Kat Esser

Every week I talk with people trying to make change in their organizations.

There is a burning question that many are asking lately with exhilarating frequency: “How do I use both improvement and innovation to address the healthcare challenges my organization faces today and in the future?” The sheer fact that this question is part of my recent conversations with many of you is noteworthy because you are boldly going to a different place with this age-old topic of improvement vs. innovation—you are expressing the potential of combining these two methodologies rather than isolating them. And the timing could not be better because the forces and shifts sweeping across all healthcare sectors require a blend of improvement and innovation—what I’ll refer to as Improv-vation. Why a blend? I believe successful healthcare organizations today understand the value of using both improvement and innovation. And they know that while these terms may have different meanings, they are equally critical for long-term organizational success. Those healthcare organizations that embrace both approaches are the ones that will not only survive, but lead in today’s complex and constrained healthcare ¬¬marketplace. I have been fortunate enough to have experienced these types of organizations during the past ten years, where I was able to practice this blend. My core methodology by training is innovation. Improvement science training in Lean Six Sigma came into my practice later, but by no means is it secondary to innovation. It is because of my blend that I have been able to contribute in ways that would have not been possible if I only practiced either innovation or improvement. I have seen firsthand, on both coasts, healthcare organizations that break out of the mold of ‘either improvement or innovation.’ These have been and (I believe) will continue to be the ones yielding successful, value-add outcomes that ripple through the levels and aspects of our health system that matter most: patient experience, workforce resilience, retention, joy in practice, operations, leadership, strategy and hard/soft dollars. Who’s doing the blend today? A few go-to organizations, in my experience, include Virgina Mason Medical Center, Massachusetts General, Rhode Island Hospital, Children’s Hasbro Hospital, Kaiser Permanente, West County Health Center, La Maestra, Denver Health, and Lifelong. Why blend now? For starters, you are ready. What makes you ready is the realization that most of the technical problems or low hanging fruit that exist in current state care delivery models have bee¬n improved or are in the process of being improved. This leaves us with complex, human centered challenges rooted in the need to meet patients at complex intersections of medical and social needs. These challenges render many of our existing systems and processes no longer valuable, successful or sustainable for providers, patients or the bottom line—no matter how much we ‘tweak’ them. Compounding this are the ever-increasing constraints on time, budget, and resources, as well as expanding patient expectations. We need to rethink how we approach and solve these complex human-centered challenges in our healthcare systems “better differently.” This requires both improvement and innovation methodologies working in parallel. So what does that look like working in parallel? Here are a few answers based on what I have seen, heard, learned and experienced during the past ten years: Know and honor the difference between improvement and innovation. There are many definitions, but here are ones that have been successful for me: Improvement is doing existing things better, innovation is doing new/different things.¬ Improvement and Innovation are not intended to be used interchangeably; this does a disservice to both improvement and innovation and detracts from the differentiating value of both. Be comfortable with asking different questions with different outcome focuses. Improvement starts with examining a current process and frames the question as: “How can I do this existing thing better to meet the status quo?” Improvements are incremental changes that make care delivery or services better in some way, whether by reducing costs, increasing value, improving safety, or enhancing quality or satisfaction. The impacts of improvements may be subtle. Innovation starts with examining a current process and frames the question as: “How can I do this in a whole new way, to add new value and ideally surpass the status quo?” Innovative ideas are ground-breaking transformations that change the organization in wide swaths. Innovation generally makes a noticeably rapid impact. Understand what it takes to create and sustain an organizational culture in which improvement and innovation dually succeed. Organizations that do this successfully engage all levels of their staff and leaders in implementing both bottom-up and top-down improvements and innovations. Both innovation and improvement thrive in organizations that foster a community of collaboration and allow staff to “speak failure.” Ongoing, active, supportive leaders who understand the importance of both process improvement and innovation. They encourage staff engagement at every available opportunity, which means allowing employees to spend time working on innovation and improvement as a blend. Develop an engaged workforce. These are the people who are most likely to be able to identify appropriate, impactful opportunities for improvement and innovation. A successful organization recognizes their employees’ collective power for improvement and innovation, then finds way to harness that potential to create positive change. Create the conditions for a blended methodology. Provide the majority of employees with a basic understanding of both improvement and innovation with access to experts in both when deeper knowledge is necessary. These experts are able to share knowledge with staff as needed, allowing everyone to contribute to the ‘blended’ effort without the need to train everyone. Whether you have just started asking this question or are in the process of answering it, I’m extremely interested to hear the following from you. What compelled you to start asking “How can I combine improvement and innovation?” What does your hybrid improvement meets innovation model look like? I look to you all to fuel this very timely and exciting conversation.