Deconstructing Innovation

What do you think of when you see or hear the word “innovation”? On a spectrum from “threat, dread, fatigue” to “exciting, energizing, and hopeful,” which end are you closer to?

With regard to psychiatry, I think we’d all agree that innovation is important to the future practice of our profession. With that in mind, APA’s Board of Trustees made “innovation” a focus of its recent retreat to give direction and support to a Board work group that is charged with exploring innovations in clinical practice.

At the retreat, Board members associated “innovation” with “inspiration,” “hope,” “disruption,” “out of the box,” “threat,” “change,” “new,” and many other terms. If we are not able to dive in and swim with innovation, we will miss an important leadership opportunity to learn how to use and harness the tools of innovation to augment the work of our profession.

It turns out that there is a science of and methodology to innovation. If you already have an M.B.A., you may know that, but for most of us at the retreat, it was a bit of a revelation. Yes, there is a vocabulary, there are standardized processes and practices, and there is a discipline to innovation. At the Carolinas HealthCare System (CHS) in Charlotte, N.C., there is a dedicated team of about six people who are charged with systemwide innovations consultation. They solve problems for CHS that relate to safety, workflow optimization, person-centered design, access, and population health. A few examples of innovations in the context of health care might help at this point.

Just as classification systems apply to science (remember phyla and genus), types of innovation can also be classified. One classification is interior focused versus exterior focused. An example of an interior-facing innovation might be one that aims to improve efficiency of existing function. The use of a six sigma or lean process to create a set of procedures that enable “same-day-next day” office appointment scheduling is an example of interior innovation in health care. The same sequence of events happens once the patient is at the appointment, but the scheduling is restructured to improve access. A sustaining innovation might be something that supports “best customers.” A health care example is enhanced patient communication that occurs directly with physicians through a “my chart” function in a health system’s EMR.

Other types of innovation can be classified as low end versus new market. An example of low-end innovation is something that is anticipated to have local and maybe limited impact. Originally, Southwest Airlines was a local commuter service that offered faster transportation between cities in Texas. Initially Southwest had low-level competition, primarily with cars and buses. Now Southwest is a major aviation company with worldwide service and good market share. A low-end health care example is the “minute clinic” in a retail pharmacy that offers easy access to care for individuals with uncomplicated health issues.

New market innovation creates products and services that did not exist before. A health care example is care management that coordinates care for elderly individuals with multiple complex chronic conditions. Conditions exist in modern health care structures that support a new market for complex care coordination across providers and health systems.

The information I’m sharing in this column was just part of the orientation we received on how to think about innovation. We also learned about innovation tools such as ethnography, analogous learning, and technology augmentation. We had a “gallery crawl” that included walking through an innovations laboratory to view several posters that demonstrated aspects of innovation. A memorable poster was the one that reviewed details of suicide-related social media use among adolescents.

APA has had an industrious committee that has been thinking about technology. The Board’s new work group—the Ad Hoc Work Group on Access and Innovation in Psychiatric Care—will add to its work and will help more of our members learn about, embrace, and maybe even harness innovation. We want to use innovation to augment things like patient engagement and outcomes while we preserve the core of what is uniquely special and healing about the practice of psychiatry. Stay tuned! ■