|By Paul E. Plsek, MS, Paul E. Plsek & Associates, Inc.; Author, Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience; former member, Innovations Exchange Editorial Board|
Health care organizations wishing to harness innovation to improve performance or address critical problems face a series of important decisions. The first decision involves selecting specific areas of performance where improvement is needed. Identifying target areas for improvement, in turn, requires simultaneous consideration of three factors.
Factor #1: Organizational Priorities
Identifying the organization’s key strategic goals and mission-critical activities is a key consideration when selecting priorities for innovation. Innovation is likely to prove the most useful if it addresses one of the following areas:
Successful adoption of performance-enhancing innovations in either of these areas will pay the highest dividends, and proposals for innovative activity to address these areas will attract the highest levels of support from key internal and external stakeholders.
- Key performance problems and challenges where improvements are necessary to reduce threats to the organization’s success or survival
- Mission-critical areas where current performance is adequate, but higher levels are possible and desirable
Identifying organizational priorities is often straightforward, particularly in organizations with well-established strategic planning processes. Even if not specified in a recent strategic plan or other document, the organization’s core, mission-critical areas that need improvement are typically well known to organizational leaders and key stakeholders, although their relative importance may be in dispute. Formal procedures for identifying and ranking areas for improvement can be helpful in facilitating consensus regarding priorities.1
Factor #2: Likely Impact of Innovative Solutions
A second consideration in selecting areas for innovation requires assessment of available innovations and their likely impacts. Although organizations with a successful track record of innovation can be bolder in their future initiatives, organizations lacking experience should select target areas and innovations to minimize risk and cost and to maximize the likelihood of rapid success. Risk and uncertainty are lower for innovations that—
Because innovation is disruptive and success depends on the commitment and support of key internal and external stakeholders, early innovation attempts should clearly demonstrate the value and benefits of the innovations' costs and disruption. Adoption costs arise from planning and preparation for initial implementation (e.g., staff training, purchasing new equipment or supplies, changes to physical space), ongoing monitoring and refinement of the innovative practices, and effort required to stabilize, institutionalize, and sustain the innovation.
- Have been in existence for longer periods of time
- Have been implemented and evaluated in multiple organizations under a range of conditions
- Have high-quality evaluation data available on costs and benefits
- Have undergone small-scale testing to determine their feasibility and potential for success
When early results are positive, successful innovation and stakeholder support can become a positive, self-reinforcing cycle. In contrast, early failures are likely to lead to a negative, damaging cycle. High-risk, high-cost innovations that trigger predictions of failure by key stakeholders may fail in practice if lack of confidence prevents stakeholder commitment and support.
The strong interdependency between expectations and success suggests that organizations in the early phases of a planned series of innovations should start with low-cost, low-risk, “sure thing” innovations, even if the potential benefits are modest. Doing so will help demonstrate the value of innovative activity, develop experience and a culture of innovation, and build support and appreciation for the value and benefits of innovation.
Factor #3: Capacity To Innovate
A third factor affecting the selection of priorities for innovation is the organization’s capacity. To fully implement an innovation and obtain its benefits, an organization should possess the requisite capital, technology, staffing, skills, experience, and culture. The greater the degree of mismatch between the innovation’s requirements and current organizational characteristics (and the organization’s ability to develop the required attributes), the higher the likelihood of implementation failure. Innovation is time- and resource-intensive, and it requires focused leadership attention for an extended period of time. Limiting the number of innovations in progress at any given time will help ensure that each innovation receives adequate attention.
When determining how many innovation initiatives can be under way simultaneously, keep in mind that implementation and the need for leadership involvement do not end after introduction of the innovative practice and completion of key activities (such as staff training and the introduction of new organizational policies). An extended period of monitoring, refinement, and support is needed to permit the organization to fully adjust to the new practices and vice versa. This adjustment includes refinement of the innovation’s operational details, as staff progress up the “learning curve” and develop new ways of working to accommodate the innovation and as customers and other key external stakeholders become accustomed to the changes. Leadership involvement is required throughout this process, which may require several months or longer.
Extensive documentation of innovation use and impacts is critical to guide future adopters and reduce uncertainty and errors in implementation. Documentation is especially important for innovations that are—
Balancing the Three Factors
- Complex and difficult to understand or replicate
- Sensitive to fine details of implementation and context
- Diverse and variable in their implementation
- Subject to significant variation in effectiveness across different settings and situations
Although the three sets of decision considerations presented above may appear to be sequential, they must be considered in parallel. For example, if the available innovations targeting the organization’s greatest priorities are too complex or costly for a newly innovative organization to adopt, it may prefer to adopt simpler, more-certain innovations that address secondary priorities. Similarly, the number of innovations an organization can adopt simultaneously depends on their complexity and target areas. A large organization, even if not highly experienced in innovation adoption, might pursue multiple innovations if each is simple and low-risk and if the innovations involve very different parts of the organization.
About the Author
Mr. Plsek is an internationally recognized consultant on innovation in complex organizations. A former research engineer at Bell Laboratories and director of corporate quality planning at AT&T, he now operates his own consulting practice and is the developer of the concept of DirectedCreativity.™ His health care clients have included the National Health Service (NHS) in England, Kaiser Permanente, the Veterans Health Administration, the SSM Health Care system, and the Mayo Clinic. Mr. Plsek is the chair of innovation at the Virginia Mason Medical Center in Seattle, an innovator-in-residence at MedStar Health (Washington, DC–Baltimore), director of the NHS Academy for Large-Scale Change in the United Kingdom, a former senior fellow at the Institute for Healthcare Improvement, an active research investigator, a popular conference speaker, and a former member of the Innovations Exchange Editorial Board. He is the author of dozens of peer-reviewed journal articles and seven books, including Creativity, Innovation and Quality; Edgeware: Insights from Complexity Science for Health Care Leaders; and Accelerating Health Care Transformation with Lean and Innovation: The Virginia Mason Experience.
Disclosure Statement: Mr. Plsek is an independent management consultant who advises health care organizations on innovation strategy.
1Rubenstein LV, Fink A, Yano EM, et al. Increasing the impact of quality improvement on health: an expert panel method for setting institutional priorities. Jt Comm J Qual Improv. 1995;21(8):420-32. [PubMed]