Are you wondering how to create a culture of innovation within your organization? We know it isn't easy. So we're discussing how you can start to build a foundation for this important work.
Are you wondering how to create a culture of innovation within your organization? We know it isn't easy. So we're discussing how you can start to build a foundation for this important work.
Here’s where you can learn more about the people, places, and ideas in this episode:
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Are you wondering how to create a culture of innovation within your organization here at the center for care innovations? We are accelerating the adoption of innovations that create fair just and inclusive opportunities for everyone to be healthy. And we know it isn't easy, but the day we are hoping that this discussion between our Colorado health innovation communities or chic for short and the talented Lynn McGuire will help illuminate how you can start to build a foundation for an innovation culture. Then McGuire is a strategy and innovation consultant with a focus on healthcare and the nonprofit sector can served for many years as chief strategy officer and head of innovation strategy at Columbus regional health in Southeastern Indiana. There, she led the creation and opening of an innovation center for healthcare process innovation, which included a simulation learning lab, lean six Sigma and design thinking today she's in New York city consulting with healthcare focused organizations that want to develop a capacity for strategic innovation. Welcome Lynn.
Thank you. It's so, so nice to be here and to meet you all. what I'm going to do is take you through, um, kind of the learning journey that, uh, I went through with Columbus regional health, but to put that in context, um, what we did there, I've also been working at applying a similar model, um, to some hospitals in New Jersey as well. And I've been working on and off with CCI over the years as well. So I'll bring a broader perspective than just CRH to the table, but the CRH story I think is pretty instructive.
So
You a little context. Um, so, uh, Columbus regional health is a County owned health system. So it's a County hospital, um, but it operates more like a not-for-profit Indiana healthcare law is a little bit different in terms of County. Um, so it's not like the big inner city County hospitals, um, but we are the only hospital in a 30 mile radius and we are the safety net hospital for the area. Um, so we are, we are the provider, we are it, we have about 25 employees and you can see the visits there.
So,
Columbus is located in a triangle between Indianapolis Cincinnati and Louisville, um, and about 500,000 people in, in that 10 County region that Columbus regional health serves. So where we're not urban,
We're not like really rural, remote,
Rural, but, um, you know, fairly rural compared to other systems. And again, we are the safety net hospital for the region. Um, the city itself is a little unusual. It has a fortune 200 company and it's known for art and architecture. So I won't say that this is a typical small town, but in many ways it is a typical small town. Um, but, uh, you know, we, we like to stay in Columbus and I think it's true of the hospital as well. It's, it's kind of weird. We're big enough to have some assets, resources, the will to get stuff done small enough to actually get it done. Um, and so, yeah, we called ourselves kind of the Goldilocks phenomenon, but that, that was the good days.
Um, so my role
At Columbus regional, I was the chief strategy officer, um, and we, our, our, our strategy was really to focus on being a role model community hospital. Um, our, you know, our feeling for the health system was similar to the way the community is just because you're small doesn't mean you can't be great. Um, and there's a different kind of greatness when you're smaller and that's what we were aspiring to. Um, and, and so we would, we would benchmark kind of best practices across different aspects of the organization, everything from employee engagement to co you know, clinical quality care, um, to Baldrige and other kinds of things next
God.
Um, and so it was that, that innovation, or, sorry, that excellence journey that kind of led us to innovation. We had a site visit by, um, some Baldrige folks who, um, their feedback was, you know, you guys give us a lot of great examples of innovation, but you don't have a systematic approach. Um, how do you know you can repeat innovation in other parts of the organization or with other people? And so, um, as chief strategy officer, I kind of took that on and said, that's a really good question. Um, and so kind of from that initial question to how does a community health care system establish, um, an ability to innovate systematically? What is, was the challenge that I took on and that we took on, um, this is where we are now. And I say pre COVID, cause COVID kind of threw a few monkey wrenches into things, but we, um, we have a physical place for innovation.
Um, in that center is also a simulation lab. Um, our clinical improvement teams, our education teams in our lean six Sigma. We have five full-time facilitators, um, that, uh, that more first lean, um, black belts, but then they learned how to use design thinking as well as other skills. Um, we run an internally, um, trained catalyst program, similar to what you guys have been through. And we have, you know, 42 different folks that have been through that training. We typically do 25 to 30 projects a year and, um, have had a very positive impact on the bottom line. It's not the way that it works is it's generally not an even million dollars every year. It kind of spurts, you know, some years are great, some years are not as good, but on average, that's where it comes out. And we also found that innovation was a great way to raise money, um, because, um, there is an element of philanthropists that, you know, like to find new things and they're attracted to innovation. I'll talk, I'm going to talk more about all of these, So, um, so I know it can be daunting to put that out there and say, this is where we are, and this is, you know, this is where you should be. That's not what I'm saying. And I'm saying that's not where we started either. You know, we started by visiting Mayo and visiting Kaiser Permanente and kind of looking at what they had and saying, there's no way we can do that. So what, what can we do
Um, so we were really
Looking at, again, [inaudible] not surprisingly, I was chief strategy officer, where are we going to start? We're going to start with strategy. Um, so for us, it was, we're not going to be innovative for innovation sake, where we need to be innovative in order to accomplish the work that we need to accomplish, um, as a system. And so, um, you know, so first and foremost, we had to define for ourselves what we wanted out of innovation, um, at this point, because a lot of the work we had done on employee culture, we had, uh, um, a very strong culture of teamwork and excellence. Um, and that kind of came into play as well. And we had a lot of individuals who liked to innovate and do things differently. And so we kind of said, how, how do we harness them? Um, from the start again, starting from scratch.
Um, we, these were what I call our guiding principles. Um, you know, I knew we didn't want like a single project. We were trying to build a systematic approach from the beginning, something that would be repeatable and would on beyond the current leaders, right. We, um, we already had a practice of benchmarking and learning from others. So we did a lot of that. Um, I was adamant that we have no, what I called parallel systems when we benchmarked various, um, systems that were doing innovation, some of them had like, it was an offsite innovation center that did projects that were unrelated to core work, um, or unrelated to systems strategy and, um, or, or they were doing their own work and it was perceived as fun. But, um, it, again, wasn't perceived as core important work and that's not where we wanted to go because we didn't think that was sustainable.
Um, if you're not part of that core agenda, we, um, we let our system strategy drive the agenda for the innovation center against surprisingly, we saw many innovation centers where that wasn't the case. Um, we, uh, believed in calling everything a pilot, so that, uh, uh, and, and, and again, this was before we had introduced design thinking or anything like that. So people didn't understand these cycles of learning, right. And so a pilot kind of did that for us. It said to people, okay, this may not be permanent. Um, we, as a community and as a community hospital, we have a lot of great partners in the community that we work with. Um, and we, we leveraged those and I'm going to talk more about that. And then the most difficult guiding principle we had for a variety of reasons, the main of which was we had just gone through a flood that forced the hospitals just shut down for five months and we had over $200 million worth of damages.
Um, and so we were, we were somewhat cash strapped given all of that. Um, and so, uh, we had whatever we did, we had to do it without adding FTEs and, and in the end, that was a real eye-opener because I think had I been able to staff up, I probably would have taken a different approach than we did. And I think this approach is a great approach. So we didn't add any FTEs and it, and it wasn't until we had done a fair amount of work that I'm going to present, um, that we actually had an innovation center space. So that, again, very different from a lot of the places we benchmarked, where they open this beautiful innovation center, and then they don't know what to do with it. We kind of waited until we knew what we wanted to do, and then we had a space. So we developed what we call our intentional innovation framework. And as I said, our goal was to have a systematic, repeatable approach, um, that would outlast, you know, all of us in leadership, um, and that, that could be carried on by others and could function in multiple places in the organization. And it's, uh, you know, we call it our five PS because each of each of the five areas starts with a P. Um, and I'm going to go through each one of those and, and kind of why they're here,
Portant,
I did want to kind of harness where design thinking and catalysts fit into our framework. So we talk about people and we talk about processes. So for us design thinking is the, it provides the tools and the methodology for again, systematically, um, providing innovation in an organization. And then our catalysts people that have been trained to use design thinking in the organization are one of the big people levers that we use. Right. And we have both, full-time dedicated, um, kind of project managers that use lean and catalysts. We also have people that I think are more like many of you that have full-time jobs and are also trained to be catalyst and to use catalysts on how to use design thinking skills, um, in your projects at work. So that's kind of where it fits in, but I think it's important to note that, um, the framework goes well beyond just those elements, right? Those elements are critical. They're absolutely critical, but you have to think a little more
Or broadly
So if we talk about the people wedge, um, you know, from the get-go again, because we were building this on existing FTEs, we decided to go to our lean Sigma group. Um, and because they were, they were amenable to it. Um, and say, how would you guys like to be trained in design thinking in addition to lean? And so we, um, because their job, they were full-time project facilitators, um, and they were already doing the improvement work in the organization. And so we thought improvement and innovation certainly go hand in hand and it made sense for us to put it there. Um, and so we have these, you know, full-time dedicated project managers, um, but we also have the design thinking catalyst, right? Which like, you all are not full-time. I mean, they have other jobs that are full-time and they also know how to do design thinking.
Um, we have, um, again, we had a culture that was very non-hierarchical, which was really helpful, um, and very focused on teamwork. We have a program founded by or funded by our foundation, um, called the innovation fellows, which, um, give, uh, a, basically an education scholarship or some kind of opportunity to an employee that is innovative in their practice. Um, and, and so, so I only mentioned that because what we were trying to do also was to flag innovation as an important competence in the organization, and as something, um, something valuable, um, we're working with HR right now, and I would very much like to have design thinking, training, be a, to being a manager. Um, so as part of managerial training in the organization, you need to have, um, become a design thinking catalyst. We're not there yet, but that's kind of what I'd like to do.
So I'm talking about, you know, things you can do to kind of embed, um, design thinking and innovation in your systems and your people systems in your organization. Um, and then the senior leadership commitment, um, is pretty critical. Again, I was part of the C-suite. Um, so that was really helpful. Um, when I left the organization to move East, um, it transitioned to the CFO. And so, so again, we've kept, um, that C-suite ownership. Um, and I think that's really critical if you want to go beyond a project, if you're just doing, you know, projects here and there, you probably don't need that, but if you want it to grow, you've, you've got to have commitment from the top, places. So we have a physical innovation center. Um, and I think there's something to be said for that. You absolutely can do this without a physical innovation center.
No question. So don't let it bog you down, but if you can establish a place, it is one of those kinds of physical symbols to others in the organization that, Hey, innovation is important here. You know, the kind of work we do is important. Um, we also found we set, we physically, um, uh, designed the space. So it looked very different than the rest of the hospital, because we wanted people to walk in and say, okay, this is not business as usual here. You know, I'm going to use different tools. I'm going to think differently. I'm going to act differently here. Um, so, but we also, so that's, that's one piece is kind of having a physical center and our physical center is also used, um, as part of our conference center facilities too. So it's not like it isn't used for anything else. Um, we also find was really helpful to identify places that were safe for innovation.
And by that maybe safe is the wrong word, but, um, uh, where people welcome innovation. I think we all know in organizations, some people are more open to trying things in new ways than others. Um, some people actually actively embrace it. Um, and so, you know, w what we learned by doing our projects is, uh, after a while, there was one particular nursing unit, our six tower unit where the leadership there really liked, um, the design thinking approach and really wanted to try things differently. And so it kind of became that unit for us, became a little bit of a test bed location, or a safe space for innovation, because they were open to it and they were more practiced in it. So I think in any organization, you can find those kinds of places. Um, and then last is virtual technological, which I think given COVID in everything we've done, I don't need to explain any more, but you can, you can do a lot virtually, um, as well. And, and, and that includes how you communicate about what you're doing. Um, you know, even having a webpage for innovation for your organization just makes it feel more real, um, uh, you know, and you can feature projects. You can talk more about it. It, again, it's about trying to elevate the conversation and having it with a broader group of people right in your organization. Um,
Yep.
Projects, piece, you know, a lot of organizations struggle with what should the work of the innovation center be, or, you know, our innovation team. Um, and again, at CRH, I, it had to come through, um, senior leadership. So it wasn't always the C-suite, it could be the next level down, but the point is that these were strategic projects, right? They weren't extra nice to do projects. They, um, and, and that all of these projects, if they're strategic and important to the organization, then they have, um, an expert facilitator or, you know, someone that has experienced facilitating a project or leading a project. So, um, some of our projects are led by our black belts who are, um, trained project managers, but not all, um, some of them are, are li are led by catalysts and some other, uh, are led by department managers. But the point is, if it's, if you deal with the project in a very business, like, you know, manner, um, where it's got, you've got skills and leadership that know how to lead a project well, right. Cause especially when you're starting out, you need your projects to be well-run, you need to learn from them if they they're not all gonna succeed and that's okay. Um, but they shouldn't fail because the project wasn't managed well, they should feel for other reasons, um,
Partners. So we have gotten a lot of different kinds of leverage out of different kinds of partnerships. Um, and I described through here, and I'm going to start at the bottom. So funders. So, um, our system had a fund, has a foundation associated with it. And that foundation was a very willing partner at the beginning. And as I said, we were in unusual circumstances financially because we had just suffered this devastating flood. Right. Um, and so there was no extra money for anything, which is why I said I had to work with his existing FTEs, but I was able to partner with the foundation who was able to raise some money for us to get our initial design thinking kind of training and some of our benchmarking work funded and then over. And then the, the foundation also funds, um, the innovation fellows program and some other kinds of employee innovation kinds of programs that we do.
Um, and there are other funders out there as well. I mean, we just happened to have a wonderful partnership with our own foundation, but, um, in New Jersey I've been working with some hospitals who were funded by a New Jersey based foundation that, uh, one of its arms is improving healthcare. And so through the partnership with, um, the Nicholson foundation, we've been able to bring design thinking to a number of hospitals in New Jersey and also starting to build some innovation center approach is similar to CRH is again through a funder. Um, I, I, I, Colorado and CCI, um, also have right funding dollars that are brought to you, you know, so I'm just saying, you know, think, think about where money might be or where, where people have money that they want to invest in improving health in the community, right. And health equity, um, because these are the kinds of skills and approaches that can help you get to those kinds of outcomes.
Um, so, so be thinking about that, um, we also have had partners that we call external drivers and those tended to be community partners. So for example, again, we ended up with this fabulous simulation learning lab because we had, there was a regional educational consortium grant that needed to put some money into, um, healthcare education and they wanted to build a simulation lab. So how lucky was that for us? And, and so, so we partnered with them to get that done. Um, and there were SIM labs and some other hospitals in the region, but we got one and we got to make it part of our innovation center. Um, likewise some of the projects are driven by external drivers, right. So right now I think Sierra, Joe's just talking to them last week. They just launched some programs on, um, reducing infant mortality. Right. I think that's an issue in, in many communities.
Um, and so that's something, obviously that's important to the hospital, but it's important to a lot of the public health and social service organizations in the community as well. Um, and we also have a healthy communities program, um, that the hospital runs, which basically has almost every not-for-profit leader in the community around the table on a monthly basis. And so that group often percolates issues and prioritizes them, and those might get driven into the innovation center. Right. So we're looking for, and, and why do that? It complicates it. Um, but it also, when you do that, it means you've got more external accountability and you've got more, you potentially have some external funding. Um, and sometimes you have some extra people that come to bear on the project as well. So, I mean, there are reasons why you make it more complicated, um, and then pay setters as the last one.
Um, so for us early on, uh, pacesetters are kind of other like CCI, for example, who were leaders in the field who can bring you knowledge that you need, and also add credibility to your program with your leadership and with your funders. Right. And so for us early on, again, we, we, we did an engagement with the IDEO. This is back in 2010. Um, and you believe, I mean, that doesn't feel like that long ago. Well, I'm old, but anyway, um, uh, but 10 years ago it was hard, um, to figure out how to get design thinking, training people weren't teaching it. Um, and so the really, the only way to learn was to watch people do it in action. And so we brought IDO in, we did a project with them and we learned a ton, um, and it also gave tremendous credibility to the work we were doing because IDEO was who male worked with and who Kaiser worked with. Um, and so our foundation was able again, to leverage that in terms of fundraising. Um, so you know, all these things kind of work hand in hand. So I, you know, for us, the partner piece of innovation has really been critical. Um, you know, we, yeah, it, I think it can add a lot of leverage, um, in a lot of different ways.
And so, you know, so early on, but again, when we started this journey, we didn't know what the processes were going to be. It was like, how do you innovate, um, how, you know, how does IDEO do it? They couldn't even describe it at that point. I mean, they did what they did, but they couldn't really describe a methodology for it, but now it's out there and well understood. Um, and so, and, and it has, I mean, I think those of us in healthcare that work with it find it's really a very powerful tool in healthcare. It works really well. Um, and so the methodologies and tools are set. And then we also, um, talk a lot about outcomes. one of the things that we've learned is you have to measure a lot of different things. So
this is our innovation scorecard. And so we have measures by our different framework categories, and then we have cross-organization measures. Um, and over the years we've kind of changed some of these measures. In fact, this is a very old scorecard, so it looks a little different now, but the categories are still the same and we're still measuring things. And you really need a mix of what I would call leading indicators and lagging indicators, right. And your lagging indicators, of course, are your outcomes. What are you actually achieving your, you know, how are you impacting the bottom line? How are you hitting quality metrics, your patient satisfaction numbers. Um, but there are other things you measure along the way that show progress, right. Um, and you know, even thing, and at the beginning, you can see here, you know, how many design thinking events did we have?
I mean, it was a big deal. We had one, but we were moving in the right direction. This was year one. Um, so, so trying to think through, um, again, getting to some kind of scorecard requires that you also have some objectives about what you're trying to achieve. Right. So you're really thinking about it that way. So I'm going to run through some lessons, right. As I said, this is from Columbus regional, and this is from working with Nicholson, um, with several hospitals in depth. Um, and then, um, also working with the new at CCI. Um, so kind of put these lessons together. I'll run through these and then I'll open it up for questions. So first start strategically. Right? So, so if you want innovation to be more than a small team doing a couple of projects, um, you have to be thinking big, right.
So, you know, what does that systematic approach look like in your organization? Um, and you know, and, and again, that's not where you're going to start, and that's why I showed you where we are now is not where we started. Um, but you have to have that end in mind. Right. Um, you also have to be in it for the long haul. And I think you guys understand that pretty well. Um, having been through catalyst training, you know, things don't always go where you think they're going to go, um, and you learn a lot along the way. Uh, and you've got to give it time. You've got to give it time. So if you don't have that time, if your organization has no patience, then I'd say, you know, then leave it where it is. And don't even try, um, because it's gonna take a little while to get there.
Um, we have learned yet that, um, you'll learn lots from other organizations, but, um, in the end you have to customize it for what your organization is, um, system or strategy drives the agenda. I've talked a lot about that. Um, calling your efforts, a pilot, I think helping people understand that, um, you're learning as you going and the, and that, that is, um, that's actually what you're trying to do. It's not, it's not a mistake to say something didn't work, right. It's, it's just a different way to work for an organization. And then, you know, the other thing that we didn't fully understand at the beginning, um, is where does design thinking fit in? Right. And so I think, uh, you know, a big learning for us is that it doesn't replace your other improvement methodologies, but it's a wonderful addition and it, it can be completely standalone. It can also piggyback really nicely with lean or with other kinds of process improvement methods. It kind of depends on where your organization is. Um, but these things at CRH, we, again, because we built it on our lean black belts, we even have kind of a mapped out process that integrates the two methodologies and it works really nicely.
So, you know, when you're doing this work, um, you want to be smart about it, right? So as I say, you know, look around for partnerships, um, that really, uh, you know, every system I've worked with, there's been an outside partner that has provided some momentum, some funding, some credibility and accountability to when people give you money, they expect you to deliver. And even if they don't give you money and you're partnering with them in some other way, there's a level of accountability there, which is helpful, um, because it prioritizes your work for the organization. Um, you want to select projects that have a high likelihood of learning and that matter to other people, um, because it's the projects that give you the stories that you talk about, right? When, when people say, well, what is it you're doing with that innovation work? Well, you can say I learned design thinking, but it's really hard to describe design thinking to people.
But if you can describe a project and how design thinking made a difference in what you learned in that project, um, and the people who were involved in that project felt the energy and have the same kind of passion that gives you great, um, great ability, uh, to, to carry momentum forward in the organization. Um, and then, uh, last is, um, you know, make sure that whoever's leading this in the organization, has the respect and the ability to work across the organization because this kind of work means you're not always following organizational rules and it's new work. And it has to be someone that's really good at working across boundaries and working collaboratively and not feel, you know, not threatening people. start small and create momentum again, I'll show you where we ended up.
That's not where we started and, you know, starting without FTEs and working right with the, with you all as the core is a great way to prove value. Um, and then based on that value, maybe you can add FTEs. Maybe you don't have to add FTEs, um, building design thinking skills within a small group and spreading to others is definitely a proven model, right? Training, you know, everybody on everything isn't is not going to work. And the last point kind of goes with this, don't force this on people. You know, there are so many people, um, that probably do want to do this kind of work. Um, and so many projects with those kinds of people, that's what you should be working on, right? Because it's a different way of working and, and it's tough enough as it is. And if you're, if you're fighting your culture, because it's the wrong kind of team to do this work, then you're not set up for success.
And initially you, you've got to show some successes. So you want to pick your projects in your people with that in mind. Um, lesson four, I promise I'm almost done. Um, start with sustainability in mind, I've talked about embedding E this competency, that innovation, it needs to be how you do your work. It's not an extra thing. Um, and if it's perceived as extra and nice to have, then the minute that VP leaves or your budget is strapped and there it goes. Um, so it's, it's really a management competency. And I think as you guys know, design thinking really has become a managerial competency, right? As being taught in business programs now being taught in a lot of different places. Um, so it needs to be embedded. Um, as I said, I think any organization can start, um, by leveraging what you have. Every organization has some innovators, it has some creative people, it has some people wanting to try new stuff.
It has, you know, so you're kind of looking for those kinds of assets in your organization and saying, how can we build on that? Um, and then expectations management absolutely critical, right? Um, that it, this isn't as simple as a normal business plan, uh, figuring out what this is going to be like in your organization. You're going to try stuff and learn some of it's not going to work. Um, and again, as we say, project failure in most organizations is not perceived as, Oh, that's great. We learned a lot, you know, so, so you have to set up expectations that in fact, that is great. We learned a lot. Um, uh, and, and again, if you can set those expectations, initially it goes a lot better later. Last one.
Um, yeah. So this kind of relates to that to build sustainable innovation. You follow that process, right? So, you know, you need to understand first find the right problem, understand what it is your organization needs to accomplish with innovation, right. That helps dictate who should be working on the projects. What kinds of projects should you be working on? What kinds of partners might you have? Um, and then if that's what you want to accomplish, right? What's the right solution for your organization. And you can experiment with things, you know, trying different types of, you know, training, different teams in catalyst training or training by project. Um, you can really experiment with almost all these PS, um, in your approach, again, depending on where your organization is, and then you incorporate what you learned and you iterate.
Um, so I recognize you guys have already done your pilot design thinking projects, um, which is great, but I think you, I don't think that precludes you from going back and thinking about some of these other things, right. So what are the innovation assets in your organization when you think about those five PS, right? Who are the people you can work with and build some momentum with, who are your champions? You know, what, what problems should you be solving for your organization? Um, and, and then, and then you use those assets to build a vision for support, you know, who on your executive team, your senior leadership team, um, could get pulled into this work. If they're not already, you know, what's a good core steering team for this work to try and get it off the ground and see where it's going. Um, is there a possibility of funding again, I think you can do this work without, without serious funding.
Um, and you know, what are you trying to accomplish? Um, you've already done the hard work of understanding what design thinking is and piloting some projects in your organization. So again, thinking about what did you learn, um, you know, what was most powerful about those experiences and how do you leverage that learning to get more resource or to spread. And then, as I said, from there, you can, you continue to refine, you know, ultimately you have to build a financial case if you're looking at sustainable innovation, right. How, how are we sustaining the people? How is this adding to our bottom line? Um, yeah. Thinking about, do you have a place if you don't have one, you know, so all of those things, but, but, you know, and, and it's interesting that pilot, that we did be new and I worked on in New Jersey with the New Jersey foundation, we essentially did the first three pieces.
Uh, well, the first two pieces with them and help them refine their visit vision. And then they did the design thinking, training and projects, but all, all of that pre-work was really important to getting, um, these hospitals to a place where it's going to be sustainable. And again, it's going to outlast the leader at a point.