We’re a non-profit teaching hospital, founded in Boston in 1869, with 395 beds. We have about 9,500 employees, and we’re affiliated with Harvard University.
When my position was created, in 2010, I was tasked to try to enhance the culture of innovation. It was very vague, as it often is. As a research hospital, we did a ton of great science, but if you had a new idea about the delivery of care or the patient experience, it wasn’t so easy to get started. There were barriers, there weren’t resources, you didn’t know where to go.
When this position was created, I reported directly to the CEO. That’s very important, because innovation is often resisted. Unless you have top-level executive sponsorship, it can be hard to get new ideas adopted. (I now report to our new chief operating officer.) Coming in, they didn’t know and I didn’t know what my budget should be. But the institution saw it as a strategic investment — they took it out of strategic funds, as opposed to regular operations. The thinking was that we’ll give this a couple years, we’ll see how it goes, and we’ll evaluate.
These are the three programs we got off the ground that I think have had the biggest impact so far.
1. Because we understood that innovators often don’t have sufficient resources, we created a small seed fund where innovators can come and apply for money to test out a new idea. Sometimes they work, sometimes they don’t. It’s small amounts; we’re not talking six figures. One example of these “Innovestment Grants” is a team that developed technology-enhanced toys for toddlers who have severe emotional regulation disorders. Another is a hat that looks like a turban that we use to re-warm babies who have had their body temperature cooled down for heart surgery. This thermal hat was invented by one of our staff nurses who has been with us for more than 30 years.
2. We also heard that people had a lot of ideas around innovative new clinical software. But that’s very hard to build, even if you were to give a doctor a bunch of money, he might not be able to get the software built that he needs, particularly in a complex environment like the hospital, where you need to access sensitive data. To try to address that need, we created a software development award. The FIT award: Fast Track Innovation in Technology. If someone wants to create a new piece of software, they apply for a FIT award. If they win it, the developers on our team will build out that solution for them. The team are full-time Boston Children’s employees. They know our ecosystem, they know who to work within it, they know about HIPAA and security. It’s two full-time programmers, a part-time business analyst, a part-time project manager, and a software architect. It’s effectively about four or five people. But we’ve been able to come up with some solutions to problems that doctors or nurses have identified, and some of them have commercial potential, we think, even though it wasn’t our goal to create products we could license to others.
We have a project through FIT called MyPassport (see below), which is a mobile app for patients that have been admitted to the hospital. People are sometimes confused about their child’s careplan and information-starved when they are admitted as patients. The app gives them access to their test results, with a graphical user interface that tries to display the results in a meaningful way. Patients didn’t always know who was on their care team, because there can often be a parade of people coming through these rooms. So we have names and pictures. And we also found that parents and children don’t always know what has to happen before the child is discharged — perhaps the fever has to come down, or the child has to be able to walk. Finally, we wanted to facilitate two-way communication, when parents or patients have questions they want to ask. That was built by my FIT team, and we’re just finishing the pilot now. Patients love it. They feel so empowered. And the clinical staff likes to use it. The idea for that gave from Dr. Bob Nguyen, one of our innovative physicians. He had been trying to figure out ways to improve communication with patients and families who didn’t speak English.
3. Strategically, we have been involved and leading the work around telehealth for remote delivery of care, which has become a major innovation initiative within the organization. It’s important to our strategy of sustaining our institution, developing new relationships, growing our volume over time. We’re planting the flag and saying, this is something disruptive that matters at the institution level. We’re working with outside technology vendors. What we need to focus on is the workflow, the new business models, the legal and liability issues — getting that all worked out. Of course, payment is a huge issue. We have one vendor we’re working with already, for our hospital-to-hospital telehealth technology, and we’re about to look for another vendor for our direct-to-patient programs. We have a pilot going on right now in the area of concussion follow-up. A child has met with someone in our brain injury clinic, and they need a follow-up visit six weeks later. We’re offering that visit virtually, from the patient’s home, as a video visit, rather than having them come back here, park, wait to see the doctor. There’s a lot of opportunity to provide direct patient care virtually. There are all sort of consultations that happen, even before and after surgery, where it’s about the conversation between the doctor and the patient or the patient’s parents, where you don’t need lab tests done or a laying on of the hands.
Developing Specific Metrics
We’ve given out 33 grants, with the awarding of our our fifth cycle recently. We have made nine FIT awards. And we have about half a dozen telehealth pilots that we’re supporting. We don’t have money to give out for those programs, but we provide people and expertise.
We have created a couple different types of metrics, in addition to how many projects we’ve helped to support. One is looking at the innovation life cycle, looking at how many projects we have ideated, piloted, and gotten across the “O-Gap” and become operational.
The “O-Gap,” or the “operationalization gap,” is a term I coined to explain the adoption barrier that you see in big organizations between a successful pilot and broad operationalization. (See the diagram below.) When you have an innovative solution, even if you tell people about it, there is no guarantee they will actually change the way they’re doing things to adopt the innovation. You need to plan early in the innovation life cycle for the O-Gap to help narrow it. Big O-Gaps can occur when innovators haven’t gotten sponsorship early enough from leaders; sometimes there’s a technical O-Gap, where you built something that worked for 10 people but does not automatically scale to 1000 users. The most important thing in closing the o-gap is the awareness of the O-Gap, and getting people involved early who are going to be key to operationalization. Try to get them involved in the pilot phase, if not earlier. Make sure the innovation is not a foreign notion to them when it’s time to operationalize it.
For each program, we built specific metrics. For the Innovestment Grants, we look at how many people applied, how much we gave away, who applied — do we have participation across the whole organization? We also look at how much demand there is. If have $100,000 to give away, and we had applications asking us just for $110,000, you have to wonder about whether we’re investing in good projects. We also track what happens with each of the projects we support. Do they lead to new clinical processes or new devices? We also track who got follow-on funding, who published something, who got a patent for the work we supported.
The Biggest Challenge: Getting People’s Attention
The biggest challenge of stepping into this role was getting people’s attention, and getting them interested in innovation. I had support from senior leadership in putting me in front of the right people, at the right gatherings. In the absence of that, it’d be really hard to create a program that affects the whole hospital, if you don’t have a way to get the message out there. Getting in front of people at meetings they have are already going to is a great way to connect. You can’t rely on posters and signs.
Each year, we put out a progress report. It’s aimed at our clinical and administrative leadership, as well as our innovators, to put a spotlight on what we’ve achieved in the past year. It’s also intended to inspire anyone who hasn’t been an innovator yet. (You can see an example of the most recent progress report here, in PDF form.)
Innovation can be a hard and frustrating process. It’s important to recognize and reward innovators. That was the idea behind an Innovation Day event we held last year at the hospital, when we had our CEO and President host the event. It was to say, “Innovators, we value what you do.” We’ve had smaller recognition programs, like receptions, to celebrate our Innovestment or FIT Award winners. Recognition really helps build the culture.
The culture of Children’s is an academic culture where people value grants and awards and get they get recognized for those successes. So our innovation program builds on that. It’s really important to understand the culture of where you work — what gets people motivated and what gets their attention.
Naomi Fried has held senior innovation and technology roles at Biogen, Boston Children’s Hospital, and Kaiser Permanente. Fried has also worked in venture capital and for startup companies in the healthcare sector.