From Our CEO: Continuous Renewal by Innovating and Seeking Perfection

Our association prides itself on being lean and agile with an entrepreneurial mentality. We call it staying "CRISP." Are we ahead of the curve or simply setting the pace for the industry?

At a recent high-profile national meeting, I was once again hearing something about the need for innovation in health care. This created a stir of uneasiness in my thinking as I glazed over during the presentation, but I was not sure why.

Peter Angood

As my thoughts wandered, several “innovation” topics I’ve recently noticed in health care quickly came to mind:

• Cost transparency.• Financial realignment.• Interprofessional leadership education.• Insurance reform.• Value-based care .• Patient-centered care.• Physician employment.• Burnout and resilience.• Multiprofessional, team-based care.

These topics are the focus in many of our formal and informal conversations. Most of you will recognize them, and likely have strong opinions for many … let alone your own list of “innovation” topics.

I also drifted to when I was a trainee, where there were two surgeons who were brothers and well-recognized for their tinkering with, or inventing, surgical instruments. These guys were a pleasure to be with in the operating room because no matter the case being performed, they were always looking for how to make improvements, or how to change things technically and procedurally. They were natural innovators/inventors, and, behaviorally, I learned much from them in terms of trying to look past what is in front of you to see what other options might be possible. They continually succeeded and were highly regarded in our community as a result. (Parenthetically, we called them the “Rear Admirals” because they were both colorectal surgeons in the era before colorectal surgery was recognized as a board specialty.)

As you think about it, however, mankind — and apes, crows and other animals — has been innovating and inventing since the beginning of time. There is really nothing new here in terms of our abilities to create innovation. What is different is the shift toward systems-based thinking in health care and how we need to innovate not only our systems, but our entire industry.

FIGURE 1: ROGERS ADOPTION/INNOVATION CURVE

Source: valuebasedmanagement.net

Straight from the Farm

Everett Rogers, and his sentinel book, Diffusion of Innovation, is often credited with the early onset of our current thought processes toward innovation. His book arrived on the heels of the Industrial Revolution and the turmoil of the early- and mid-20th century — very much predating our digital revolution. He initially analyzed how farmers made their decisions on which crops to plant annually — not health care.

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Most of us are aware of Rogers’ adoption curve for human behaviors when people are confronted by innovation or change within their environments (see Figure 1). What is less well-appreciated is the underlying theory that supports the graphic illustration of our behavior and how innovation gradually diffuses — or doesn’t.

Rogers’ book, first published in 1962, argues that diffusion is the process by which an innovation (an idea, concept or good that is perceived as new) is communicated over time among the participants in a social system. As individuals, and within our social systems, there are five stages we pass through as we decide whether to adopt an innovation or new idea — awareness, interest, evaluation, trial and adoption.

There also are four main elements that influence the spread of a new idea: the nature of the innovation itself, the communication channels available, the passage of time and the nature of a social system (see tables 1 and 2).

For individuals, this diffusion process relies heavily on human capital and how humans adjust — or the rate in which they adjust. The innovation must, therefore, be widely adopted in order to self-sustain. Within the rate of adoption, there is eventually a point at which an innovation will, by necessity, reach critical mass if adoption is to succeed.

For organizational (and even industrial) adoption of innovation, there are several other factors at play beyond adoption by individuals. Accordingly, Rogers suggests there are three additional components in these environments:

• The tension present for needed change (motivation and ability).

• The innovation-system fit (compatibility).

• The assessment of implications (observability) for innovation.

As in health care, organizations and industries often feel significant pressure for change beyond their usual and natural pace of change, invention and innovation.

How We Adopt

When these situations arise, innovations are often adopted through two types of innovation decisions: collective innovation decisions and authority innovation decisions. As implied by the terms, collective decisions are most related to a natural process of consensus and adoption preferences. The latter is where authority creates the demand (and expectation) for innovation to occur. Each situation will have different rates and acceptance levels for the innovation — and failure might also occur.

It seems health care as a whole only recently has paid closer attention to Clayton Christensen, a best-selling author on innovation. His seminal 1997 work, The Innovator's Dilemma, introduced one of the main concepts that is also now his most disseminated and recognized one: disruptive innovation. This is the type of innovation that truly creates a new market and value network, and eventually fully disrupts an existing market and value network, displacing established market-leading firms, products and alliances. As a result of his work, most of us now recognize disruption in our professional and personal lives.

Being a multifaceted innovation thinker, Christensen also addressed health care several years ago. There is a well-articulated piece on our industry that has an important segment we should consider as physician leaders:

“Once an industry is in crisis, individual leaders often become paralyzed. They’re incapable of embracing disruptive approaches because the profitability of the institutions they lead has been so eroded. Typically, not only do they ignore the potential disruptions, they actively work to discredit and oppose them. Thus far, this pattern has held true in the health care industry as well.”

— Clayton M. Christensen, Richard Bohmer and John Kenagy, “Will Disruptive Innovations Cure Health Care?” Harvard Business Review, September-October 2000.

So, the question becomes: If we are natural inventors and innovators, and if we have known about diffusion of innovation since the early 1960s, and we have known about disruptive innovation since the mid-1990s, and we now have several years of increasing tensions in our industry for needed change, why have we not succeeded and are apparently still in the talking phases of creating significant innovation?

This is a call to action as leaders in health care.

It's CRISP, Not CRISPR

Physicians are the natural leaders in our industry. Yes, there are pockets of innovation occurring within the industry. And, yes, physicians are known for their abilities as inventors and innovators. But it is time for all of us as physician leaders to bring our individual and collective efforts to bear — to foster more productive innovation and change for the industry. We need, however, to continue to figure out and drive the diversity of ways in which we can bring these efforts into focus and to positively drive our influence on the industry.

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The board and staff of your association have been on a path of creative innovation for the past several years. We have, in a relatively short period of time, introduced nearly 200 ways in how we invigorated the internal structure and processes of AAPL. Externally, we continue to follow and expand our core strategic directions of providing exceptional learning strategies, professional development tactics, deep levels of informational resources, a fast-evolving technical platform that supports our AAPL community, and an ever-expanding network of influence within the industry.

Internally, we often say we stay CRISP — Continuous Renewal by Innovating and Seeking Perfection.

The association’s overall intent is to help create significant change in health care through the platform of physician leadership. And I strongly believe we are not only ahead of the curve for the world of association management, but in some ways we are actually setting the pace for the industry. We are on the far left of the Rogers graph.

AAPL heavily promotes the message that, at some level, all physicians are leaders. At its core, AAPL maximizes the potential of physician leadership to create significant personal and organizational transformation. Physicians are the natural leaders for health care. We should embrace that privilege and create the innovative change needed in our industry —innovation that does not need to be disruptive all the time, but, like the Rear Admirals, always happening as we do our work. So let’s collectively take action to continue precipitating change and innovation for our practices, our industry — and, most important, our patients.

By the way, a disruptive health care force already happening, if you have not yet paid attention, is CRISPR.

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CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats, which are the hallmark of a bacterial defense system that forms the basis for CRISPR-Cas9 genome editing technology. In the field of genome engineering, the term CRISPR is often used loosely to refer to the various CRISPR-Cas9 and -CPF1 (and other) systems that can be programmed to target specific stretches of genetic code and to edit DNA at precise locations, as well as for other purposes, such as for new diagnostic tools. With these systems, researchers can permanently modify genes in living cells and organisms and, in the future, may make it possible to correct mutations at precise locations in the human genome in order to treat genetic causes of disease. (Learn more at bit.ly/2ddOV99.) Yes, I will admit as a surgeon, I had to take a few minutes to absorb all of that as I considered the potential ramifications of disease management and optimization of wellness strategies for our populations.

I encourage all of us to continue seeking deeper levels of understanding and to generate influence at all levels to which we are individually comfortable. As physician leaders, let us get more engaged, stay engaged and help others to become engaged. Creating a broader level of positive change in health care — and society — is within our reach.