While talking to a fellow podcaster/healthcare innovation advocate last week, I had a sudden visual that came to my head which seemed to me a great metaphor for what happens to new ideas (aka “innovations”) brought to the healthcare system: a spaghetti colander. Here we are, we entrepreneurs, idea people, purveyors of the new/better/different, cooking up a recipe of what we believe will cure the systems ills, or at least make some meaningful difference. Then we pour the mixture into the colander and only the tiniest molecules get through – the water molecules. The pasta itself—the “meat” of the meal, gets stuck in the basket, unable to reach the other side. And meanwhile, all of those water molecules go right down the drain anyway.
I know you’re thinking, “well that’s the point of the colander, to keep the good stuff in the basket..” Yeah, but that’s the problem. If we keep the good stuff contained in our departments of innovation or in limited pilots or in other little boxes, it doesn’t get to where it needs to go. That’s my point – innovation needs to get out of the basket and penetrate all the nooks and crannies of an organization.
This visual metaphor for me was pretty compelling because in my experience trying to make a difference directly (as entrepreneur) or indirectly (as investor), most big new ideas get stuck in the basked and only smaller, incremental things get through and get adopted. It is frustrating as hell. When those big ideas do occasionally break through and take hold, it is worth celebrating. It happens, but it’s like a holiday meal – occasional, worth a party, and often accompanied by a hangover that leaves one thinking, “never again!”
The primary headwinds to change in healthcare, and probably in every industry, are twofold: cash and culture. We can talk about workflow and integration and access and all of the other stuff that we use to excuse why it’s so hard to make change in our messy industry, but my firm belief is that in the end, it’s cash or culture that sinks the ship or spoils the spaghetti.
Cash is Numero Uno among the offenders, by which I mean economic incentives to change are very difficult to create. When people are paid to do things a certain way, it’s pretty hard for them to wake up one day and say, “Hey, I think I’ll light fire to my own paycheck today and hope that the meal I am going to cook instead will pay off big time in 5 years. In the meantime it’s ramen for every meal but, hey, it will be worth it!” The problem with that is, of course, that 1) we don’t know in advance if it REALLY will be worth it – everyone wants to know the gamble will pay off before betting it all on black; and, 2) most of us are not big fans of delayed gratification, even if we believe. If we were, then a lot of the world’s problems would be solved.
The reason the whole Las Vegas business model works is that while they can’t solve for #1, they have totally solved for #2 – you don’t know if you’re going to win but you find out really quickly so you’re willing to take a chance. Casinos have also figured out the psychology of winning and use it to great advantage – if I let you win sometimes you think you will win again so you keep at it. In healthcare, we are not organized to let that many wins through, so we don’t create the cadence of occasional reinforcement that keeps people at the table despite knowing the odds.
Culture is the other antidote to innovative change (by the way, $50 to anyone who can come up with a better buzzword than “innovation” – it has become so damn trite). Rebecca Kaul, Chief Innovation Officer at MD Anderson, talked about this in her recent appearance on the Tech Tonics podcast. In that episode, Rebecca spoke about the difference between innovation professionals and innovators, the former being at their best when they focus on helping operations realize a vision for change by serving as the facilitators, not as the problem solvers. Culture change, she notes, is the key ingredient to successful scaling of innovation.
And boy, oh boy is she right. One just can’t make change happen if the environment is designed to prevent it. We need a form of immunologic treatment to create real change in organizations – something that literally allows us to reprogram the cells and be open to new inputs. By putting the innovation in its own department and not engaging the whole of the organism, we risk leaving the new ideas in the colander – sitting in the basket while the old, tired band plays on.
It is always fascinating to me that people from outside healthcare are so eager to get in. Maybe it’s the same rationalization process that drives people to take up boxing. Yeah, I’ll get smacked in the face but how bad can it be? Oh, I don’t’ know…maybe as bad as a broken face? Brain damage? Concussion and coma in front of a cheering audience of thousands? And yet, new boxers are born every day and refugees from other industries come willingly to healthcare with their gloves on and a smile. I’m thrilled, actually, that this happens, but also wish that newcomers would spend a little more time training in the ring before promising to change the world from the outside in. We have seen way too many companies of late concede that they probably should have brought some healthcare expertise along with them when they set off to fix the industry. What they really need is some sort of Pied Piper-ish capability to drive culture change in an industry full of antibodies to exactly that.
I think we don’t put enough emphasis on the critical nature of charismatic leadership when it comes to change management – we worship engineers and doctors, but we should worship people who can make other people want to rise up in revolution, or at least evolution (if they happen to be engineers or doctors, great; but lots of other types of people should be welcome to try) . We go through a lot of energy to “prove” our ideas are good but not enough effort to really understand who wins and who loses economically when new models are adopted. Knowing who is going to be on which side of the water when your innovation rocks the boat is very important. No one likes to go down the drain and everyone is worried that’s where they’re headed when change comes.
I know I sound so negative, but I actually think of myself as more of an optimistic cynic. Or a cynical optimist. Whatever. I know that the spaghetti is going to stay in the colander, but I keep seeking out one with bigger holes in hopes of something good getting through. I whine and moan about how hard it is, but I, like many of my colleagues, keep trying at chef, sous chef or, at the very least, pasta consumer. I criticize 99.9% of the ideas I see but fall in love with them once in a while and do all I can to make them work. Sometimes they do, sometimes…down the drain.
It’s been funny for me lately, as I have had an opportunity to do some investing in non-healthcare things. It seems so much easier. I’m sure it’s not that much easier to actually make a big return, but the number of issues that stand in the way of product and market adoption are much fewer as compared to healthcare. It is definitely not good training for healthcare investing because it provides the illusion that consumers and everyone else will drop what they are doing for the right new thing. In healthcare, this rarely happens. In fashion or food, it happens all the time.
And so it goes. So all you entrepreneurs out there who aspire to “fix healthcare,” enhance the “consumer experience,” and dramatically “improve outcome,” remember: cash and culture. Who stands to win, who stands to lose, and what do you have to do to change people’s psyche to allow that to happen without a fight? In other words, who is emotionally equipped to help turn people’s fear into curiosity (as author Penelope Ward says) and what do you have to pay to get that done? Those are the questions you cannot overlook as you bring your shiny new thing to market.