Innovationeering: Innovation in the time of coronavirus

Putting together the "Innovationeering" series has made me refresh — and occasionally reconstruct — my legacy thinking about the practice of innovation. What has also emerged is the reminder that one of the key characteristics of innovators and the systems they lead is that they must be nimble.

We had a lineup planned for the next installments in this series, but then the world got knocked off its axis, so we have responded by rapidly changing our focus to the novel coronavirus (2019-nCoV or COVID-19). Here goes…

Some of us have been afflicted by the virus, but we all seem to be affected — at minimum, psychologically or economically. Morale is low, the energy we derive from social contact is subdued and the optimism of participating in the innovation ecosystem is restrained.

This piece is not about virology or epidemiology; it's about philosophy. Specifically, I want to make a case for doubling down on "innovation in the time of coronavirus" — a concept inspired by Love in the Time of Cholera, the 1985 novel by Nobel Prize winner Gabriel Garcia Marquez, which features as a prominent plot point the conflation of physical and emotional disease.

I have heard about a very disturbing trend that seems to be the default election in some academic medical centers and research universities. As enterprise teams are reformed and resources — both human and financial — redirected, innovation has been demoted, if not shelved and starved. The argument is that we are facing an immediate threat, and the very nature of innovation is too long to success and fraught with failure to potentially suck away a dollar of funding or an hour of time. Innovation is often considered a "nice to have," not a "must have," when corporate budgets are assailed, let alone when the basic fabric of our society is under attack.

Let's unite to flip that script for the reasons that are well known to the sophisticated innovation leaders reading this column. Innovation isn't superfluous — it's central. Innovation has been both the solution and the outcome for almost all human crises, particularly when there has been a demand for strides forward in practical application of technical or scientific knowledge. Let's not forget that the great accelerator, collaboration, is an innate characteristic of the innovator and something we can demonstrate for those who may be more comfortable in a competitive milieu.

In distilled form, here are the three domains in which innovation is making an immediate impact on healthcare's retaliation to the COVID assault:

  • Novel intellectual property: Of course, at the most basic (read: foundational) level, we are seeing a robust number of disclosures come to our enterprise innovation function. In the past, I have described this as "latent" and "opportunistic" innovation. Whether it is diagnostic and therapeutic molecules or assays, new mask and gown designs, or novel ventilators — frontline clinicians and engaged scientists are leveraging their intellect and experience to find solutions to the crisis.
  • Delivery strategies: Not all advances will be protectable intellectual properties in the drug or device realm. We may be experiencing a sea change in how we deliver care in both synchronous and metachronous ways. Our forced reliance on virtual health and telemedicine as a substitute for face-to-face interactions is pushing the technology and legislation envelopes. My conjecture is that this will be the inflection point for the practical use of virtual visits and the way they are recognized and reimbursed.
  • Self preservation: Let's face it, we can't quit or close. We have to be there for patients, not to mention that our healthcare systems are often the largest employers in the municipalities in which they reside and serve. We must fulfill our mission, regardless of circumstance. For most of us, that includes treating the sick, conducting discovery science and training future leaders. Instead of performing the "Ostrich Maneuver," we have discovered ways to work from home, use videoconferencing to conduct important business and academic conferences, and even rely on our portfolio of relationships both inside and outside of traditional healthcare to help keep our basic science research afloat.

The element that recurs or catalyzes all these responses is collaboration. I am heartened by seeing traditional competitors lay down their business cards and work together in communities to open joint testing centers and share equipment. Frankly, these are pages taken out of the book of the innovation capacities; we have always shared resources and permitted ideas to interact.

That spirit of collaboration must exist within and between our institutions. My first recommendation is to promote, not prevent, innovation to be part of the solution to the ambiguity and chaos we've all inherited. The second is to let the way our innovation ecosystem has conducted our affairs — transparently and collaboratively — be a model for how we mobilize to meet challenges of considerable gravity affecting large populations.

I'll invoke another literary homage: the "Black Swan Theory." In Nassim Nicholas Taleb's 2007 bestseller, The Black Swan: The Impact of the Highly Improbable, he drew on the experiences of 17th-century Dutch explorers and 19th-century philosophers to espouse the namesake theory. To qualify, an event should (1) be surprising to almost all observers, (2) be of considerable, even global, magnitude and (3) have an element of predictability if data would have been assembled differently, studied more thoroughly or handled better, had risk mitigation responses been better positioned.

It will be long debated whether COVID-19 was a "Black Swan" event or not. What I hope is never disputed is whether innovation personnel and resources should have been included or excluded in the response. My Appalachian upbringing has imbued me with countless aphorisms; the one that comes to mind in this circumstance is, "The fishing is always better in muddy water."

We may not know exactly how we got here, and we don't have a crystal ball to tell us how this will all turn out. What we do know is that we need to care for each other, we need clear thinking and we absolutely require innovative thinking. Leaders lead, and innovation leaders lead creatively and collaboratively. Let's get to it…and wash our hands.

Thomas J. Graham, MD, is a clinical professor and director of strategic planning and innovation in the Department of Orthopedic Surgery at NYU Langone Health. Dr. Graham, formerly the inaugural chief innovation officer of Cleveland Clinic, is the author of Innovation the Cleveland Clinic Way.


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