Even after securing millions to build an innovation hub, partnering with high-profile industry players to launch cutting-edge initiatives and gathering a dedicated team of innovators, a healthcare innovation program can still be easily sidelined if that team has not been properly trained in the art and science of innovation.
Rubin Pillay, MD, PhD, chief innovation officer at University of Alabama at Birmingham Health System, is a firm believer that one of the first and most important steps to innovation — up there with locking down funding and executive buy-in — is building organizationwide expertise in innovation, backed by a thorough training program.
"Innovation does not happen spontaneously, and for organizations and health systems to innovate, the initial strong focus has to be on innovation capacity development. Otherwise, it just becomes a theoretical discussion, and it's very, very difficult to apply," said Dr. Pillay, who is also a professor of healthcare innovation and assistant dean for global health innovation at the UAB School of Medicine. "You can't have one or two people of 20,000 in a health system being the innovators."
With only a small group of innovation experts leading the charge, he explained, hospitals and health systems will be unable to establish the culture of innovation and entrepreneurship necessary to advancing healthcare, nor will they be able to create an equally important "critical mass of ideas" for that advancement.
Here, Dr. Pillay explains not only how he has built a highly skilled, widespread innovation team at UAB Health, but also how those outside the traditional realm of healthcare can overcome the assumption-laden "valley of death" to play a role of their own in healthcare innovation.
Editor's note: Responses have been lightly edited for length and clarity.
Question: What does innovation look like at UAB? What are your goals and priorities for your role?
Dr. Rubin Pillay: It spans a broad gamut, from putting in place the structural systems and processes within the institution to actually culminating in the diversification of revenue and organizational sustainability. My role is all-inclusive, although our initial focus has been more on getting organizational aspects in place before we start more specific programmatic initiatives.
Q: What are some of the initiatives that you have started so far?
RP: There are several initiatives that have been launched. We have set up a whole UAB e-medicine operation, which has its own leadership and team, and that group covers the diverse spectrum of e-health opportunities, from just remote care to exploring e-ICUs, etc. We're also aggressively pursuing process innovation as a strategic tool, with a focus on the bottom line, and that has a separate unit and team focusing on that. And then we have more high-risk operations focusing on things like personalized medicine. That is just a sample of some of the things that we're doing; everything is in process, and they're all at different stages.
Q: Who makes up your innovation team at UAB?
RP: As chief innovation officer, you essentially work with everybody, but we take a very focused approach. Sometimes you have to make some strategic organizational decisions pertaining to structure, and in areas like process and e-health, which are major areas, they can't just be another thing that a chief innovation officer leads.
So, those areas have their own units: We have a director of e-health, we have a medical director of e-health, and they have support staff. With process innovation, that's a very specific operational skillset; we have experts in process optimization, and that's a separate faction called the Office of Performance Excellence. We have a precision medicine institute, and they've coordinated the whole precision medicine initiative.
That's one of the structural implications of setting up initiatives: You have to get to a point where these things are managed as separate business units within the major operation, within the system.
Q: What are some barriers you've run into when innovating within healthcare?
RP: There are several: The cultural barrier is one. Using the word "innovation" in an evidence-based profession is oxymoronic by definition, so that manifests itself in trying to get people to be creative and innovative. But, having said that, if you go about this very systematically and precede innovation with information and communication and training, that's one of the ways in which you mitigate these barriers.
There are many constraints in innovating in healthcare that are no different to innovating in any established corporation. Firstly, you have the normal organizational constraints of trying to be innovative and come up with new products and service lines while maintaining an existing operation. That's always a challenge, but that's not unique to health — every company has that. What's unique is we've got an evidence-based culture, and we've got to mitigate that as well.
It's not insurmountable if you go about this in a very systematic way. People in healthcare get the imperatives for innovation, and I think one of the roles of the chief innovation officer is precisely to tackle that: to actually ensure that the system has a critical mass of people who can lead the innovation initiatives. So, one of the first things you have to do — and certainly something that I've done — is set about launching what I call the "health innovation academy." We put people through what is essentially a training program, and in that way, we ensure that throughout the organization we have people who are skilled in innovation to lead the initiatives. We employ 20,000 people — we are not expecting 20,000 innovators, you just need a pretty good mass of that 20,000 people who are going to innovate and lead innovation.
This stuff doesn't happen spontaneously, so you've got to start by training people. I think most organizations that struggle with innovation have not done this. My approach has been, put simply, that you cannot set off on the innovation path without having knowledgeable people within the organization who understand the language, firstly, let alone the process and the structures you have organizationally to achieve your innovation goals.
Q: What are some major mistakes that players in the healthcare industry are making when it comes to healthcare innovation?
RP: With the external technology folks, they build a lot of their predictions and forecasts on assumptions of how we operate and the assumption that patient and physician adoption can be taken for granted. We saw this with the advent of EMRs — it's the same thing playing out again — where the EMR companies assumed their technology solutions were going to be what addressed the pain points of physicians and users. Well, we're here 20 years later, and there's still almost universal dissatisfaction with EMRs. So, because a lot of the technologies are based on assumptions of adoption, assumptions of utilization, assumptions in understanding the pain points, we've seen that it's much easier to come up with a technology than to get people to use it. That's where the "valley of death" is: in the adoption.
Sometimes, I think we're in the initial stages of the technology hype cycle. I'm a very, very strong proponent of technology utilization but, to me, a key issue is that the mass of technologies that are flooding the market are not doing us any good. I'm all for market-based approaches, but from a user point of view, when a physician is suddenly faced with 15 different remote monitoring technologies or AI-driven algorithms to read X-rays, it becomes an issue. We have never been this inundated with a mass of technologies all having the same kind of output, and, being an evidence-based profession, I think we're going to see that cultural component play into our technology adoption as well. Startups and major technology players are going to have to provide the evidence — both clinical and, now, of course, the business case evidence as well — to facilitate that process.