Care Redesign
Relentless Reinvention

The Challenges of Health Care Innovation’s “Bright, Shiny New Toys”

Interview · February 6, 2017

Amy Compton-Phillips and Molly Joel Coye

 

Amy Compton-Phillips: Hi, this is Amy Compton-Phillips, Chief Clinical Officer with Providence St. Joseph Health, here with NEJM Catalyst, and I’m speaking today with Molly Coye, Executive in Residence for AVIA and former Chief Innovation Officer at UCLA Health. Morning, Molly.

Molly Coye: Good morning. Thank you.

Compton-Phillips: What do you think is the proper role for innovation in health care?

Coye: There are a lot of different ideas about this. There is no single animal out there. My opinion is that it should be closely linked to the strategy of the organization, that it’s not about the academic exercise of just inventing new things, which is very valuable on its own. That has a value, and it shouldn’t be principally about commercialization, that it really is a question of understanding the deep problems for patients and for systems that are trying to work for those patients and finding innovations that will help in those tasks.

Compton-Phillips: That’s really helpful, because I think one of the challenges we get from the health care side is we have a lot of people coming to us with bright, shiny, new toys that they want to bring into our system, and sometimes it feels like it’s simply going to add cost and add complexity rather than change. How do you help us distinguish what is a real innovation and what’s a new shiny object?

Coye: First of all, I think in most cases you’re talking about innovations that actually have been fielded somewhere. If they’re coming to you from the outside, you do have the opportunity to do due diligence, to actually go out and see what the impact has been, but don’t waste resources. If they’re not tackling something that’s important to you, no matter how much traction they get, it’s really not going to benefit you to adopt them. That’s why I think you start with a problem or the opportunity.

The other problem frankly for a lot of health systems is internally there’re a lot of people who think they can invent something better than what’s out there. That may be true, but they tend to forget how much capital, marketing, organization building, et cetera is required to get from an idea to something that’s going to really have an impact.

Compton-Phillips: That makes total sense. I think part of the challenge with wholeheartedly embracing new innovations in health care comes from our recent embracing of EHRs, and so many physicians I speak with, and nurses and caregivers of all stripes, find that with the adoption of EHRs, we have enhanced communication, but we’ve so increased the burden of care that it’s blamed for contributing to burnout. So, adopting things becomes a challenge. How do we adopt things that are right and that help minimize the burden of care and enhance the joy of care? Do you see innovations that get there?

Coye: Definitely, and I think there’s a whole category of innovations, which we call health information technology and services. It’s using lighter, simpler in many cases, technologies to make providing services and enabling patients, engaging them and helping them much easier. So,we have to have a test. We talk about, is there patient satisfaction? We also need to have the providers within 12 or 24 months of being involved in an innovation be delighted with it.

Compton-Phillips: Do you have some examples, like some breakthrough kinds of things that have done that?

Coye: I’ll give a couple of examples. One is Augmedix, which is — and I want to be clear I have no financial relationships — Augmedix is the Google Glass used for remote scribing. You know how much time doctors and nurses spend in documentation. In this case, using the Google Glass with an offsite scribe, the EHR is completed at the time the patient leaves the office. That has relieved physicians of so much work. They are delighted with that innovation.

Another quick example is at UCLA Health, we put care coordinators in the clinic to focus on the 20% highest-risk patients. And at first the physicians thought, “Another body around that I’ve got to explain everything to?” Within 6 months they were killing to get them in their clinics, because it really helped. So, we should really be focusing on delighting the patients and helping to relieve the burden on the clinicians.

Compton-Phillips: I really like that, because it’s not only technology but it’s workflow and people and thinking about innovations much more holistically. It really isn’t just a new toy. When you started as Chief Innovation Officer at UCLA, how did you message the role of innovation for everybody you worked with, whether it was physicians or staff or the C-suite?

Coye: Well, first of all, we tied it back to the goals of the organization. We had very clear pillars and strategies, et cetera. I have to tell you, it doesn’t always work. It’s really hard, and we tried very hard to get the remote management of ICUs in, because we thought UCLA could be a good hub for that, and that model existed in other places around the country, and we were completely unsuccessful.

Sometimes it doesn’t work, but when it does what you’re doing is explaining to people why, and again, I think you’ve got to have pretty short time frames on this, 12 to 24 months in most cases. Life is going to be better for them and for the patients, and with that you really have some traction.

Compton-Phillips: Brilliant. One last question. What do you think personally are your top takeaways from your time at UCLA Health as a leader in really trying to bring this kind of uphill change you’ve been talking about into an organization?

Coye: Unfortunately, it’s a kind of tough message, but we really need the economic incentives to buttress what we know patients need and want, that operating in a PPO environment makes it very difficult to meet the needs of the patients because we should be investing. And some of these innovations were innovations 30 or 40 years ago, and community health workers, social workers, mental health workers enabled by technology now as they weren’t 30 years ago. That’s what our patients need and want, and we just don’t have the wherewithal unless we’re in a system that ties reimbursement to improvement in health.

Compton-Phillips: Aligning incentives always makes a difference. Well, thank you so much, really appreciate your words of wisdom. It was great talking to you today.

Coye: Thank you.

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