Patients are not singular problems. Health care largely takes place outside of the office visit bubble, where complex humans carve out paths through everyday life. It occurs when parents, caregivers, second shift and working professionals make decisions like food choices and tradeoffs like exercise versus family time or overtime to pad a paycheck.
By enabling new care delivery methods, technology such as video visits is nudging provider awareness closer to that patient reality and feeding a growing knowledge base for providers. Combining that new information with technologies for care collaboration produces endless possibilities for improving health. Leaders face the challenge of supporting and identifying those innovations that best suit an organization and its customers, as well as implementing them.
Dr. Bill Marsh knows how leadership fosters innovation. Now Associate Executive Director of Care Delivery IT for The Permanente Federation, in a previous role with the Colorado Permanente Medical Group Dr. Marsh co-chaired a workgroup tasked with hatching new virtual care capabilities, including mobile applications, telemedicine and telehealth.
The Health Leadership Forum tapped Dr. Marsh’s experience to discuss leadership capabilities for successful innovation and technology’s evolving role in care delivery.
Health Leadership Forum: What are some of the most challenging innovations in care delivery at Kaiser Permanente you have recently implemented or have underway?
Dr. Bill Marsh: Since our inception 70 years ago, Kaiser Permanente’s organizing principles have been the foundation for all of our care delivery innovation.
Because we are a pre-paid, physician led organization, our medical groups take complete responsibility for managing the quality of care for entire populations of patients across the care continuum. They are also responsible for identifying, surfacing, and disseminating innovations that improve care quality.
Unlike most health systems and medical groups, Kaiser Permanente is not new to health care technology. Twenty years ago we built and implemented HealthConnect, our shared electronic health record, across all of our regions and facilities – a significant challenge that required a massive organizational commitment and significant resources. But we recognized its long-term potential to transform the way we care for our patients. Today, we are focused on leveraging those early investments to deliver state-of-the-art health care to our members.
HLF: With the industry catching up to the integrated Kaiser Permanente model, what care delivery strategies or patient-centric items is Kaiser Permanente looking to move the needle on?
Marsh: The entire industry is facing a colossal change. Instead of expecting patients to always come to the medical offices, we need to expect that more and more care will be delivered to the patient outside of that setting – in the home and perhaps elsewhere – and in new ways. This care will require bringing together all the knowledge of patients’ lives: their health history, their genomics, their social context, their medical record, their remote monitoring data, and their personal preferences. Only when we integrate all these aspects do we truly meet patients where they are.
Kaiser Permanente has always been committed to empowering our members to maximize their total health – mind, body and spirit – and our delivery system is uniquely designed to proactively support a member’s journey through life. Where other organizations have a mission statement, we have a calling: to lead the way to a better future for health care.
HLF: Regarding one of those innovations, what actions by leadership helped overcome threats to successful implementation?
Marsh: The success of any new innovation requires sponsorship and vision from organizational leaders at the outset. This means creating a culture and environment that allows innovation to occur at the local level and point of care. I’ve taught many junior physician leaders about the importance of sponsorship. Sponsorship means being present and taking accountability for the complexity that our members face in navigating their health
Let’s take the case of expanding access to telehealth services, for example. Video visits with physicians are an obvious next step in health care delivery, as the technology has dramatically improved and people are using it in many other aspects of their lives. Our pre-paid model enables our physicians to solve member problems and respond to their needs outside the face-to-face office visit, so we have successful sponsorship of these initiatives.
But the field of telehealth remains a surprisingly immature space nationwide. We face some of the same regulatory and interoperability challenges that other provider organizations face, but we believe those are solvable over time.
HLF: What are the top 3 to 5 qualities or skills a leader in today’s health care environment needs to successfully guide an organization through disruptive change?
Marsh: First and maybe foremost, a leader needs to have a keen situational awareness of their organization’s potential to be disrupted. They must be clear on their current strategic direction and be able to execute nimbly if a shift is needed.
Second, leaders have to understand their organization’s strengths and advantages. Leaders must then embrace change, unleash innovation that furthers those strengths, and work to align incentives to support the culture and the outcomes they seek to achieve. For us, the partnership between our physicians and health plan is core to our success.
Third, leaders have to maintain a deep understanding of the customer’s needs and wants. We have to listen with intention to what our patients are saying. Often times, as physicians, we don’t realize what we ask them to do. We have to provide solutions that are not only evidence-based from a medical perspective, but that also take into account the complexities of our patients’ lives.
HLF: What are the biggest lessons you’ve learned about leadership for successful innovation?
Marsh: Effective leadership that creates the environment for innovation to occur relies on influence as well as authority. Leaders must influence both up and down in the organization. Influencing up ensures there is adequate strategic buy-in, sponsorship, and funding. Influencing down engages the innovators, early adopters, and champions whom others will follow. Our physicians all take responsibility for continuously innovating to produce better outcomes for patients. It’s a never-ending process.
HLF: What can leaders do to encourage innovation by staff and establish an environment that encourages innovation?
Marsh: Listen, listen, and then listen some more. Innovators are present in every corner of the organization and they are looking for sponsors who will support them. This supports a continuous, strategic process to “disrupt ourselves.” We aggressively seek out and test new approaches for innovative care delivery models from within.
Take the rapid of expansion of possible disruptive innovations like “bolt-on” telehealth services that allow patients to access doctors through applications on their smart phones. People use technology in virtually every area of their lives and are beginning to demand the same from their health care providers. However, we know that true health is produced through much more than an application on a phone, and innovation should never be for innovation’s sake alone. Our commitment, therefore, as we test these innovations, needs to always be grounded in enhancing the existing physician-patient relationship while providing care where, when, and how our members want it.
HLF: How can a senior leader persuade the C-suite to support and implement a big change?
Marsh: If an organization’s leadership at every level buys into and shares a common vision and set of values, gaining support and resources is not challenging. At Kaiser Permanente, we have a strong and coherent set of vision and values that we all tap into when thinking about change. We want to make lives better for our members and the communities we serve. Everything we do is viewed through this framework. This means that engaging senior leaders in innovation and change initiatives is less about persuasion and more about prioritization around our strategic vision of our future state.
HLF: Finally, what’s in your innovation toolbox?
Marsh: There are several tools in the toolbox. Design thinking is critical, as it frames all the work. We think of innovation not only through a technology lens, but through the lens of people and process. Most of the time, the challenges in implementation lie in the people and process components. Rarely are we innovating a brand new technology; rather, we are finding new ways to modify or apply an existing technology in a different setting. Determining how to use it, in which clinical setting, and for which population means that we must adequately address the people side of change to ensure success.
Mary Topping is a freelance healthcare writer. This blog was first posted at athenahealth’s Health Leadership Forum.