I was recently asked to present at a forum run by the Australian College of Health Service Management on Controversy, Collaboration at Innovation. To try and fit into the theme I focussed on innovation, but tried to be controversial about how the collaboration between the technology sector and the health provider sector has failed to date. You can see the presentation at this link.
To me the main issue is the difference between invention and innovation. From the technology industry’s perspective there has been a lot of inventions which have been passed off as healthcare innovations. However they have not been successful for a couple of reasons. Firstly they are not actual healthcare innovations, and just calling them that doesn’t make them so. They are new tools that need to be built into a process, and to date that has been the main barrier. Secondly, healthcare providers, who really are the folk who would deliver innovation in healthcare, have never been trained to seek innovation. This is mainly because they are taught to practice in a risk averse way, so trying new things is not something they do as part of their normal business. In some ways this is a good thing, you don’t want your doctor running random experiments on you, but there are ways to provide safe sand pits where those sort of experiments can be done. Linking this to a quality and safety agenda is key to this. Thirdly, the current way we evaluate new healthcare interventions is designed for evaluating drugs and specific interventions, and not process improvements. Assigning a process innovation to a double blind placebo controlled randomised study is both difficult, and often counterproductive. If the clinicians have a robust quality and safety framework they should be able to integrate process innovations into their normal workflow, and be able to build up at least anecdotal evidence of how these process innovations would affect the care they provide.
Clinical care is a very individual thing, both from the provider and the patient perspective. Whilst it is important to have a best practice mind set, individuality is important in at least style of care delivery. After all people pick their providers not just based on their knowledge, but on their personality. By enabling them to also be innovative, and test those innovations in the real world, we should see a Darwinian evolution of new clinical processes. Those that are most effective, or most efficient should become more prevalent, whilst those that are not will go the way of the DoDo. This requires a level playing field to be developed from the outset. Today the processes that have become more prevalent are more a result of perverse incentives in reimbursement models rather than effectiveness. If we can remove these perverse incentives and enable clinicians to be able to choose how they do things in a reimbursement independent way, we should see a new growth in healthcare innovation, driven by healthcare providers. I believe it will not only spur new innovation, but also improve the morale of our healthcare sector and make being a healthcare provider something our younger generation will aspire to, like they did in the past. Who know’s they may even get naming rights to these new innovations, something we used to do a lot of in the early 20th century with diseases. Personally I would like my name to be associated with a cure than a disease.