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Two Types of Innovation: What is the Right Balance?

December 17, 2012

I recently coined a phrase while talking to our senior leadership at Partners HealthCare.  I told them that we aspire to bring them “innovations they don’t yet know they need.”  Folks at the Center like this, especially those that are primarily focused on innovation.  They feel that it defines us as cutting edge.  And you know I would not put forth such an aspirational goal if I did not have evidence we could achieve it.

Let’s talk about innovation for a moment. In the early part of the last decade, Microsoft and its hardware partners released a series of products called Tablet PCs.  They were trendy for a year or two but then withered away, to be replaced by newer fads such as Netbooks and the like.  Tablet PCs failed because the technology was not really portable – they were too heavy to fulfill many of the use cases for slate type devices, and in retrospect, they were poorly designed.  So in 2009, when Apple was preparing its launch of the iPad, if they had gone to consumers and asked them about their interest in another Tablet PC, chances are they would have gotten a tepid response. In fact, Steve Jobs was quoted as saying they did not do any consumer research for the iPad because, “We don’t expect consumers to really know what they want.”  By envisioning the tablet as a large iPod Touch, Apple revolutionized the concept.  They brought us an innovation we did not know we needed.   Another, more mundane example of this is the story of the Post it Note.  That product failed in early consumer focus groups because it was viewed as a not-very-sticky glue.

At the Center for Connected Health, we’ve delivered a few innovations of that type.  We started working on telemonitoring for congestive heart failure (CHF) in 2002 (a collaboration with Partners HealthCare at Home) and were met with derision from conventional medicine.  Fast-forward to 2012 and that program is now in mainstream use for our high-risk patients with CHF.  In 2005, we conceived of a need to streamline home vital sign monitoring for chronic illness.  That lead to the creation of our Remote Monitoring Data Repository (RMDR) and more recently, the infrastructure that facilitates the integration of home monitored vital signs into our electronic medical record.  Both of these milestones show the value of early-stage innovation, or innovation that Partners “did not yet know they needed.”

Looking back on these examples, it’s tempting to focus our whole team on this type of innovation.  But, I don’t think that is a good idea.  The flip side of the coin is interacting with and listening to customers.  People who pay you to do work are a critical part of the innovation feedback loop.  History has many stories of people who were far ahead of their time and died destitute.  They are praised in the history books but ostracized while on earth.

We have innovation going on in our Center that is in response to customer needs.  Much of our work in text messaging for reminders and education falls in this category.  Programs such as OB Connect were developed in collaboration with both pregnant women and midwifes and continue to thrive in our provider environment.  We also have a large Collaborative Media Group that acts as a resource to physicians at our hospitals who wish to engage in more traditional telehealth activities, such as remote consultations and home video visits.  Are these efforts as glamorous as innovating out of whole cloth with an eye towards utility 5-7 years out?

That is really not the relevant question. The relevant question for us is how to best be of service to Partners HealthCare System as we move into the exciting new world of provider-payer risk sharing, a care model that is ideally suited for connected health to thrive.

So we must do both the type of innovations that people don’t yet know they need and the type that is born from creating products and services that customers ask for and are refined by customer feedback.

The question I’m pondering now is what is the ideal mix of these two strategies.

I’d be delighted to get your thoughts on any of this.

34 Comments leave one →
  1. December 17, 2012 11:26 pm

    Reblogged this on lava kafle kathmandu nepal.

  2. December 18, 2012 10:24 am

    Simulation may be able to help! The ideal mix of these two strategies can be determined through advanced analytical approaches. A platform that replicates the complex network of interactions & connections make it possible to see emergent patterns and unexpected events.

  3. December 18, 2012 11:58 am

    Focus on integrating the health innovations with all the other silos of life.

  4. December 18, 2012 12:57 pm

    Over the next few years (shorter term), I believe that innovation will come from addressing a broader, more holistic and comprehensive customer need.

    Currently organizations are focused in on technologies to support a specific health issue such a mobile tool for helping a patient manage his diabetes. How does this mobile tool help the patient address his other co-morbidities or tie in with other mobile apps to support his wellness?

    In the future, organizations will need to develop an innovative platform to enable a consumer to manage her health holistically as well as the health and well being of all members in her family, through the lens of both family history and individual patient history.

    Imagine this platform where all the tools are integrated and data is flowing across applications to present to, capture from and share relevant information with each family member….. where the platform uses algorithms to ask patient about emerging symptoms to intervene earlier as well as leverages individual information to ask about related health issues… helping the patient to connect the dots on her health and helping her become more preventative and proactive in her care management

    • December 18, 2012 1:21 pm

      Great vision Sherri! The pieces to the innovative platform you mention are currently available. Organizations are an organization just needs to put them together.

      • Kamal permalink
        December 18, 2012 6:13 pm

        That’s a great point – components of ‘playforms’ needed are already available and are being developed by big players. The question is what’s the niche CCH should carve for themselves in this ecosystem? Are they competing at all, if not what’s the value addition they can bring to the market, which in the future will be more and more unified?

    • December 19, 2012 8:43 pm

      thanks for your thoughts, Sherri and Adam

  5. December 19, 2012 11:27 am

    I think you need to think about your patients and what communications they already have.

    So globally markets are skipping desktop and going for mobile. However, in advanced countries people have other net connections which are essentially free.

    It is seductive to engage with state-of-the-art mobile internet and it has a global market potential. However, in US, more value can be delivered immediately by solving problems and using established (free) infrastructure.

    The main question in connected health is to prove the added value for patients and providers – in most cases the technology has existed for many years. The connection you need to make is around what patients use for email or even Facebook (although I am not a big fan of Facebook).

    Future proof applications should be provided around standard syntax and semantics such as IEEE/ISO are providing. The communications techniques are a secondary priority.

    Innovations of value connect with better patient care and have nothing to do with the latest generation of tablet computer. I hope I make myself clear.

    • December 19, 2012 11:57 am

      I would imagine the “filters” by which you judge the balance between the two might be: 1) Cost, 2) Quality (that is, effectiveness), and 3) Convenience (or Delivery or Channel).

    • December 19, 2012 8:42 pm

      thanks to both of you.

  6. Lee Kauffman permalink
    December 19, 2012 12:21 pm

    Consumers are driving the market for self-monitoring medical devices. In a recent study, IMS a Colorado based research firm indicate that consumers are driving 80% of this market versus telehealth organizations ( http://www.healthcare-informatics.com/news-item/report-consumer-self-monitoring-will-drive-wireless-health.).

    Reluctance of payers to fully fund telehealth is only one reason. For better or worse, I believe the consumer’s goals in self-monitoring are divergent from healthcare providers. Consumers (in the absence of acute illness) are more concerned with the more ephemeral results of better health (i.e How do I look?). Devices such as the Nike Fuel Band cater to this by creating competitive gameification and social media opportunities to post results. Consumers are more attracted and responsive to exercise measured in “Fuel Points” (the new Nike Analytic) than the more medically relevant analytic of calorie burn.

    Like the Ipad, vendors such as Nike continue the Steve Jobs approach and are successfully telling consumers what they need. Telehealth providers need to part of this dialog and work with these vendors to leverage the devices ability to serve both the consumer and the healthcare provider. One of the obvious benefits of this approach is that these vendors tend to have much larger marketing budget then even the largest healthcare systems.

    Some vendors, such as “Fitbit” are producing devices that meet consumer expectation and are designed to connect with standards compliant PHR’s such as Healthvault. By exporting HL7 complaint data these devices meet not only the consumer needs but provide structured data for healthcare providers. This is the model that is waiting to happen to actually boost the utility of the PHR.

  7. Lee Kauffman permalink
    December 19, 2012 12:21 pm

    Consumers are driving the market for self-monitoring medical devices. In a recent study, IMS a Colorado based research firm indicate that consumers are driving 80% of this market versus telehealth organizations ( http://www.healthcare-informatics.com/news-item/report-consumer-self-monitoring-will-drive-wireless-health.).

    Reluctance of payers to fully fund telehealth is only one reason. For better or worse, I believe the consumer’s goals in self-monitoring are divergent from healthcare providers. Consumers (in the absence of acute illness) are more concerned with the more ephemeral results of better health (i.e How do I look?). Devices such as the Nike Fuel Band cater to this by creating competitive gameification and social media opportunities to post results. Consumers are more attracted and responsive to exercise measured in “Fuel Points” (the new Nike Analytic) than the more medically relevant analytic of calorie burn.

    Like the Ipad, vendors such as Nike continue the Steve Jobs approach and are successfully telling consumers what they need. Telehealth providers need to part of this dialog and work with these vendors to leverage the devices ability to serve both the consumer and the healthcare provider. One of the obvious benefits of this approach is that these vendors tend to have much larger marketing budget then even the largest healthcare systems.

    Some vendors, such as “Fitbit” are producing devices that meet consumer expectation and are designed to connect with standards compliant PHR’s such as Healthvault. By exporting HL7 complaint data these devices meet not only the consumer needs but provide structured data for healthcare providers. This is the model that is waiting to happen to actually boost the utility of the PHR.

  8. William Boyles permalink
    December 19, 2012 12:31 pm

    Superb analysis. We are in a structural change versus the familiar, recurring cyclical changes of past decades. Partners is one of the very few health systems in the world that understands — and acts upon — this distinction. Congratulations. You are the future of medicine.

  9. December 19, 2012 12:57 pm

    Joe, maybe the quandary isn’t about the balance between innovations with an identifiable need and those not as yet identified. Maybe we should we talking about a process that systematically, knowledgeably identifies an array of possibilities, assesses them according to meaningful criteria, and ranks them against each other by impact, urgency, difficulty and cost of implementation, and other criteria. Maybe that comes out 30% vs. 70%, or vice versa but it doesn’t make any difference because those decisions would be made based on value delivered. You don’t lose anything from the queue, the opportunities just get re-ordered.

    • Molly Coye permalink
      December 19, 2012 2:01 pm

      Joe – that is a great post! Exactly the kind of innovations we’re sorting through and with all the same happy contradictions. And I like Gail’s comment, too – although even the prioritization by potential value has important ingredients like fit with culture, availability of leaders/champions and bandwidth, etc., that are more specific to the organization than to the needs of the consumers/patients. Thank you…

      • December 19, 2012 8:37 pm

        So nice to hear you chime in. I’m honored. thanks

  10. William Boyles permalink
    December 19, 2012 2:08 pm

    One of the curious characteristics of the ‘m-health’ universe is the belief that there is a missing silver bullet for changing behavior, and that it will be scaleable to large populations. I see this in the common misconception that because a new app or solution “can” do something that it will be adopted widely. Innovation that scales up doesn’t work that way unless you are Steve Jobs and you can create demand where none existed. In the shared savings world you cite, solutions that end up having impact across millions of patients only happen when we stop looking for silver bullets and start applying new technology to old problems. Telehealth is really the epitome of this. Fitness devices are not.

    • December 19, 2012 8:36 pm

      Thanks. I lost you on the last bit. Telehealth is the epitome of which?

  11. December 19, 2012 2:31 pm

    Great article. I agree that listening to customers (and other key stakeholders) is vital to innovation, but differ in the sense that this process can be much more than incremental in its impact and can lead to the generation of completely new products and services. The key is to engage with your customers in an open and intimate way that explores both functional and emotional needs and desires, and then build innovations around the opportunities uncovered.
    When Continuum worked alongside P&G to explore opportunities in floor cleaning, the early focus was on discovery of the next advancement in detergents; through extensive observation of people cleaning floors in their own homes, we witnessed the challenges and conflicts involved the process – people were spending more time changing into old clothes and washing the mop than they were actually cleaning the floor. This critical observation, combined with the insight that a clean floor was important to how people wanted to project their values, led to the Swiffer and the creation of a completely new and lucrative category.
    Innovation in healthcare is no different although the number of stakeholders involved and their different, and often tangential, needs makes the process both more complicated and more necessary.
    New technology is great and can be transformative, but engaging with your customers has to be central to a successful and disruptive innovation strategy.

  12. December 19, 2012 2:36 pm

    SAP Healthcare has created a seperate group that is singularly focused on partnering with Technology Partners, Providers, Payers, Medtech with the sole purpose of innovating around the needs of the patient as well as the organization. The expansion of existing and new platforms that integrate with other platforms will be mandatory in providing both the caregivers and patients the transparency and collaboration necessary in reducing healthcare spend and affecting outcomes in a positive manor. The question that needs to be answered and built upon is what does the business models look like that will allow all these entities to work more closely together. we continue to work with all the parties in an effort to identify the correct engagement model that allows for greater adoption of these technologies and ease of use. We believe that innovation will expand exponentially if we can ensure ease of use and minimize the interuption to lifestyle.

  13. Gene Sacco permalink
    December 19, 2012 3:37 pm

    The issue of balance may be less about results and more about the investment in tools and culture change. To keep up, organizations must actively facilitate and nurture innovation. But the toolkit for facilitating disruptive innovation (“didn’t know they needed it”) is a little different from the toolkit for facilitating customer-directed incremental innovation, although there are plenty of tools common to both. Organizations need to progressively facilitate and nurture both types of innovation, using the right tools, supported by an innovation culture supported by leadership. The balance of those efforts, like the balance in an R&D portfolio, is directed by the organization’s mission and its strategy for reaching that mission (i.e., do you compete on incremental or disruptive innovations?). But, like the R&D portfolio, a balanced effort doesn’t always give balanced results.

  14. George Mathew permalink
    December 19, 2012 7:35 pm

    Underlying all innovations needs to be a measurable benchmark or goal, to show either goal accomplishment or improvement. When you have an ‘innovation sandbox’ such as yours that allows you to test new disruptive technologies and designs, having these benchmarks should not only demonstrate how close you are to reaching your goals, but also help you with validating the necessity of the innovation (i.e. using this technology or design has led to X fewer chronic care visits or $Y/year). We used to use many of these metrics in our Lean Sigma/DFSS projects. These benchmarks can be reviewed regularly to determine if they truly reflect the goals of the organization, and if necessary adjusted.

    Moreover, looking at these projects through either a usability (UX) lens or a customer development lens should help winnow the herd further – determining which projects have the highest likelihood of acceptance of your stakeholders will help determine the success of your projects in the future, and point the way to further incremental innovations and refinements down that path. Not all constituents will use the same technologies the same way, and it is important to adapt to their needs, rather than try to jury-rig their systems around the technology – we’ve seen the effects of that with EHR implementation already.

  15. Jim Hutchinson MD permalink
    December 20, 2012 9:33 am

    The relevant question is NOT how to be of best service to a “system,” but how to manage the human factors of both providers and patients as they work together in avhieving the goals of better citizen health. The closer we come to reaching this goal then benefits both the “system” and the payer. That requires patience, constant adoption and modification of technologies and allowing innovation. Motivating care recipients effectively is a major challenge, as is moving acceptance of care delivery afforded by our technical successes by the providers. Recall, most providers were not truly trained to deliver these services in this new and ever changing arena.

  16. January 14, 2013 12:20 am

    Great post once again Joe! You asked: “…what is the ideal mix of these two strategies.” With the “two strategies” being “both the type of innovations that people don’t yet know they need and the type that is born from creating products and services that customers ask for and are refined by customer feedback.”

    In my humble opinion, it’s not about getting the “mix” or ratio of the two right, it’s about understanding what to expect from each approach. In all my years of building new businesses and creating new products I’ve concluded that customers are great at helping you iterate but only innovators can help you innovate.

    • January 14, 2013 3:01 pm

      Well spoken. I still feel like in a resource constrained environment, one has to make choices and they are sometimes difficult.

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