Institutionalizing Innovation
When the McKinsey Global Institute (London) asked more than 1,400 executives how important innovation was to their companies’ future growth, 70% said it was crucial, but only 35% were very confident in their ability to execute it. The problem is that too many enterprises treat innovation as a sideshow, according to an article by McCreary¹ published in the September 2010 issue of Harvard Business Review. “It may get its due in lip service without being appropriately supported or well understood,” he writes. “Worse, it isn’t integrated into the fabric or behavior of business.” One health-care organization is rewriting the book on innovation by going beyond the conventional pursuit of new technologies or tangible projects in search of new service-focused innovations. McCreary describes how Kaiser Permanente (KP), Oakland, California, implemented a thoroughly innovative new team, called the Innovation Consultancy, that has made a measurable difference in the efficient and safe delivery of health care throughout the organization, and perhaps even beyond it: The team invited 16 other not-for-profit health-care providers to join the Innovation Learning Network for the transfer of knowledge among peers through regular meetings. KP’s Innovation Consultancy got its start during a three-month consultancy in 2003 with IDEO (Palo Alto, California), a design company known for practicing a method that calls for exploring how people work, live, think, and feel. The relationship turned into an 18-month immersion in IDEO design technique for the KP team; its first project tackled how information is exchanged during shifts—a terrifying time for critically ill patients and a vulnerable one for quality. Nurse Knowledge Exchange resulted. It is a formula for passing information reliably to the next shift at the patient’s bedside. McCreary details the development of KP’s MedRite program to illustrate how the team works and its potential effects. Designed to eliminate medication errors and piloted in 2007, MedRite was rolled out in 75% of KP hospitals by early 2008. It cost $470,000 to develop and has resulted in $965,000 in cost avoidance for care associated with treating the consequences of medication errors. The Whole Truth To begin getting to the fundamental problems in medication errors, the team used a technique intended to uncover the untold story. Instead of asking nurses what was wrong with the process of distributing medication (and being told that nothing was wrong with it), the team asked them to draw pictures of themselves in the process, some of which resulted in pictures of nurses with frazzled hair and sad faces. When the nurses were asked why they drew themselves with their hair standing on end, the stories were forthcoming. This was followed by an observation period in which team members observed multiple disruptions and distractions. In the process of trying to give one person one medication, one nurse was interrupted 17 times. Because it was impossible to protect nurses from distractions completely, the team aimed to find a solution that would shield nurses during the medication-distribution process when they moved into the deep-dive phase of the innovation process, which took place in KP’s brainstorming and prototyping facility in Oakland. Nurses, physicians, pharmacists, and patients were enlisted, and the group, which numbered 70 codesigners, went at the problem, producing 400 ideas. One idea conceived by a nurse—a smock that would read Leave Me Alone—resulted in one of the program’s key innovations: a bright-yellow sash that sends the message to stay clear, effectively creating an interruption-free zone for the wearer. The team also created a zone around the central medication dispensary, using color on the floor, that can be occupied by just one person at a time. A five-step process for ensuring the correct dispensing of medication was the central innovation. Once an innovation has been devised, the team develops a change package that includes a set of detailed guidebooks that explain the innovation, the reasoning behind it, how it was developed, the anticipated benefits for staff and patients, user testimonials, and the measurements that will be used to evaluate its performance over time. Far from the hue and cry of Washington, the creative work of the Innovation Consultancy is democratizing health care by giving patients and caregivers a greater role in designing its delivery, McCreary concludes.