How delivery system innovations can succeed: ‘Do fewer projects, but do them better’

The need for changing healthcare delivery is clear, according to David Bates, MD, MSc, chief of the general internal medicine division at Brigham and Women’s Hospital in Boston. Allowing those changes to succeed in the world of value-based care, however, may require organizations to devote more of its own resources to delivery system reforms.

Bates, along with coauthors Aziz Sheikh, MD, MS, professor of primary care research at the University of Edinburgh in Scotland, and David Asch, MD, MBA, executive director of the Penn Medicine Center for Innovation, wrote about strategies for innovating in care delivery in the March 2017 issue of Health Affairs.

Changes to the healthcare delivery system has “lagged behind” similar evolutions in other industries, the trio wrote, but the move to value-based care over fee-for-service in new payment models is offering new incentives to make changes in both academic and non-academic health systems.

The issue in both settings comes down to investment and focusing on delivery systems internally rather than relying on support from outside forces.

“Externally focused innovation, which is targeted at commercial success, generally falls into one of three categories: drugs, devices, and information technology. Internally focused innovation is directed at improving care delivery, and its success requires managing what innovators call the innovation value chain, which consists of idea generation, conversion, and diffusion,” the authors wrote.

The key to making these strategies work, they wrote, is making it a priority. Then come addressing other concerns, like how much money and space can or should be dedicated to testing new delivery system reforms and how to insulate these changes from the demands of day-to-day operations.

There doesn’t appear to be a one-size-fits-all way of achieving those goals. The article offered several different examples, like leadership-driven care delivery innovations at the Cleveland Clinic to “simnovations” at McGill University, where new methods which might be too radical to apply immediately to clinical processes are first tested in a simulated environment.

The opportunities are clear, Bates and his coauthors wrote: delivering care in less intensive settings, promoting efficiency among providers and increase care coordination. But there are also plenty of potential pitfalls. The biggest problem the authors identified is organizations just aren’t committing enough money.

Their recommendation, taken from a Harvard Business Review article, is to “invest 10 to 20 percent” of organization revenue on “developing, sustaining, and spreading big, disruptive innovations, and that they move resources from daily operations to do so.” The authors admit no one is coming close to that threshold.

“Given these challenges, we suggest the following strategies for organizations that want to innovate successfully: Do fewer projects, but do them better; allow the important to triumph over the urgent; and use a “slow trigger, fast bullet” approach—that is, find the root cause of a problem before deciding on a solution,” Bates and his coauthors concluded.