical Records<br />Wireless<br />Core<br />Enabler<br />Wired Communication<br />Virtual Grid<br />Rails<br />TCP-IP<br />Innovation<br />Health Information Exchange<br />Social Networking<br />High Speed Train<br />Video Conferencing<br />
    15. 15. New Model of Stroke Care in London <br />Convergence<br />NCL SU and TIA<br />HfL HASU designation<br /><ul><li>High variability to consistent outcomes</li></ul>Thrombolysis rate <10->20%<br /> Mortality >30% to <10%<br /><ul><li>Move from Local to Regional to International Health Care Systems</li></li></ul><li>HDR Translational Initiative – Research Driven Healthcare<br />Research<br />Workshops<br />Colloquia<br />Evidence Based Design <br />Post-Occupancy Evaluations<br />Toronto General Hospital & Princess Margaret Hospital<br />
    16. 16. Advanced Multimodality Image Guided Operating (AMIGO) Suite<br />Disruptive Technology<br />Connected Modular Procedure Rooms = Laboratory<br />PET/CT<br />Fluoroscopy, US, Optical<br />MRI<br />Robotics, Navigation, Mass-Spectrometry, Histology<br />
    17. 17. “Strange Attractors…deal with the rich and diverse types and sources of information which could potentially inform decisions” G.R. Gates<br />MRI<br />Optical probes<br />Gamma probe<br />Beta probe <br />In vivo imaging<br />In vivo spectroscopy<br />PET<br />Histology<br />MRI<br />PET<br />Navigation<br />Pathology<br />Ex vivo <br />spectroscopy<br />Validation of Multimodality Imaging<br />Disruptive Technology<br />
    18. 18. c<br />Lessons Learned from HDR’s Translational Health Science Initiative<br />
    19. 19. Translational Health Science Center Design<br />Kit of Parts<br />Clinical Trial<br />Intervention<br />Patient Care<br />Hospital | Out-Patient Care<br />Lab<br />Translational Zone<br />Bioinformatics<br />Research & Development<br />Faculty | Classrooms<br />Medical Education<br />Simulation<br />Vivarium<br />
    20. 20. Translational Facility Typology<br />The Evidence of Translation<br />Single Organ / Disease Specialty<br />Transdisciplinary Integration<br />Multiple “Centers of Excellence”<br />KnowledgeTransfer<br />KnowledgeTransfer<br />Mechanical<br />Mechanical<br />Mechanical<br />Laboratory<br />Clinic<br />Hospital<br />Office<br />Clinic<br />Laboratory<br />Office<br />Hospital<br />Clinic<br />Office<br />Office<br />Laboratory<br />Hospital<br />Support / Technology<br />Support / Technology<br />Support / Technology<br />Laboratory<br />Clinic<br />Hospital<br />Med Ed / Outreach<br />Amenity /<br />Interaction<br />Clinic<br />Hospital<br />Laboratory<br />Vivarium<br />Core Tech<br />Core Tech<br />
    21. 21. Vertical Integration to Horizontal Integration<br />The Evidence of Translation<br />Inpatient<br />Research & Admin<br />Diagnostic & Treatment<br />Research<br />Ambulatory<br />
    22. 22. MEEI Research Building<br />
    23. 23. The “Pike”<br />Brigham and Women’s Hospital<br />
    24. 24. VISION | MID-CAMPUS EXPANSION<br />Brigham and Women’s Hospital<br />Future Site of Patient Tower<br />AMIGO Suite<br />BWH Cardiovascular Center<br />New 350,000 sf<br />Translational Research Building<br />
    25. 25. Delivering on a Concept<br />iPad?<br />iPhone?<br />What device made by Apple has had the most disruptive impact on the handheld industry?<br />Newton!<br />The Newton, which failed because it was technology without application<br />