Our educational offerings benefit from having ongoing discussions of key topics. If you recall, last June, Dr. Herzlinger and a host of individuals presented a fascinating assessment of the state of health management education. Their general theme “Teaching Innovation in Health Care: How To Make it Happen,” made the point that health administration education has failed to include sufficient training in “innovation.” The next generation of healthcare leaders will need to be more innovative to help our system face the many challenges we face. This theme reappears in a Harvard Business Review article in November “Bridging Health Care’s Innovation-Education Gap,” in which Dr. Herzlinger continues to provide evidence that poor outcomes (high costs, unequal access, and erratic quality) in our healthcare system persist because leadership does not have the training to determine and implement innovative solutions to the many problems we face as a system. From surveys of healthcare executives, the respondents indicated that they wanted employees who, in her words, “can investigate problems, find solutions through process and organizational innovation, and drive them forward — people who can work on a diverse team, understand failure and its causes, and manage change.”
Naturally, those of us in the educational system may become immediately defensive with these types of claims. Of course we teach innovation; our graduates are highly innovative, we train students to work in diverse teams and effectively manage change. The reality is that current leadership in the healthcare system is largely trained by us and that evidence derived from poor system performance suggests that she and others suggesting that a problem exists may be correct. We need to own failure in the system to a point and be careful that we do not ignore input from the “real world.” Input from current leaders may in fact have more than a little validity. Should we seriously contemplate changing our competencies to include innovation in the manner she suggests?
What are the origins of this discussion? The criticism of the appropriateness of preparing professionals has a long tradition. In a 2005 HBR article, Bennis and O’Toole systematically addressed “how business schools lost their way.” They conclude that there are three primary drivers:
- Failure to understand that business preparation is not an academic discipline, like Chemistry, but rather a professional school. Health administration is also professional training.
- The faculty in business schools lost their academic diversity. Faculty in most business schools now tend to be hired from other business schools only rather than bringing in scholars from a wide variety of disciplines.. Health administration programs, on the other hand, consistently include faculty from a wide variety of disciplines such as business, nursing, medicine, economics, psychology, and others.
- Faculty with practical experience tend to be excluded from the best business schools. Dr. Herzlinger makes a strong case for including practitioners into the classroom to foster innovative thinking. Health Administration programs have strong ties to the practice community generally. We often utilize faculty with professional experience rather than just academic experience. Most everyone has some type of executive in residence; we utilize local practitioners regularly in formal classroom work, project efforts and cases; many of our programs have mandatory or suggested internship or residency experiences. In my 30+ years in the field, our integration with practice has increased dramatically.
Is this a real problem? It seems to me that there is evidence that our graduates have been highly skilled in providing innovative leadership over the last 20-30 years. As an industry, our industry leaders have faced substantial and continuous fundamental changes in government regulation or technology. A number of examples demonstrate this:
- Ongoing changes in payment methodologies. Navigating a delivery system through changes in payment requires that the leadership understands changes in delivery that will result and develops a clearly defined plan to accommodate those changes. For example, the introduction of DRGs as a payment mechanism for Medicare patients in the early 1980s changed the incentives that hospitals faced to expend resources in treating patients. Hospitals quickly innovated and reduced the overall hospital length of stay from about 9.9 days in 1980 to 5.4 days in 2013. That is a 40% reduction in overall average length of stay with most of it occurring by 2001. Hospital leadership had to mobilize virtually all inputs to make this happen including facilities, staffing (numbers and mix), treatment protocols (discharge planning, care coordination), modification of physician behavior, timing and currency of clinical and financial information, pre admission testing protocols, post discharge therapy and follow-up, just to name a few. DRGs were only one of these changes because during this time, for example, managed care became more popular, physician reimbursement changed with RBRVS, nursing homes system payments changed, and home health payment methodology changed.
- Substantial changes in medical and informational technology. The constant development of new business and clinical technologies requires innovative leadership to stay abreast of the changes and design appropriate responses. The electronic health record, for example, represents a technology that is changing many aspects of delivery and requires significant structural, capital, training, staffing, and monitoring efforts by organizational leadership. Other changes have been documented in many sources (http://www.medpagetoday.com/InfectiousDisease/PublicHealth/17594) and include such items as the Human Genome, targeted therapies for cancer, combination therapies to improve HIV survival, minimally invasive surgery, and robotics. While these are clinical advances, the physical and staffing infrastructure necessary to support these innovations require administrative leadership to understand, anticipate and implement necessary changes to accommodate the clinical advancements.
- Social media. While still unfolding, social media is a current change that has the potential to roil healthcare delivery and require innovative responses by both clinical and administrative staff (https://getreferralmd.com/2013/09/healthcare-social-media-statistics/). Just some of the pertinent findings from this source have significant potential implications for delivery and will necessitate innovative solutions:
- More than 40% of consumers say that information found via social media affects the way they deal with their health. Similarly, 41% indicated that social media would influence their choice of hospital, physician, or medical facility. Leadership will be required to create and post educational content for social media to accurately inform and attract potential patients.
- 90% of respondents from 18 to 24 years of age said they would trust medical information shared by others on their social media networks. A potential source of future patients but also a threat to loss through misinformation.
- 31% of health care organizations have specific social media guidelines in writing and 31% of healthcare professionals use social media for networking. The competition is already adopting thus all organizations must respond. At this point innovative approaches will be needed to stand out in a crowded field.
- From a recent study, 54% of patients are very comfortable with their providers seeking advice from online communities to better treat their conditions. Not only does your organization need a social medial presence, you must work to get your provider network up to speed on this.
How do we proceed? We need to clarify the questions surrounding teaching innovation and we need to better document our progress in this domain. A number of questions may help us to understand the issues:
- Is it possible to argue against preparing leaders who can innovate? Innovation is by its nature a good thing for all. Questioning innovation makes you appear to be against a positive feature, a Luddite, or just resistant to change. Just as you can’t resist an effort to provide quality, innovation has a positive position in our thinking.
- What content or competencies do we reduce to make room for additional content to support innovation education? I would argue that finance, ethics, quantitative analysis and legal training, for example, stand up well against innovation. Saying we need to teach leaders how to innovate begs the question of what we give up in the process. This discussion must be done in a holistic manner. My fear would be that after something is reduced, we have another study in five years wondering why we don’t teach ethics sufficiently.
- Can our future leaders effectively design and implement innovation without detailed understanding of the working of the current system? Saying a system is less than ideal and that change might bring about a better system makes sense. However, creating a cohort of healthcare managers with training and a mandate to “innovate” will not necessarily move us to a better position if these individuals do not fully understand the existing system. Not all subsystems are ineffective, thus innovation needs to be targeted toward areas that are failing. You can’t know where to target without knowledge of how things work. It is possible that some aspects of fundamental system change needs to be supported but originates elsewhere.
Now the call to action. What aspects of our educational processes prepare students to be critical thinkers able to “investigate problems, find solutions through process and organizational innovation, and drive them forward — people who can work on a diverse team, understand failure and its causes, and manage change.” Let me know what we do well in this area and why we are perceived as not preparing our students for the future. As you do this it might provide some content for your inspirational graduation speeches!