Who would you trust more to tell a hospital how to run itself: a business executive, or a health care professional? In a recent article published in the New England Journal of Medicine, Mack Institute Co-director Christian Terwiesch and his colleagues make the case that when it comes to innovation in healthcare, importing solutions from other industries should take a backseat to “insourcing,” seeking insight from clinicians within the healthcare system itself.
The authors propose implementing a solution process as a way to help ensure that suggestions from outside firms are put into the context of the unique challenges facing healthcare. This means ditching the habitual trips to the consulting firm and institutionalizing innovation. The “solution process” that the authors propose includes four parts:
The four stages are contextual inquiry — immersion in the way things currently work; problem definition — reexamination of the challenge, to ensure that the right problem is being solved; divergence — exploration of alternatives to the first ideas; and rapid validation — moving quickly from prototyping to designing of focused experiments testing critical assumptions.
The people performing these steps would not be consulting firms, but nurses and physicians. The base of insourcing is the conviction the clinicians themselves are in the best position to understand the nature of the everyday problems they face, and to recognize what solutions would work. The four-stage process would save money and preempt mistakes that come from clumsily importing solutions from a different industry.
While in print the model doesn’t seem particularly radical, adopting the four stage process outlined in the article implies a restructuring of how clinicians approach their work. Healthcare professionals on the front lines tend more toward what the authors identify as “incremental gains along established dimensions” than they do toward breakthrough innovation. Another barrier is the tricky question of how to allocate time for busy professionals to step back from their critical patient-oriented work and think about big picture goals for innovation.
The implementation of the proposed four-stage solution process is not without its difficulties. However, opportunities like the University of Pennsylvania hospital system’s innovation tournament, which opened the door to suggestions from all front-line employees, proved that clinicians are excellent sources of innovation insight for their own industry. Now the industry just needs to organize itself for tapping into that knowledge.