Driving Front Line Innovation in Health Care

Harvard Business Review

Jennifer Stinson was a nurse at The Hospital for Sick Children (SickKids) in Toronto who enjoyed brainstorming new ideas for improving care, especially for the kids with cancer she treats. But even as she gained status by getting her PhD and becoming a clinician scientist, she came up against persistent bureaucratic and organizational barriers to innovation.

Stinson's challenge is common at big organizations, but overcoming bureaucracy and breaking down silos is especially critical in healthcare. To tackle these obstacles at SickKids, CEO Mary Jo Haddad in 2010 elevated innovation to a "strategic direction," and engaged Innosight to help devise a full system needed to spur innovation. The resulting system has three major components:

  1. An Innovation blueprint detailing the types of innovations the organization wants to encourage. SickKids prioritized encouraging doctors, nurses and clinicians to look for unmet needs they could address, rather than wait for solutions from IT or top management. That required creating a focus group with 25 front-line healthcare workers to discover and catalog key "jobs to be done" (like reducing the length of hospital visits), surveying all 5,000 employees, and training most of them on how to integrate the innovation system into their daily practices.
  2. An innovation pipeline to reliably take ideas from concept to reality. This involved establishing a new 18-member Central Innovation Group of leaders from different areas of the hospital, a team that was tasked with prioritizing and advancing ideas and projects through various stages. The team helped innovators test prototypes, make adjustments, and then scale to a wider population.
  3. An innovation culture that features the right people, in the right roles, speaking a common language of innovation. A key enabler of this culture was the establishment of a $250,000 Innovation Fund to provide seed money for promising ideas. Now, instead of being stalled by permission hurdles that suppress initiative, promising new ideas could be funded, fast-tracked and prototyped.

Consider how the new system helped Stinson bring a transformative innovation to life. Every year at SickKids, thousands of children are battling various forms of cancer. It's vital that they keep accurate diaries tracking their pain, but if it's not done daily the data are virtually worthless. Typically these diaries must be filled out by hand, an annoying task that children with cancer aren't motivated to do. The result is poor reporting and suboptimal pain management.

Stinson had the spark of a solution: use technology that kids love to turn the pain-reporting chore into a game. Her idea went into the pipeline before the hospital's own innovation fund was set up, but with outside funding she set out to develop and test an iPhone/iPad-based pain diary. A design firm called Cundari contributed $80,000 in-kind services to develop the app. To motivate patients to complete the diary, Cundari and Stinson recruited support from two of Canada's most popular police detective shows, Rookie Blue and Flashpoint, to provide actors and visuals for the reward system in the app. She called the app The Pain Squad. The numbers so far are impressive. Whereas pain reporting with paper diaries yielded compliance rates below 50%, and Web-based diaries yielded 70%, Pain Squad has boosted rates to more than 90%.

The hospital is now scaling the innovation by making the app a standard part of care, and other hospitals in Canada are adopting it too. This spring, SickKids will launch it for free on the Apple AppStore for hospitals all over the world.

A different kind of idea came from Dr. Darius Bagli, a senior urologist who was frustrated with a patient billing system based on "paper, paper, paper." Although Canada is a single-payer system, hospitals must still track all procedures so that the hospital and its doctors are properly paid. At SickKids, only 30% of procedures were being filed accurately and on time. "We were doing the worst job imaginable," Bagli says.

The traditional route to solving such a problem would be to mandate that IT develop a solution over a period of perhaps a year or two. Bagli believed billing could be done better and a solution implemented more quickly by creating a simple one-screen billing app for the iPad. With a $10,000 grant from the new innovation fund, Bagli went from idea to pilot in three months. His App is now in used throughout several departments in the hospital. In urology, billing compliance rates went from below 50% to higher than 99%. "The thing practically paid for itself during the three month urology pilot alone, and will generate ten times, maybe twenty times that in one year," Bagli says. "The funds we bring in will easily buy tablets for every department, with plenty recovered to fund other initiatives."

The mobile billing and Pain Squad apps are just two of dozens of innovation projects that are making their way through the SickKids pipeline. By unleashing the creativity of front-line providers, SickKids has rapidly introduced low-cost innovations with big impacts. It's a model that should be widely adopted.

Press spacebar to pause and continue. Press esc to stop.

Bloomberg reserves the right to remove comments but is under no obligation to do so, or to explain individual moderation decisions.

Please enable JavaScript to view the comments powered by Disqus.