Challenges of innovation in a public healthcare environment

1. NAVIGATING THE INNOVATION
JOURNEY
Dr. Andrew Maxwell, Canadian Innovation Centre and York University
Helen Leighton, Leighton Maxwell Inc.
Introduction for Public Health Organization - April 4, 2017

2. IMPLEMENTING INNOVATION IN THE
CANADIAN HEALTHCARE ENVIRONMENT
Agenda:
• Understanding The Innovation Imperative
• Organizing for Innovation
• Assessing Your Innovation Challenges
• Introducing an Innovation Process
• Fostering Innovative Behaviours
It’s easy to come up with new ideas; the hard part is letting go of what worked for you two years ago,
but will soon be out of date. Roger von Oech
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3. WHY IS INNOVATION SO
CHALLENGING?
• Organizations don’t turn their concerns about innovation into actions
• There is confusion about what innovation is and is not
• We organize for performance, not innovation
• People are hired, trained and incented for performance
• Measurement systems monitor and track incremental performance
• Daily pressures to deliver short-term services and results
If you always do what you always did, you will always get what you always got. Albert Einstein
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4. WHAT IS INNOVATION?
• An initiative that is new to your organization, has an uncertain outcome, significantly
improves quality/outcome and/or reduces costs and use of resources
• Requires changes in the way we:
• Assess and incent individual and team behaviour
• Foster collaboration
• Implement processes
• Allocate resources
• It is challenging to make these changes when there is daily pressure to deliver on
short-term performance goals
Discovery consists of seeing what everybody has seen and thinking what nobody has thought. Albert von
Szent-Gyorgy
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5. UNDERSTANDING THE
HEALTHCARE INNOVATION
IMPERATIVE
• Based on trends in healthcare needs, costs & GDP - in 15 years, BC healthcare costs
consume over 45 percent of government spending
• The Fraser Institute1 concludes that such increases may be unsustainable and risk
crowding out other programs or requiring fiscal adjustments
• Future Agenda2 cites five cost drivers:
• Aging population (with higher costs)
• Increasing number of patients with chronic conditions
• New treatments and technologies
• Rising costs of trained staff
• Personalized care
1Fraser Institute: The Sustainability of Health Care Spending in Canada 2017
2Future Agenda: http://2015.futureagenda.org/category/topics/health/
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Provincial spending as % of economy

6. PROVINCIAL HEALTH SPENDING AS A
PERCENTAGE OF THE ECONOMY (GDP), BY
PROVINCE, 1998-2015
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Sources: CIHI, 2015; Statistics Canada; Fraser Institute

7. TOP TECHNOLOGY INNOVATIONS
LIKELY TO IMPACT IN HEALTHCARE
• Web based services: Patient self-service/appointments/patient records
• Wireless devices: Remote monitoring/sensors/wearables
• Autonomous machines: Robots/drones/homecare
• Online resources: Telemedicine / Web based diagnostics
• Big Data and Artificial intelligence: for data analysis and prediction
• 3D printing: Body parts / organs
• Personalized pharmaceuticals
• Miniaturization and local intelligence: Medical devices
• Augmented reality: Surgery / treatment / diagnosis
• Blockchain: Secure transactions/ interoperability/ data interchange
Any sufficiently advanced technology is indistinguishable from magic. Arthur C. Clarke
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8. CHANGE IS DIFFICULT UNDER SHORT
TERM PERFORMANCE PRESSURES
Here is Edward Bear, coming downstairs now, bump,
bump, bump, on the back of his head, behind
Christopher Robin.
It is, as far as he knows, the only way of coming
downstairs, but sometimes he feels that there really is
another way, if only he could stop bumping for a
moment and think of it.
And then he feels that perhaps there isn't.
A.A. Milne, 1926, Winnie The Pooh
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9. TURNING INNOVATION FROM A
WISH INTO AN ACTION PLAN
• Talking about innovation does not action the innovation imperative
• Innovation requires: organizational re-design and a different culture
• Innovative outcomes will only be possible when behaviours change
• Designing for innovation means different people play different roles
• Innovation is not just coming up with new ideas. It is implementing them
The innovator has for enemies all those who have done well under the old conditions. Machiavelli
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10. THE DICHOTOMY OF
ORGANIZATIONAL INNOVATION
Performance engine success
• Efficiency
• Repeatability
• Predictability
Innovation engine success
• Speed
• Impact
• Failure
Great energy only comes from a correspondingly great tension of opposites. Carl Jung
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11. ORGANIZATIONAL
AMBIDEXTERITY
PERFORMANCE ENGINE
Characterized as exploitation
• Follow the rules and drive out
variance and slack
• Focus on serving existing
customers and their needs
• Manage and refine existing
competencies
• Optimize the organization for
existing rules
• Invest for short term savings
If you look at history, innovation doesn't come just from giving people incentives; it comes from creating
environments where their ideas can connect. Steven Johnson
INNOVATION ENGINE
Characterized as exploration
• Break the rules and promote
variance and slack
• Serve new customers with new
needs
• Develop and lead new
competences
• Develop new organization
system with new rules
• Invest to save money in future
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12. ASSESSING YOUR INNOVATION
CHALLENGES
Your organization was designed for performance. Some design aspects
foster innovation; others stifle it.
The Innovation Quotient is a diagnostic tool to help you identify
opportunities for improvement on five critical dimensions:
• Strategy: Leadership, markets/services, performance expectations, strategic guide
• Resources: Hiring, managing risk, allocation
• Culture: Values, experimentation, incentives, risk-taking
• Processes: Innovation, hiring, engagement
• Relationships: Internal, external
Without change there is no innovation, creativity, or incentive for improvement. Those who initiate change
will have a better opportunity to manage the change that is inevitable. William Pollard
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13. INTRODUCING AN INNOVATION PROCESS
1. Establish critical innovation objectives
2. Define how you will assess which opportunities you will resource
3. Establish a mechanism for collecting ideas – linked to an evaluation process
4. Develop rapid first cut response
5. Establish multi-functional initial review team with mandate and budget
6. Set short-term deliverables for each project (and constrained budgets)
7. Be clear on implementation goals and how performance will be measured
8. Develop a communications strategy
9. Embed a scale up strategy
10. Design an appropriate incentive/compensation plan
Common barrier to innovation is lack of follow up, i.e. encouraging people to suggest ideas, then not
implementing/resourcing them, exacerbated by not providing rapid feedback on decisions ALM
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14. THE INNOVATION PROCESS IS A
MULTI-STAGE ELIMINATION PROCESS
Identify
Priorities
Collect
Ideas
Screen
Ideas
Initial Pilots Experiments Scale Up Roll Out
Priorities
Ideas
Criteria
Resources
Fieldtrials
Resources
Engagement
Non-priority
Weakideas
Poorideas
Parkedpilots
Failedpilots
Parkedprojects
Not-scaleable
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An innovation process enables the development of an innovation portfolio – using a real options approach,
which encourages failing fast, and scaling up on successful experiments. ALM

15. What does an innovation culture look like?
• Encourages team and cross-functional collaboration
• Sharing ideas with internal and external partners
• Two way, open, knowledge exchange,
• Deferred judgment and idea exploration
• Speedy decision making
• Experimentation and willingness to learn from failure
• Incentives that reward new activities
• Achieving balance between loose practices & tight processes
FOSTERING AN INNOVATION CULTURE
The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to
himself. Therefore all progress depends on the unreasonable man. George Bernard Shaw
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16. TRUST AS A BEHAVIOURAL CONSTRUCT
• Viewing trust as an auditable and coachable behaviour
• The Behavioural Trust Framework (BTF) enables individuals to
understand how they build, damage or violate trust
• It allows individuals to audit others’ behaviours
and decide whom to trust
• Higher levels of trust reduce relationship
risk, & the need for trust proxies (controls)
• Trust fosters innovation by facilitating collaboration,
knowledge sharing and alignment
Trust is the universal lubricant that enables innovation, it fosters collaboration and enables the innovation
engine to engage with the performance engine. ALM
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17. INNOVATION
Innovation Capacity is a ƒ(level of trust)
The level of trust =
∫(Trust building - trust damaging) behaviours – ƒ(controls)
MEASURING INNOVATION CAPACITY
Learning to collaborate is part of equipping yourself for effectiveness, problem solving, innovation and
life-long learning in an ever-changing networked economy. Don Tapscott
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18. Trusting:
• Disclosing: Shows vulnerability by sharing confidential information
• Reliance: Willingness to be vulnerable through reliance on others
• Receptive: Demonstrates ‘coachability’ and willingness to change
Capability:
• Competent: Displays relevant technical and/or business ability
• Experienced: Demonstrates relevant work/training experience
• Judgment: Shows ability to make accurate / objective decisions
Trustworthiness:
• Consistent: Displays of behavior that confirm previous promises
• Benevolent: Exhibits concern about well-being of others
• Alignment: Actions confirm shared values and/or objectives
Communication:
• Accurate: Provides truthful and timely information
• Explanation: Explains details & consequence of information provided
• Openness: Open to new ideas or new ways of doing things
BEHAVIOURAL TRUST FRAMEWORK18
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19. NAVIGATING THE INNOVATION
JOURNEY
Creating strategy, culture, & processes to enable innovation in public healthcare
Andrew Maxwell andrewlmaxwell@gmail.com
Helen Leighton helen.leighton@gmail.com