To fix healthcare, think big, start small: Q&A with Mayo Clinic innovation leader Dr. Nicholas LaRusso

Healthcare is an industry in need of innovation, and Nicholas LaRusso, MD, might just be the man for the job. As founding medical director of the Mayo Clinic Center for Innovation, Dr. LaRusso is tasked with cultivating innovation, overseeing nearly 40 innovation projects in 2014 alone. Along with CFI's co-founders, Gianrico Farrugia, MD, and Barbara Spurrier, MHA, he's authored a new book that shares Mayo's journey to developing what Dr. LaRusso refers to as "innovation capacity," along with the processes and structure it uses to embed innovation into the organization.

"Think Big, Start Small, Move Fast: A Blueprint for Transformation from the Mayo Clinic Center for Innovation" (McGraw-Hill Education, 2014), shares some of the CFI's biggest successes, which taken on their own, seem rather small: For example, the book opens with a story about the development of the pediatric phlebotomy chair. Alone it won't revolutionize healthcare, but it does revolutionize the act of pediatric blood draws for technicians, parents and their children.

The pediatric phlebotomy chair isn't transformative innovation; it's iterative. But, Dr. LaRusso and the CFI believe that transforming healthcare delivery isn't going to happen with a single "big bang" — healthcare is too complex for that. Instead, the impact of these incremental innovations will eventually move us to a transformed system of delivery for patients.

ThinkBigStartSmallQuestion: Some of the innovations the book highlights, like the phlebotomy chair or an app for asthma management, seem small compared to big picture of transforming the entire healthcare system. How do we get to the future state?  

Dr. Nicholas LaRusso: If I look at how we're going about it at Mayo, let me put this in context for you: I think the single greatest innovation in Mayo's 150 years is the innovation of the group practice at the beginning of the 20th century, and I think our strategic plan at Mayo continues to be transformational. There needs to be a big vision focused on solutions to the problems we face. For us, that "Think Big" is transforming the patient experience. We pay more for healthcare than anywhere else on the planet, and we're getting less than optimal results. Having a system that doesn't provide access, that clearly differentiates among classes of people, these are all things that we've identified as big issues. But this is a 10 or 20 year journey.

Q: You allude to that in the book, this idea of transformation taking time. "Tearing down everything and starting over is not an option," you wrote. That idea is embodied by how CFI approaches innovation and speaks to the 'Start Small' in your mantra of 'Think Big, Start Small, Move Fast.' Why does innovation in healthcare need to be iterative to be successful?

NR: Our ability to reinvent ourselves within our society is influenced by a whole host of factors. There's a healthcare establishment that already exists, and that establishment improves the way we currently practice medicine. The establishment, more frankly, interest groups, in so many instances would prefer to protect the status quo, and more specifically, their income. So, while we have launched projects within the Center for Innovation based on the philosophy of tearing everything down, that isn't really possible. The medical establishment is so entrenched and there are so many constituencies that are threatened by substantive change.

Q: So, it's the small innovations that eventually move us toward the "Big" idea of a better patient experience?

NR: Exactly. Complex systems get changed incrementally, and one of the points we try to convey in the book is that building an innovation capacity is a process — a process that's very collaborative in nature and has stops and starts and periods of great uncertainty. Clarity evolves over time.

Q: In the book, you write, "We intend to transform health and healthcare. And we intend to do that by transforming the patient experience." Why focus on the experience, when costs and quality are still so problematic?

NR: If you've ever interacted with the healthcare system, you realize it's a global experience; that experience includes things like what time your appointment is; if you have to fast; where you park the car; how you're greeted when you walk in the front door; and if your family members are allowed to come in with you. These things make the experience positive or negative. So, while it's about access, integration costs and outcomes, it's a very personal experience, and a very emotional experience. The more serious the condition, the more emotional it is. Everyone that's trying to figure out the healthcare system should be a patient. When all is said and done, you can't lose sight of that.

Q: If you had to boil all the lessons in the book into one key takeaway, what would it be?

NR: I think it's the title, I really think it's the 'Think Big, Start Small, Move Fast' philosophy. As a scientist, what I've learned over the years is that you spend too much time and effort working on trivial problems, minutiae. Don't work on trivial stuff, but you have to 'Start Small' if you want to solve a big problem. You can't boil the ocean; you have to start with a concrete project and do the experiment. Then, 'Move Fast.' Don't get bogged down in doing things for extended periods of time. Learn quickly, or as quickly as you can, from the experiment.


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