Innovation at Intermountain starts with empathy: 'Design for people,' says innovation director Todd Dunn

Todd Dunn is the director of innovation for Intermountain Healthcare and leader of the Healthcare Transformation Lab, where he oversees the Salt Lake City-based system's wide variety of new and ongoing innovation projects.

One such innovation — and one that will "continue to excite [Mr. Dunn] for a very long time" — is a collaboration with Velano Vascular, an early-stage company developing needle-free blood draws. Since launching the partnership in April, Intermountain has performed more than 400,000 needle-free blood draws and received countless notes of gratitude from patients, parents and phlebotomists.

"To be able to take what has historically been such an archaic way of getting blood out of someone with a cold needle and replace that with a method of drawing blood without a needle has been one of the most satisfying projects, frankly, that I have ever worked on," Mr. Dunn said.

Other cutting-edge advancements, including computer vision and voice technology, and their potential to speed diagnosis and ease clinicians' workload are equally thrilling: "That technology will remove the friction points out of a lot of the work that's done in healthcare and just make things easier for people. Any type of innovation like that excites me," he said.

Here, Mr. Dunn discusses Intermountain's "constraint-driven" and empathetic approach to innovation, and explains why healthcare innovation should be executed not as an art, but as a science — rigorously applied scientific method and all.

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

Question: What does innovation look like at Intermountain?

Todd Dunn: It looks like business model innovation. If you look at what we've done with Civica Rx, with our drive for fee-for-value and with other things that we're doing around the business model of healthcare, you will see business model innovation at Intermountain.

I'd also highlight our work with continuous improvement: the fact that we have an Intermountain operating model and we have a system in place across all of Intermountain to improve the day-to-day work people are doing from an efficiency perspective and a safety and quality perspective.

We work quite diligently to collaborate with our clinical teams and other caregivers to really understand the struggles they have and the gaps they have between where they are and where they want to be. We then partner with a number of early-stage companies around the world to harness the world's knowledge to make us a better place in terms of both safety and quality.

Depending on where you look within the system, you'll see us innovating on many different fronts and types; the work Dr. Shannon Phillips is leading around the patient experience, for example, is innovative in how we're making the patient far more central to the way that we collaborate and work as a team across the system. It all goes back into our DNA of trying to be a model health system. There are many different types of innovation, and we choose the most appropriate type for the appropriate context.

Q: What are your goals and priorities for your role?

TD: The goal for my role, as a small part of a grand system, is to collaborate very deeply with our caregivers, whether that's teaching them about innovation and how we think about it, finding tools and methods to do it better or interacting with a number of early-stage companies around the country and the globe to harness what they do. My real priority is to understand the struggles we're having and either help teams resolve those struggles through our own abilities as innovators or partner with external companies to make the world a better place for our patients and our caregivers.

Q: What is an initiative or project that you'd like to implement but is still out of reach, due to a lack of resources or funding, or because the technology is not yet there, for example?

TD:
I really don't see many things that are beyond reach when we collaborate really deeply and prioritize. But if I look at it from a more abstract view or from the view of the industry as a whole, the initiative that is on my mind the most is how we can take a more standard industry approach to innovation. If we think about care pathways or care process models that we use inside of our systems, what about an innovation process model that harnesses the rigor and the structure of the scientific method and the use of standard tools — a language, a theory, a method — in how we innovate?

If we're talking about business model innovation and we don't have a standard tool or language for doing it, it just creates unnecessary waste in the type of innovation that we really need to do together, because innovation has certainly become not only a team sport, but an ecosystem sport. That is one thing that I would love to see implemented more broadly across the industry.

Q: What are some of the barriers or challenges you come up against when you are innovating in healthcare? How do you overcome those obstacles?

TD:
One of the biggest obstacles is time. Everyone is so busy, and you need the space to be able to innovate, with "space" being the mental and physical time to do it. The way to overcome some of those struggles of time — and, sometimes, of money — is to relentlessly collaborate with the people who have the struggles.

In contrast to idea-driven innovation, where we do a bunch of brainstorming and come up with all these great ideas, you flip that coin a little bit and go to "painstorming," where we collaborate deeply with clinicians and patients who are struggling. The best way to overcome the obstacle of time is deep collaboration: building alignment around those struggles that are very meaningful and that we need to solve for, and creating a really clear definition of the struggles and the needs of the people experiencing them.

That, to me, has been the "secret sauce" of being able to be more successful with innovation projects: to start with a structured understanding of, in [Harvard Business School professor and innovation expert] Clayton Christensen's framework, the job to be done. That's how we overcome the barriers. You can't remove all of them — this just makes it easier to overcome them, because you're not trying to fish through to see which idea works. You're starting with an understanding of the struggle and then looking for an idea to help solve it.

Q: So, rather than attempting to get rid of the barriers and the struggles, you acknowledge them and end up becoming an even stronger innovator?

TD:
Yes, if you acknowledge the fact that there are constraints — I love the notion of constraint-driven innovation. I have this funny little thing — I don't know if it's funny or not, maybe I'm my own comic — but I call it the "three Cs of design disease": conference rooms, conference calls and cubes. We've spent far too much time bringing people out of their context; we bring them into a conference room and we ask them to describe in excruciating detail the struggle they're having and what they need to overcome the struggle. One of the ways that we've overcome the barriers is to go to the context: We do ethnographic research and couple that with interviews to build a deeper understanding of the struggles. When you add that fourth C, the context, to the three Cs of design disease, all of a sudden the other three aren't such a problem.

Q: What is a big mistake that you see people — whether on the clinical side or those moving into healthcare from the tech industry — making when it comes to healthcare innovation?

TD:
Assuming that their belief is a fact; assuming that everything they believe about someone's context is right. On the clinical side, we've been very good at avoiding this — the scientific method has been around a very long time. But on the innovation side, we often don't apply the same discipline in distinguishing between assumption and fact.

Again, the lack of a standard tool set is keeping us from performing experiments and learning what we need to learn before investing more time or money. We don't put innovation through the rigor that has traditionally been one of the greatest assets in making progress clinically, by developing theories and applying the scientific method to them. Instead of just believing a great pitch, we should be calling a timeout — you write down your assumption, design an experiment, run a test, get insight. That would overcome the biggest mistake of assuming that, because someone's smart, their idea or belief is a fact. Until you have evidence, it's not a fact.

If you ask a room full of innovators if they've ever spent time or money developing out an assumption that they didn't have evidence for and that turned out to be completely wrong, most people will raise their hands. The solution is simple, but not simplistic: Let's go back to the principle basics of adopting the notion that it's OK to validate or invalidate an assumption through rigor.

Q: Do you have a piece of advice for other healthcare innovators?

TD:
I don't see myself in any way as the end-all, be-all of this, but through my experience in the last 10 years of letting this be my life, focus and passion, my advice to other innovators is to adopt the standard tool set — a theory, a language and a method — and the rigor that it takes to drive evidence-based innovation, rather than more "faith-based innovation."

Q: Any final thoughts?

TD: The thing I would close with — and this is Todd's view of the world — is that it's important for us to remember that empathy is the heartbeat of healthcare. When we innovate from an empathetic and a curious stance, we will do a much better job of innovating for people. It's my hope that we spend more time in an empathetic and curious stance and design for people, versus just designing for innovation.

More articles on innovation:
Cleveland Clinic names top 10 medical innovations for 2020
Rush, Cedars-Sinai, Christiana Care & more join $22M funding in AVIA innovation network
Florida Tech building $18M health sciences research hub

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