Innovation challenges in healthcare

1. NAVIGATING YOUR INNOVATION JOURNEY
Dr. Andrew Maxwell,
Chief Innovation Officer, Canadian Innovation Centre
Professor, Lassonde School of Engineering, York University
Fraser Health Management Team Business Meeting, June 8th

2. INNOVATION IS HARD
Recent Bain & Company study showed that:
• Two-thirds of CEOs made innovation a top three priority.
• Less than 25% believed their companies were effective at innovating.
• Less than 20% claimed they were strong at “breakthrough” innovation.
Innovation is hard, because it requires changing what people do and how they
behave. And because usually leaders have been successful previously in
organizations that were in steady-state.
2

3. MAXWELL’S THREE LAWS OF INNOVATION
INERTIA
1.There is a natural tendency for organizations to keep doing what they’re
doing and resist changes. In the absence of a force, they will continue to do
what they’ve always done.
2.Larger organizations require more force to change what they are doing than
smaller organizations.
3.For every force there is a reaction force that is equal in size, but opposite in
direction. When someone exerts a force on an organization, he or she gets
pushed back in the opposite direction equally hard.
3
The innovator has for enemies all those who have done well under the old conditions. Machiavelli

4. INNOVATION INERTIA IN HEALTHCARE
Innovation in healthcare is particularly challenging because of the
multiplier effect:
1. Individuals are normally risk averse, which means that the benefits of taking a risk
have to be more than double the perceived costs.
2. Public healthcare organizations operate under public scrutiny, which means that
failures raise difficult questions.
3. The medical profession is by nature conservative; doctors are encouraged not to
take unnecessary risks.
The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself.
Therefore all progress depends on the unreasonable man. George Bernard Shaw

5. OVERCOMING INNOVATION INERTIA
FOUR FORCES OF PROGRESS
5
© Re-Wired Group

6. PUSH OF THE SITUATION
THE HEALTHCARE INNOVATION
IMPERATIVE
• Based on trends in healthcare needs, costs & GDP - in 15 years, BC healthcare
costs will consume over 45 percent of government spending
• The Fraser Institute1 concludes that such increases may be unsustainable and
risk crowding out other programs or requiring fiscal adjustments
• Five Cost Drivers2
• Aging population (with higher costs)
• Increasing number of patients with chronic conditions
• New treatments and technologies
• Rising costs of trained staff
• Personalized care
1Fraser Institute: The Sustainability of Health Care Spending in Canada 2017
2 Future Agenda: http://2015.futureagenda.org/category/topics/health/

7. MAGNETISM OF NEW SOLUTION
TECHNOLOGY LIKELY TO IMPACT
HEALTHCARE
• Web based services: Patient self-service/appointments/patient records
• Wireless devices: Remote monitoring/sensors/wearables
• Autonomous machines: Robots/drones/homecare
• Online resources: Telemedicine/Web based diagnostics
• Big Data and Artificial intelligence: for data analysis and prediction
• 3D printing: Body parts/organs
• Personalized pharmaceuticals
• Miniaturization and local intelligence: Medical devices
• Augmented reality: Surgery/treatment/diagnosis
• Blockchain: Secure transactions/interoperability/data interchange
Any sufficiently advanced technology is indistinguishable from magic. Arthur C. Clarke

8. HABBITS OF THE PRESENT
CHALLENGING TO CHANGE BEHAVIOURS
• Difficult to change individual behaviours
• Need to manage current performance leaves little time for looking at, and
investing in, change
• Challenging in organizations designed for steady state processes
• Can impact individuals’ roles and responsibilities (and their jobs)
• Current rules instituted to ensure compliance (discourage deviance)
If you always do what you always did, you will always get what you always got. Albert Einstein
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9. ANXIETY OF THE NEW SOLUTION
• New solutions involve risk:
• Technical risk - the solution won’t work
• Financial risk - money will be wasted, or more money will be needed than anticipated
• Emotional risk – they will be blamed if things go wrong
• Organizations and their policies often designed to punish failures
• Innovation implementation can have unintended consequences:
• More work for the innovator
• Need for additional resources
• Possible changes in job and role

10. CHANGE IS DIFFICULT UNDER SHORT
TERM PERFORMANCE PRESSURES
Here is Edward Bear, coming downstairs now, bump,
bump, bump, on the back of his head, behind
Christopher Robin.
It is, as far as he knows, the only way of coming
downstairs, but sometimes he feels that there really is
another way, if only he could stop bumping for a
moment and think of it.
And then he feels that perhaps there isn't.
A.A. Milne, 1926, Winnie The Pooh
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11. THE INNOVATION QUOTIENT
TOOL TO ASSESS INNOVATION BARRIERS
The Innovation Quotient is a diagnostic tool to help you identify
opportunities for improving innovation in five critical dimensions:
• Strategy: Leadership, expectations, organizational design
• Resources: People, assets, funds
• Culture: Values, experimentation, risk-taking
• Processes: Innovation processes, decision-making, engagement
• Relationships: Hierarchical, cross-boundary, external
Without change there is no innovation, creativity, or incentive for improvement. Those who initiate change
will have a better opportunity to manage the change that is inevitable. William Pollard
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12. FRASER HEALTH LEADERSHIP
VIEW OF INNOVATION
QUOTIENT
0
1
2
3
4
5
6
7
Strategy
Culture
ResourcesProcesses
Relationships
Your view on critical barriers:
49% - System or current processes
33% - Lack of time or resources

13. YOUR SURVEY RESULTS
BARRIERS TO INNOVATION?Strategy
• “Not clear what is meant by innovation, so a clear definition that can be operationalized and a clear process.”
• “Knowing that innovation is an important part of our work and that we are supported to try new things.”
Resources
• “Allowing the time and providing better incentive to be innovative rather then having the expectation of doing
innovation by the side of your already filled desk.”
Relationships
• “Leadership staff stepping out of their comfort zone in corporate and operational areas to develop new ideas and
ways of getting the work done rather than sticking to historical tried and true practices.”
Processes
• “Empower managers and frontline staff to make decisions without having to run the gauntlet of Directors, ED and
VP for approval.“
Culture
• “A culture that encourages us to take risks…and even some degree of failure.”
• “Organization's leadership (needs) to be more open, flexible, and supportiverather than only results focused.”
It’s easy to come up with new ideas; the hard part is letting go of what worked for you two years ago,
but will soon be out of date. Roger von Oech

14. STARTING YOUR INNOVATION JOURNEY
• Six key innovation recommendations:
• Clarify innovation strategy .... to guide decisions
• Modify organizational design …. to allow innovation focus
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15. THE DICHOTOMY OF
ORGANIZATIONAL INNOVATION
Performance engine success
• Efficiency
• Repeatability
• Predictability
Innovation engine success
• Speed
• Impact
• Failure
Great energy only comes from a correspondingly great tension of opposites. Carl Jung
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16. ORGANIZATIONAL
AMBIDEXTERITY
PERFORMANCE ENGINE
Characterized as exploitation
• Follow the rules and drive out
variance and slack
• Focus on serving existing
customers and their needs
• Manage and refine existing
competencies
• Optimize the organization for
existing rules
• Invest for short term savings
If you look at history, innovation doesn't come just from giving people incentives; it comes from creating
environments where their ideas can connect. Steven Johnson
INNOVATION ENGINE
Characterized as exploration
• Break the rules and promote
variance and slack
• Serve new customers with new
needs
• Develop and lead new
competences
• Develop new organization
system with new rules
• Invest to save money in future
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17. STARTING YOUR INNOVATION JOURNEY
• Six key innovation recommendations:
• Clarify innovation strategy .... to guide decisions
• Modify organizational design …. to allow innovation focus
• Introduce formal processes …. to structure decisions
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18. INTRODUCING AN INNOVATION PROCESS
1. Establish critical innovation objectives
2. Establish a mechanism for collecting ideas – linked to an evaluation process
3. Develop rapid first cut response
4. Establish multi-functional initial review team with mandate and budget
5. Set short-term deliverables for each project (and constrained budgets)
6. Be clear on implementation goals and how performance will be measured
7. Develop a communications strategy to share success and failure
8. Embed a scale up strategy
Common barrier to innovation is lack of follow up, i.e. encouraging people to suggest ideas, then not
implementing/resourcing them, exacerbated by not providing rapid feedback on decisions ALM
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19. THE INNOVATION PROCESS IS A
MULTI-STAGE ELIMINATION PROCESS
Identify
Priorities
Collect
Ideas
Screen
Ideas
Initial Pilots Experiments Scale Up Roll Out
Priorities
Ideas
Criteria
Resources
Fieldtrials
Resources
Engagement
Non-priority
Weakideas
Poorideas
Parkedpilots
Failedpilots
Parkedprojects
Not-scaleable
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An innovation process enables the development of an innovation portfolio – using a real options approach,
which encourages failing fast, and scaling up on successful experiments. ALM

20. STARTING YOUR INNOVATION JOURNEY
• Six key innovation recommendations:
• Clarify innovation strategy .... to guide decisions
• Modify organizational design …. to allow innovation focus
• Introduce formal processes …. to structure decisions
• Allocate resources …. to undertake experiments
• Foster an innovation culture …. to create personal safety net
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21. What does an innovation culture look like?
• Encourages team and cross-boundary collaboration
• Sharing ideas with internal and external partners
• Two way, open, knowledge exchange
• Deferred judgment and idea exploration
• Speedy decision making
• Experimentation and willingness to learn from failure
• Incentives that reward new activities
• Achieving balance between loose practices & tight processes
FOSTERING AN INNOVATION CULTURE
The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to
himself. Therefore all progress depends on the unreasonable man. George Bernard Shaw
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22. STARTING YOUR INNOVATION JOURNEY
• Six key innovation recommendations:
• Clarify innovation strategy .... to guide decisions
• Modify organizational design …. to allow innovation focus
• Introduce formal processes …. to structure decisions
• Allocate resources …. to undertake experiments
• Foster an innovation culture …. to create personal safety net
• Greater reliance on trust …. to foster collabortion
22

23. TRUST AS A BEHAVIOURAL CONSTRUCT
• Viewing trust as an auditable and coachable behaviour
• The Behavioural Trust Framework (BTF) enables individuals to understand how
they build, damage or violate trust
• It allows individuals to audit others’ behaviours and decide whom to trust
• Higher levels of trust reduce relationship risk, and the need for trust proxies
(controls)
• Trust fosters innovation by facilitating collaboration,
knowledge sharing and alignment
Trust is the universal lubricant that enables innovation, it fosters collaboration and enables the innovation
engine to engage with the performance engine. ALM
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24. INNOVATION
Innovation Capacity is a ƒ(level of trust)
The level of trust =
∫(Trust building - trust damaging) behaviours – ƒ(controls)
MEASURING INNOVATION CAPACITY
Learning to collaborate is part of equipping yourself for effectiveness, problem solving, innovation and
life-long learning in an ever-changing networked economy. Don Tapscott
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25. Trusting:
• Disclosing: Shows vulnerability by sharing confidential information
• Reliance: Willingness to be vulnerable through reliance on others
• Receptive: Demonstrates ‘coachability’ and willingness to change
Capability:
• Competent: Displays relevant technical and/or business ability
• Experienced: Demonstrates relevant work/training experience
• Judgment: Shows ability to make accurate / objective decisions
Trustworthiness:
• Consistent: Displays of behavior that confirm previous promises
• Benevolent: Exhibits concern about well-being of others
• Alignment: Actions confirm shared values and/or objectives
Communication:
• Accurate: Provides truthful and timely information
• Explanation: Explains details & consequence of information provided
• Openness: Open to new ideas or new ways of doing things
BEHAVIOURAL TRUST FRAMEWORK25

26. For a copy of this deck, email:
Andrew.Maxwell@lassonde.yorku.ca
or download from:
https://www.slideshare.net/AndrewMaxwellPhD/
FraserHealthKeynote
NAVIGATING YOUR INNOVATION JOURNEY
The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low
and we reach it. Michelangelo