Unconventional Leadership

by Nancy M Schlichting

  Patient gowns. We received considerable national media attention for a simple and smart innovation that enhanced patient satisfaction enormously—an improved hospital gown. The new gown was the first to address one of the most common style complaints from patients—namely that the open back of the gown is drafty, embarrassing, and uncomfortable. About the improved design, comedian Ellen DeGeneres smartly quipped: “Leave it to Ford to cover the junk in your trunk.”

  New delivery models. Cognizant that younger generations want a speedier, more convenient outpatient health-care delivery experience, HFHS pioneered a new kind of clinic, called QuickCare, in Downtown Detroit. Staffed with Henry Ford Hospital nurse practitioners, in consultation with physicians, as needed, QuickCare offers what we are calling Radical Convenience—an on-demand approach to medical care that will help us meet increased demand following the passage of the Affordable Care Act. In addition to routine primary and urgent care, services include acupuncture, massage, and immunizations for traveling abroad.

  The Innovation Institute

  Academic institutions are structured to deliver education. Health-care organizations are designed to deliver quality health care to patients. Neither of these functional areas is set up to support an innovation team tasked with commercializing opportunities and creating new businesses. But because of our mandate and mission, we have made a strong commitment to commercial innovation as something that’s of clear institutional value. As a result, we created the Innovation Institute as a separate entity, with funding to support professional innovators and designers.

  Launched in 2012 under the leadership of Dr. Scott A. Dulchavsky, chairman of surgery at Henry Ford Hospital, the Innovation Institute is a way to codify the system’s inventive culture and create a mechanism for commercializing the innovative ideas that come from staff and practitioners. The institute focuses on engineering innovative solutions to problems and shaping the future of health care. Both a physical and virtual resource, it provides system innovators with access to resources and programs including opportunity assessment, engineering services for prototypes, seminars designed to convey opportunities, programs aimed at developing specific medical products, and educational offerings in areas such as translational medicine and the entrepreneurial arts. The disciplined process has oversight from Dr. Dulchavsky but also from our chief innovation officer, Mark Coticchia, thereby joining clinical and business expertise.

  Housed in a retooled 1924 Albert Kahn building at the center of the Henry Ford Hospital complex, the institute’s seventeen employees—including designers from the Detroit College for Creative Studies—work on high-tech tools for robotic surgery and on software for applications such as fitness tracking, as well as on solving thorny problems like lowering readmission rates for patients once they leave the hospital. We now have more than three hundred projects sourced from all parts of the health system being funded through philanthropic and industry support.

  The institute partners with private-sector companies as well. Institute leaders have created a robust corporate innovation program that invites companies from medical device firms to small manufacturers to come to us with their ideas. What we bring is a multidisciplinary theme and an open innovation model. Recognizing that one of our biggest roadblocks to innovation is shaking ideas free from Henry Ford employees, as well as outside industry, the institute sponsors ongoing “innovation challenges” to draw out new solutions to some of health care’s biggest unsolved problems.

  Creating a Culture of Innovation

  Barriers to innovation are everywhere in large organizations. People are busy and plowing ahead at full capacity, funding is targeted, and innovation is risky. When a person approaches a leader with an idea, he often gets shut down or turned away. There is always other complex work going on, so there’s a tendency to say, “Let’s get back to that idea later.” But later never comes. Once leaders put up a wall, people back down. Another factor that blocks innovation is an organization’s response to “failed” endeavors. How you respond to adversity either turns people off or keeps them coming back. To me, regardless of the outcome, innovation is always a learning opportunity and a building block.

  Routing around these barriers and others requires a deep commitment. It would be simple to say that people have day jobs and innovation will happen as a matter of course. Some of us are natural-born entrepreneurs and others are not. But that thinking isn’t enough to allow innovation to flourish, so I have tried to embed innovation deeper into our culture.

  I am not the first leader at Henry Ford (starting foremost with our namesake) to put a stake in the ground and make innovation a priority. The culture work I put into place is a continuation of past efforts combined with new insights from our Baldrige journey. When we identified innovation as one of our core competencies, we needed to create clear pathways to enable it. The Innovation Institute, for one, has helped us to codify the way we innovate. And there are a number of other steps we took across the system to create an environment where people are constantly thinking about improvements and new ways of working. We have fostered the culture and given people permission to think differently in ways that make us stronger and able to thrive even when the environment around us is challenging.

  Use a Problem-Solving Lens

  One of the fundamental ways that we embed innovation into our culture is by putting a strong emphasis on creative problem solving. This perspective brings innovation right down to earth and has some important additional benefits.

  First, associating innovation with problem solving allows us to focus squarely on the everyday task of serving patients better. It melds with our mission as caregivers and puts innovation front and center for everyone. For example, two Henry Ford doctors, frustrated with the outdated and inefficient pager-based system used for sharing information, developed StatChat—a communication tool that allows clinicians attending to a particular patient to see what other caregivers have done over the course of the patient’s treatment.5 Similarly, when doctors and nurses on the women’s health team at Henry Ford found that new mothers were frequently overwhelmed by instructions delivered to them at discharge, they created a solution. They invented a system called Virtual Nurse, which uses avatar technology to help patients understand discharge information, allowing nurses to focus on areas where patients need more hands-on assistance. In both these cases, caregivers found a way to solve their own problem and better serve the needs of their patients.

  Next, putting a problem-solving lens on innovation helps us zero in on solutions that are practical. A practical focus makes innovation urgent and accessible as opposed to esoteric. It also drives home the idea that anyone can invent and innovate. The new tool that helps operating room nurses open instrument containers is an excellent example. The device, conceived and prototyped in twenty-four hours, offers an immensely practical solution to an everyday problem that OR nurses had faced for years. Likewise, hospital gowns designed to provide better coverage have made thousands of patients happier and more comfortable in the hospital. It doesn’t get much more practical than that.

  Finally, problem solving keeps us focused on continual improvement. The “we can do better” mind-set, I have found, has prompted us to come up with genuine innovations. When there are no existing evidence-based ways to prevent a negative outcome, then innovators need to create a new approach in order to address it. We saw this over and over again as part of our “No Harm” campaign. For instance, when the conventional means to reduce catheter-related bloodstream infections in hemodialysis patients resulted in only modest improvements, we were motivated to develop a new best practice. The innovative “antibiotic lock protocol” we established has led to a 34 percent decrease in dialysis mortality since its implementation in 2008. In these cases and others, innovation equaled solving problems, plain and simple.

  Keep It Inclusive

  When I was head of strategic planning at Akron City Hospital I had a very small staff. There were three of us—
not enough people to do the job the way that I wanted. I decided then and there that everyone across the organization was going to be a planner. Instead of trying to do everything with a few colleagues, I created a broader context for the organization so all employees could think differently about their work. My department provided a lot of data to management across the hospital, and we all became planners. Everyone was a part of the team.

  That was one of the seeds of my philosophy on innovation. If there is one thing I firmly believe about innovation, it is that it can happen anywhere in an organization. It doesn’t matter if you’re a CEO, a housekeeper, a laundry worker, or a brain surgeon. Everyone, no matter their job description or pay grade, can and should be involved.

  The benefits of an expansive perspective on innovation are numerous. The first is performance. When people are engaged in innovation they start to think big and they take ownership of their ideas and of the wider business. That ownership mind-set is empowering, and people get more involved in the success of their work, thereby pushing up performance. In addition, an organization of twenty-three thousand innovators can accomplish much more than one isolated group of professional designers who happen to be creative. At HFHS, anyone can bring an idea to our Innovation Institute, to his department head, or right to me. We get to look at more concepts that way and we talk to many more innovators about change and improvement. Lastly, a related upside of expansive innovation is engagement. Innovation is exciting and positive, and being a part of it makes everyone’s job much more meaningful. And it is extremely useful for recruiting staff and physicians. If you were choosing between a vibrant workplace that puts a strong emphasis on cutting-edge ideas and one that is a little more traditional . . . well, let’s just say that our spirit of innovation is a big draw for HFHS.

  An additional benefit of thinking broadly about innovation, for us, has been getting beyond any one type of idea. A large number of innovators are bound to think about different aspects of our business: How do you improve process? How do you create new services? How do you look at clinical breakthroughs? And so on. These can be major innovations or smart incremental changes. Any doctor or employee can come in with a back-of-the-napkin idea. I look at it this way: you have to have a lot of base hits to win the pennant. With that mind-set, innovation can happen at any time, in any place, and with any person who is up at bat.

  Incentivize Innovation

  There are some innovations that don’t cost much money. The tool that allows operating room nurses to access surgical instruments is a prime example: it’s an extremely useful, low-tech device that is important but inexpensive to design and produce. I like those kinds of innovations, but not everything comes on the cheap. When we pursued Dr. Menon’s robotic surgical solution, for example, we made the decision to invest in a cutting-edge operating room even as we were reducing costs pretty radically across the organization. Similarly, when we created the Innovation Institute we took $15 million out of our foundation to support the institute’s setup and launch. When high-potential concepts present themselves, you need to pay attention.

  No two innovations are alike. We pursue both mission-driven and commercially viable concepts. Mission-driven innovations aid us in our work as healers and are an important part of our responsibility as a teaching institution. Market-driven innovations, on the other hand, have commercial potential and, in theory, may offer a return on investment for the organization. Our award-winning hospital gown, for instance, is used not only in Henry Ford’s five hospitals and thirty-two medical centers, but is licensed for use by other hospitals in the U.S. and abroad. Interestingly, that was a concept we expected to be primarily mission driven but that turned out to be a bona fide commercial opportunity. Regardless of the return, people at Henry Ford will tell you that if a notable idea bubbles up, there is usually a funding path to be discovered.

  Another, more unconventional way that we invest in innovation is by incentivizing employees for being creative and injecting a little competition into the mix. The HFHS intellectual property policy offers innovators a 50 percent share of future revenues that come from product ideas that end up in the market. That’s a pretty impressive call to action for employees who might have a great idea in their hip pocket. Our “Innovation Challenges” are even more of a major draw. These ongoing contests, run by the Innovation Institute, target specific problems and opportunities in health care by engineering the collision of talent and resources. For example, in 2015 the institute sponsored a competition that called on HFHS employees to submit their best ideas for clinical applications of wearable technology. Employees were not only encouraged but also incentivized to participate, with $10,000 in prizes offered. Finalists competed for an investment of seed capital and commercialization support.

  Winning entries included:

  A system that used wearable activity trackers to record and encourage mobility of acute-care patients

  Wearable sensors used for total hip replacement patients that monitor and limit range of motion in rehab

  A health and wellness reminder system for elderly patients, leveraging location-based sensors and smart watches

  A mobile game interface, powered by activity trackers, designed to fight obesity by encouraging children to exercise

  These challenges are very much in keeping with our Innovation Institute’s mission. For years, we had a lot of good ideas that we pursued internally, but we seldom took the next step by commercializing them. We didn’t have the bandwidth to translate them into business opportunities. The Innovation Institute takes these ideas and commercializes them, creating economic value for the hospital and the surrounding community—as well as for the innovators involved.

  Yet, for me and for all of us here at HFHS, incentives for innovation are about more than splitting profits. Our Innovation Challenges are really about getting enthused to solve problems and keeping people engaged and satisfied by allowing them to be creative, no matter what their job description says.

  Involve the Community

  Health systems rely on their surrounding communities as much as the members of those communities depend on them for quality care. The relationship is reciprocal across the board—and innovation is no exception.

  We want our organization to be part of the solution, to help figure out ways to make Detroit succeed because in doing so we succeed, and vice versa. Urban areas like Detroit are rich in diversity and creativity; as an anchor institution of the city, we’ve tapped into that richness to produce innovations that benefit both Henry Ford and Detroit residents in terms of economic value and state-of-the-art care.

  Our vastly improved version of the hospital gown came about through a partnership we formed with the College for Creative Studies here in Detroit. I laugh when I think about how the idea emerged. We brought CCS students and faculty into the hospital to observe our work and they looked at the patients—walking around in the same gowns you’d find all across the world—and did a double take. They basically said, “You’ve got to be kidding me. You can’t do any better than this?” They were right! It’s no secret that patients in drafty hospital gowns feel uncomfortable and exposed.

  So the CCS team went to work designing a gown that was warmer and more modest, and offered some basic features like a collar and a pocket. The designers met with doctors and nurses to understand what they needed in terms of access to the patients following a variety of procedures. Then we used Henry Ford Hospital as a learning laboratory to test the gowns, with numerous iterations of design. We knew that we were on to something when units within the hospital were competing to be the first to use them. Sometimes the greatest innovations are wonderfully simple.

  It took a smart, objective, empathetic perspective, and help from the surrounding community, to see what we couldn’t see. And that perspective works both ways. We’ve recently installed touch-screen health kiosks in churches and schools across Detroit. This bold initiative gives community residents the latest information about critical hea
lth issues such as diabetes, sexually transmitted infections, breast cancer, prenatal care, hypertension, and even alcoholism. Our objective is to disseminate important information to the people in Detroit by meeting them where they go. Many don’t have Internet access where they live and they may visit the hospital only after it is too late—often in the end stage of a disease.

  We developed the content in conjunction with local ministers and made the kiosks simple to operate—and they are getting tremendous use out in the community. Residents are better informed through more than seventy-five modules, community leaders are grateful, and our employees are proud. Contributing to the local community, and helping to improve it through innovation, is important not only to the community but also to the people who work within the system. They want to have an outlet, and formal programs, to not only commercialize great ideas but also to contribute to the local community from an economic development standpoint.

  Keeping Innovation Alive

  Henry Ford was an innovator, and that legacy puts innovation at the center of everything we do. We tend to be pretty laid back when an experiment doesn’t pan out. After all, Ford wasn’t successful every time. He was in his forties when he created the Ford Motor Company, and he had a number of failed companies under his belt. In fact, when Henry Ford Hospital was created, Ford had been part of the investment group that was building the Detroit General Hospital. In Ford’s mind the project was a major failure—it was behind schedule and over budget. He became fed up with the endeavor, paid off the investors, and built the hospital on his own. That resilience is baked into what we do.

  Between the Innovation Institute and thousands of individuals across Henry Ford, innovation has brought us eminence and the opportunity to make things better. In addition, our innovation efforts serve to reduce our costs, increase quality for patients, and even earn revenue to aid us in our not-for-profit mission of serving our community.