I am a practicing community urologist recently bitten by the innovation bug. This past year, through simple networking alone, I have met many other community clinicians who share my passion for innovation and entrepreneurship. We are “regular” doctors and nurses — not at major centers, not in start-up hotbeds like Boston or the Bay Area — but nonetheless, many of us are thinking big. I write this piece on behalf of clinicians like us, because I believe that the innovation movement has much to gain from us, and much to offer us in return.
What Is Innovation in Health Care?
Health care is experiencing a burgeoning innovation movement today. Clinical medicine and innovation medicine are fundamentally different endeavors. The former emphasizes development of new devices or new drugs, whereas medical innovators seek to establish an entirely new paradigm for care. Clinical medicine has traditionally looked to improve. Innovation medicine, on the other hand, seeks to transform.
Digital applications that bring doctors and nurses directly to patients; personalized and precision medicine tools that track data and provide live coaching; artificial intelligence technologies that can process big data, identify patterns, and make accurate diagnoses; teleconferencing solutions that are bringing virtual visits closer to standard-of-care are only some of the innovations taking place in medicine today.
How Innovation Medicine Happens
In his book, Creativity Inc., Pixar President Ed Catmull, writes about a concept he calls “unhindered communication.” This is a free-flowing form of communication that involves and supports all voices. It is the language of creativity.
Catmull describes a room where some of Pixar’s most important meetings were held. As in most meeting rooms everywhere, the leadership team clustered at the center, while other key participants lined the periphery, and still others occupied a third tier of seats at the outskirts of the room. No one questioned this setup until one day, by happenstance, the meeting was held in a different room — one with a square table and no assigned seats. Consequently, people sat where they wanted, with each person in plain sight of the others. The new arrangement changed the discussion landscape. There was fuller participation, better idea flow, better eye contact, freer-form thinking — and better ideas as a result.
Now envision a second meeting room, this one from my own residency and fellowship. The setup of weekly conferences in this room is: chairman at the head of the table, program director next to him, other attendings nearby, chief residents farther down the table, junior residents at the periphery, and medical students in an even lower tier, standing in the back or seated under the projector screen with necks craned backward trying to see the screen. Sound familiar?
The second scenario illustrates how we usually gather in clinical medicine. It is a time-honored tradition that has worked for many years. But is this how we should gather in innovation medicine? Should highly visible entrepreneurs, innovators, and thought leaders at major centers dominate the central space at the “medical innovation table”?
Certainly, these leaders are in major centers because they are ambitious, passionate, and talented individuals. And, historically, progress in medicine (e.g., new surgical approaches, devices, drugs) has migrated from major academic centers to smaller communities in a hub-and-spoke configuration.
Innovation medicine, in contrast, seeks to dismantle this hierarchical approach by emphasizing disruption and creativity — elements that are not restricted to any particular geographic area or clinician. I would argue that we, as “off-hub” clinicians, possess some valuable experience to guide innovation. We work with patient populations who may not be represented at large academic centers. We manage a high volume of “bread-and-butter” clinical conditions that need to be maximally leveraged during innovation scaling, which is the process of allocating and optimizing resources to expand an innovative concept through the market. In addition, many of us have more day-to-day interactions with non-clinical staff, ancillary providers, and administrators, and as such might be in a better position to understand the pain points of health care processes that do not directly involve physicians. Finally, many community-based clinicians simply have a gentler lifestyle and a lower complexity of clinical practice, which creates more bandwidth for non-clinical pursuits.
Practicing Innovation Medicine
The question then follows: How do community clinicians become involved? When I first learned of the medical innovation movement, I was very excited — but also somewhat discouraged, because I wasn’t sure where I was going to fit in. As a practicing physician in a relatively small community in the Midwest, I worried that I was too far from the places where all the buzz seemed to be happening. Many of my peers have expressed similar concerns.
I believe that part of the issue is an unfamiliarity with the innovation process itself. Many physicians are simply unaware that innovation is a process and that entrepreneurship is a discipline. Innovation does not occur by a magical and mysterious process known only to a few. Entrepreneurs and innovators do not have access to special knowledge that allows them to create products out of thin air. Just as in clinical medicine, there is a playbook of sorts. Books such as Disciplined Entrepreneurship by Bill Aulet are a helpful starting point for interested clinicians to begin to understand this process. For further engagement, academic programs like Penn’s Master of Healthcare Innovation or Duke’s online course in Healthcare Innovation and Entrepreneurship are just two examples of the many options that can be explored. Teaching community clinicians that there is a process — and that they can play a part — is the first step toward engagement.
To directly involve themselves in this process, community clinicians should be intentional about finding opportunities. If they practice relatively near a major center where innovation is happening, they should look for meaningful partnerships. Even small- to medium-sized organizations that are launching innovation hubs that aim to drive innovation from within the system can be a tremendous asset. For those who do not have local access to such an innovation hub, virtual and online opportunities abound. The American Medical Association is rolling out an online matching program that aims to connect entrepreneurs and start-ups with interested clinicians. Conferences such as Medicine X, Exponential Medicine, and TEDMED are great places to develop passions, meet like-minded individuals, and improve connectivity and discourse among innovators nationwide.
The Clinical Entrepreneurship Programme in England is a deliberate national initiative that engages practicing clinicians and intentionally recruits and includes community physicians, regardless of geographic location or type of practice. This program, run through the U.K. National Health Service under the guidance of Tony Young, the NHS National Clinical Lead for Innovation, allows entrepreneurial residents to have a flexible schedule so they can pursue their ventures while staying on track toward becoming a practicing physician. When I had a chance to meet Tony, as well as some of his resident entrepreneurs at a recent conference, it was amazing to hear what these residents are doing “on the side” — and even more amazing to hear how much their endeavors are supported by the NHS. Whether an orthopedic surgery resident with a digital tool that streamlines the informed consent process, or a recently graduated medical doctor with a medical photography mobile applications, these clinicians are innovating wherever they are planted, and the NHS gives them the time and resources to get their projects to the next level.
The ingredients for success in innovation medicine are already present. Self-employment among physicians has decreased, leaving many hungry for a chance to expand their professional opportunities, to recapture the creative, business-minded activities once afforded by traditional private practice. We are fortunate to be part of a profession that continues to attract some of the world’s finest talent. If we are purposeful, we can retain this talent, bolster and diversify the innovation pipeline, and improve patient care.
This blog post originally appeared in NEJM Catalyst on April 26, 2017.