A core piece of UCSD Health's innovation strategy is pontification: 'You have to be a visionary,' says innovation chief Matthew Jenusaitis

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At University of California San Diego Health, Matthew Jenusaitis, chief of staff and chief of innovation and transformation, oversees one faction within the academic health system's robust, three-pronged innovation strategy.

Among UCSD Health's seemingly endless list of ongoing innovation projects — and among those most exciting to Mr. Jenusaitis — are the newly expanded Center for the Future of Surgery, an initiative to "harness the power in big data" by leveraging the mass amounts of information within the EHR systems of UCSD and its partners and advances in immunotherapy for highly personalized cancer treatments.

There's also Mr. Jenusaitis' vision of deploying drones to deliver blood samples to and from UCSD Health's laboratories, which has become something of a pet project for him, and something of a running joke across the health system. UCSD is aiming to launch a pilot of the project in collaboration with Matternet within the next few months — a moment that will undoubtedly serve as both professional and personal triumph for Mr. Jenusaitis.

"It's become kind of a tongue-in-cheek joke of the health system, but I keep hanging onto it," he said. "Our CEO teases me a lot about this project, but I'm a little bit reluctant to give it up, just because I think it's interesting. Maybe when Amazon starts delivering your packages via drone, everybody's finally going to agree that we need to be in the drone business."

Here, Mr. Jenusaitis discusses UCSD Health's multifaceted innovation strategy, which relies largely on being a "fast follower," a step removed from the cutting edge, to maximize innovation while minimizing risk.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What does innovation look like at UCSD? What are your goals and priorities for the role? 

Matthew Jenusaitis: It's a little bit amorphous at UCSD. UCSD is one of the top five research institutions in the country, and our medical school is incredibly gifted in terms of what it contributes to the science of medicine. In addition to that, there's a few innovation pockets in the U.S.: The Bay Area is an innovation hotspot, Boston and the Cambridge area is a hotspot, Seattle, to a large regard, is a hotspot, and Minneapolis, too, with Medtronic and Boston Scientific. And Southern California is the same thing, so we're in a great institution with a great research presence and we're in the middle of an environment in San Diego, in Southern California, that's an innovation hotbed. Really, my big goal and objective is inoculating the healthcare system with everything that's going on around us, and making sure the level of healthcare that we deliver is commensurate with this high-technology, innovative environment that we are in.

In terms of the organization and what innovation looks like at UC San Diego Health, there are three factions that all work closely together: There's my group, there's an information innovation group run by our CIO and then there's a physician-led innovation group.

My group focuses mostly on process and operations: What are the innovations and the technologies in the process and operations aspects of running the hospital that are going to define the future of healthcare? Within the group, I have a team that focuses on new technologies, new processes and continuous improvement within the hospital system. In parallel with that group, there's a whole Lean Six Sigma initiative, and we have a process here where we will review the performance of different aspects of the hospital or review the opportunities of particular service lines, and then we will assign resources based on where the needs and the opportunities are. 

A second group in my area is all about figuring out how we can use telemedicine more effectively. We've carved that out as a strategic priority for the future of our healthcare system, and we're trying to invest in telemedicine in different areas of the business. 

The third area that I manage directly is our contracts and joint ventures and hospital affiliations. We do affiliations with other hospitals, and we have lots of joint ventures that we work on with other companies, many of which are in post-acute care.

Q: What are some barriers to healthcare innovation? How do you overcome those obstacles? 

MJ: The biggest barrier is that innovation is inherently risky, and there's a high likelihood of failure in almost everything that you work on. It's really a portfolio management exercise: When you invest in technologies and in innovation, you need to take a portfolio approach, where you recognize that it's inherently risky and that the size of the portfolio you can develop will determine how much risk you can take. If there's a 90 percent likelihood of failure and you're investing in 100 things, you know that 10 of them are going to hit. But if you only invest in two things, chances are, both of them are going to fail, so you have to invest in less risky things, and then the rewards are going to be less.

And then the third piece of that is the hospital business is, as a whole, financially constrained. Healthcare costs are out of control, and everybody's trying to figure out how to reduce the cost of healthcare and drive costs out of the system. In an environment where the costs are being pushed out, it's hard to take on a lot of investments. So, probably the biggest barrier to innovation is having the capital required to invest in an innovation portfolio in this very cost-constrained healthcare system. People do it by managing the size of their portfolio based on how many things they can afford to invest in, and they balance it with philanthropy and by partnering with technology companies, and they may look for ways to be able to invest appropriately in innovation so that they could build a broader portfolio.

Another challenge that I see is change management in general. Healthcare delivery is a cautious business. When you need brain surgery, you don't want it to be risky, you don't want it to be cutting edge — you want to know that it's going to work. There's a certain amount of risk avoidance inherent to the nature of healthcare, but innovation is based on taking lots of leaps of faith, knowing that things are not going to work out all the time, so change management and dealing with the inherent risk aversion of healthcare is probably the second-biggest barrier. 

The way we deal with it is, you need to be a visionary. Our CIO Chris Longhurst, the physicians that make up our physician-led innovation team and I all spend a lot of time pontificating, selling the vision of "this is what it could be" and "this is why we're doing this thing." And at the same time, we build in as much risk mitigation as possible because, obviously, we're not going to take chances on patients.

Q: What does that "pontification" entail? 

MJ: We're selling a vision; I think leadership is a lot about creating a vision of what things could be like in the future and how they could be better. Telemedicine is a lot like that: Right now, for a primary care physician to see a patient via telemedicine vs. having them come to the office, it's easier for the physicians if you have the patient come to the office because they don't have to deal with different technological elements. But the vision that I keep talking about is that healthcare is changing. It's becoming consumer-driven. Making it easier for the provider is not going to be what motivates a millennial to choose your healthcare system. The consumers are going to decide what they want in healthcare, and if we don't provide it for them, somebody else is going to, and what's going to end up happening is our business is going to atrophy. 

That's the kind of pontification that I do — talking about what this means to us long-term. Today, it might be easier to just have the patient come here and see us, but a year from now or five years from now, we'll realize really tangible benefits that will allow us to continue to survive and continue to make investments in other technologies.

Q: What do you see as the biggest mistake that players in the healthcare industry are making when it comes to innovation?

MJ: One is being myopic. If you're short-sighted and you only look at what things are going to be like today, it's almost impossible to justify any of these investments in new technologies or innovation. You really need to look to the future, first and foremost.

There's a couple of other mistakes — I talked about that portfolio, and I think, as an organization, you need to have an innovation strategy. You need to understand how much risk you can afford to take and know that it's not always about being on the cutting edge. The most successful innovators are not the ones that are necessarily way out on the edge and are investing first. Often, the companies that follow, that watch what the leaders do and learn from their mistakes, those are the ones that eventually dominate the industry. 

You have to have an innovation strategy that matches your organization. At UC San Diego, our innovation strategy is not about being the leading edge or the bleeding edge. Our innovation strategy is much more about being a fast follower. There's a lot of times we are presented with technologies that we think are really cool and would be really valuable, but we recognize that it's probably a little bit too early in their development cycle for us to be able to withstand the inherent risks associated with them being so early. 

Another mistake is not effectively collaborating with other people. I really believe that collaboration is the key to innovation. It's really easy when you're a technology person to start to develop a mindset that you know better than other people or that your ideas are somehow sacred and more valuable than other people's ideas, but I've been in this business for a long time, and the one thing that I've learned is that collaboration drives a whole that's much, much greater than the sum of the parts.

One more common mistake — and this is another one that's kind of obvious — is not listening to the people that work for you and not listening to your users. I can sit in my office and put on my engineering hat and say, "We should do this," or, "We should do this," but when I go talk to the physicians in the clinic, they might say, "That's the stupidest idea ever. You're totally missing the boat." 

You have to listen to the people that are doing it day-in and day-out; they have great ideas and they have simple solutions to problems that are much better than some of the elaborate technological solutions. Innovation is not about technology. Technology can be a useful component to innovation, but innovation is about new, creative ways of solving existing problems, and you get a lot of that from just listening to the users.

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