Is this the problem: too little (or no) innovation in service delivery?

Joan Escarrabill
 

Interdisciplinary team to evaluate patient experience

The meaning of words is sensitive to the determinants of space and time. The context gives meaning to the words. For example, what is the point of referring to cosmopolitanism as a remarkable quality when planetary interconnectivity is a generalized fact?(1) Without going into a debate about whether this "cosmopolitanism" is of any interest, can the same thing happen with innovation? The Mayo Clinic suggests that the main current problem is the lack of innovation in the provision of health services(2). The first question that this proposal suggests is whether innovation in the field of health has a "Darwinian" behavior, In other words, innovation is not linear, but is best explained by Stephen Jay Gould's (1941-2002) "punctuated equilibria" proposal: short periods of great agitation followed by long periods of calm or even lethargy(3). Maybe. Furthermore, perhaps innovation is not homogeneous in all fields.

Team stuck? The three factors to drive change successfully

Pere Vivó

Let's see if you recognize this situation: endless care agendas full of telephone visits that do not add value, repeated requests that do not follow a scheduling logic or a reasonable priority, few and highly complex face-to-face visits that take up more time than expected, tense situations with some patients and, finally, ending the day with a bitter feeling that the work is pending or poorly resolved...

If the answer is yes, you are in luck because your organization will need deep changes that can be an opportunity for transformation and collective motivation.

More primary care, a disruptive innovation

Jordi Varela
Editor

 

One of the bad news that 2020 brought has been Clayton Christensen's death, a Harvard Business School professor who developed the theory of disruptive innovation and who already deserved the care of our blog with the commentary on the book The Innovator's Prescription, where the author analyzes the reasons why healthcare systems are so refractory to innovation. As I believe that the effort that Christensen has made to adapt his theory of innovation to healthcare is worth it, as a tribute, I have recovered a video of a lecture he gave at King's Fund in 2013.

Do we really want to change things? About Kotter’s 8 steps

Jordi Varela
Editor

 

Our iceberg is Melting is a fable that illustrates very well that detecting problems is not the same as wanting to fix them. Fred, an observant penguin, realizes that his iceberg is cracking, a matter that will be catastrophic for the entire colony living obliviously to the problem. The author, John Kotter uses the fable to unravel the 8 steps that any individual, in Fred's circumstances, should follow if they want to save the penguin colony:

The health care system of the future is here now

Josep Mª Monguet
 

Who took the chestnuts out of the fire?

In difficult moments, everything is shown as it is and that is when authentic leadership can be identified. In this sense, a revelation of the recent stage, which we could already intuit, is that health care professionals have shown an exceptional capacity for response. It’s not a common occurrence in the public system. Despite the multiple deficiencies faced, they have assumed the difficult part of the situation and overcome it.

Training is essential for change management

Nacho Vallejo

The actors who intend to get involved in the orchestration of changes in our healthcare system tend to agree on the difficulties and barriers that limit the development of improvement strategies for healthcare organizations. We have already seen it in previous posts on this blog, where we asked ourselves what has become of the professional's experience and how to "unclog" our institutions.

Disruption doesn't show on the tip of the iceberg

Joan Escarrabill

By chance, a couple of years ago, I found some images of Gediminas Pranckevicius, a Lithuanian graphic designer. Some of these images present a (small) upper part in which he describes familiar scenes, but the rest of the image (the lower part) is very complicated. The metaphor is automatic: there is (extraordinary) life in the submerged part of the iceberg.

Pinterest

Disruptive changes take place in the submerged part of the iceberg that, in a short time, change the image of the visible surface. Taxi is a service that is changing in a profound way. The digital press also gives us some clues. In New York, it appears that there are ten times more alternative taxis than conventional taxis, which has caused a decrease in the income of taxi drivers (by almost 30%), a reduction in the value of licenses and a negative impact on traffic due to the large number of vehicles that circulate without passengers. It's a significant problem from many points of view, and the most impressive thing is that these profound changes have taken place in less than five years.

Exponential innovation, or getting ahead

Josep Maria Monguet

The sustainability of health services is associated with rational development. The key element is the generation of knowledge-intensive employment, which can only be the result of innovation.

In general terms, innovation in health must have an exponential dimension and be based on:

• The generation of intelligent demand by health professionals
• The participation of citizens and all social and economic agents
• The promotion of business models based on value for users

Self-management is the way

In traditional companies, such as health companies, power is very concentrated. Individuals above distrust those below because they believe that if they allow them the autonomy they will blow their budgets and, as a result, professionals have simply become rigid gears in the machine with virtually no room to make decisions. For their part, politicians always find reasons to distrust managers in case of any budgetary deviation or up-tick in citizen unrest - waiting lists for example. Managers, fearful of their predicament, concentrate power in a few subordinates to maintain tight control of objectives whilst rejecting any innovations from those below due to suspicion of increasing expenses or creating scandals.

Primary care: reforms based on innovation

The primary care reform initiated in Spain in 1985 was inspired by the Alma-Ata statement that WHO had proclaimed a few years earlier. The need for change was evident since the previous model was characterized by access difficulties, the predominance of curative care, medical orientation focused on diseases and the absolute lack of teamwork. Thirty years later, primary care is in a crisis of exhaustion due to multiple factors, of which the lack of budgetary endowment, the ageing of the population and the rigidities and bureaucracies of which it has been endowed stand out, and for a long time the call for reforming the reformed has been heard and create a new model more appropriate to the present day.

Management according to Elon Musk. Tesla, SpaceX and SolarCity

Tino Martí

Elon Musk is one of the trendiest entrepreneurs and undoubtedly the most controversial one at the moment. He is the leader of Tesla, SpaceX and SolarCity, three young, ambitious and dynamic companies that show how far they are willing to go to change the world through the internet, renewable energy and the race to Mars.

In 2018, he made it to the headlines for different reasons. First, proposing technical solutions to rescue children trapped in Thailand and end up insulting their monitor. Second, and probably the most popular, with the announcement via tweet to privatize Tesla for $420. In the American financial and stock market context, privatizing a publicly-traded company means repurchasing all its shares. The action elicited strong reactions, and the board of directors concluded his position. Shortly afterwards, Musk again announced problems in the production of Model 3 and wanted to assure the market that he is giving it everything by announcing his strenuous workday: 120 hours per week. To top it off, in a live radio interview, he accepted smoking marijuana. No one can say that he goes unnoticed, regardless of his apparent privacy.

The future of primary care: "Build the plane while it flies"

Josep M. Picas

Recently, The King's Fund, based on a study by the National Centre for Social Research (BSA), reported a significant decline (7%) in the assessment of satisfaction with English primary care by its citizens. This is probably due to the difficulties of access, caused by the scarcity of resources and the increasing complexity of patients. We do not know this information in other countries and especially in Spain, but it would surely be very similar, since the problems are global.

Innovation or decadence. There’s no middle ground

Josep Maria Monguet

Innovation is not a fad; it’s a structural phenomenon of the future, largely a product of the acceleration in the production of new knowledge. Innovation was always part of our world, but there are two new factors nowadays:

1. Accelerated innovation: more novelty in products and services are observed more frequently.
2. It's everyone's business: each one of us are protagonists of innovation.

Innovation 3.8 over 10: a clear "not passing"

Josep Mª Monguet

Self-deception is the path to regression. A few years ago (in 2006), I was invited to speak at the opening course conference for one of the entities of my university. I spoke about the deficit in innovation observed in Spain, sustained by multiple data. The rector, who spoke later, did his best to deny it using the sole argument that the universities had a large scientific production [1]. It became clear that he didn’t understand the difference between innovation and academic scientific production. Well, ten years later, our country is still the same if not worse. We can continue doing nothing about it, but we must understand that for building an innovative country, the islands of excellence are essential, but not enough.

I don’t know ... but it seems to me that times are changing

Joan Escarrabill

Health care’s future is an issue that is debated multiple times. The most academic visions or those that start from the observation of reality have common elements. Increasing the number of professionals (more doctors and nurses are needed, is strongly agreed), to the extent that the weight of the hospital will be reduced and interventions in the community will gain prominence, health education of the population is very important or in what way are we going to create sustainability in a system that has contributed significant improvements during the last years, can be just a few examples of these common places of all the debates.

Keep calm and leave the mobile for a while

Josep Mª Monguet

The trade fairs tend to present the technological innovations somewhat passed by the commercial magic, which puts at risk the necessary objectivity to evaluate what they will actually contribute. This is aggravated if we consider that technology is nowadays advancing much faster than human capabilities. As technological innovation progresses exponentially, the adaptive and changing capacity of individuals and organizations is logarithmic.

In general, to take advantage of the new options that technology offers, you have to know where you want to go and what to do to get there; the problem is that we just grope. The good news, however, and the fair is a good exponent, is that so many of us are doing it that the possibilities for progress don’t stop multiplying. Remember Edison when he said he had discovered 10,000 ways of not making a light bulb.

Hospitals: 10 necessary structural reforms

Hospitals are structures that generate a powerful influence on the overall health system. Their effectiveness in the resolution of certain acute diseases, especially surgical, gives them a great social prestige. This fact should not, however, hide two structural problems that are burdening their perspective:

a) The first problem is internal. Bureaucracies themselves are showing signs of fatigue and this affects the quality of services, especially in the safety of admitted patients.

The chronic patients’ care needs disruption and no reforms

Clayton Christensen, a professor at Harvard Business School, defines disruptive innovation as a process that, by simplifying a product or service, is expanding the markets until the new products or services manage to get better than the originals that are obviously heavier and more expensive. Disruptive technologies have simplified products, made them cheaper and thus have brought millions of new consumers to the market. Such is the economy of the new millennium.

In The Innovator's Prescription, Christensen says that the health system lacks disruptive innovation, that hospitals concentrate too many specialists, too much investment and too much technology; and according to him, this accumulation is an obstacle to the arrival of more simple services, but perhaps more effective in larger populations.

Differences between a leader and a manager

Las diferencias entre un líder y un gestor - John Sculley http://t.co/Y9U4xssKv6
— Julio Mayol (@juliomayol) February 22, 2014

The tweet edited by Julio Mayol lead to a video about an intervention of John Sculley, Chief Executive Officer (CEO) at the beginning of Apple. Those who have seen the movie about the life of Steve Jobs will recall that Sculley was the Pepsi Cola manager joining a young and sassy Apple, in order to turn it into a business. Those who have not seen it should know that this ended badly, especially because the leader, Steve, had a vision focused on innovation, while the businessman was focused on market and profits. Jobs was fired in 1985 and the company without him, continued fighting in an emerging market, with good results, as Sculley wanted, but without the punch of a leader. Jobs ended up buying Apple, thirteen years later, when the company, now without Sculley managing it, went into bankruptcy.

These two figures: the leader and the manager are essential for businesses, both public and private ones alike. The leader is associated with the vision, and thus with a project, while the manager is associated with a board of directors or the public administration directly. The success of institutions relies on the two figures finding a common work field where they can negotiate and share objectives. From Jobs-Sculley type confrontations, only resounding failures for both parties can arise.


Jordi Varela

Editor

Hospitals: 10 necessary structurals reforms

Hospitals are structures with a powerful influence on the overall health system. Its effectiveness in solving certain acute health problems, especially in the surgical area, gives them a major social prestige. However this fact should not undermine two structural problems that are weighing their image down:

a) The first problem is internal. The own bureaucracies are showing signs of fatigue and this affects the service quality, especially when it comes to the safety of admitted patients.

b) The second problem is relational. The hierarchical superiority of hospitals has placed them apart from the communitarian reality and the primary care, and causes now a serious difficulty in dealing, in an integrated manner, with the complex chronic disease care and with the geriatric frailty.