In a January 2023 article describing their take on 5 predictions for telehealth in 2023, the American Medical Association (AMA) promoted its recently published report: “Closing the Digital Health Disconnect: A Blueprint for Optimizing Digitally Enabled Care”. The report’s purpose? “Help bridge the digital health chasm as the pace of digital health progress in medicine does not yet match the technology’s potential.”
I have to commend the AMA on (indirectly) recognizing this chasm as one of the biggest threats to the healthcare system the AMA traditionally represents. Because if America’s health centers, clinics, and hospitals cannot figure out how to take advantage of the “digital health technology’s potential”, others will (and they will not be members of the AMA).
From my perspective, the biggest threat to the American healthcare system as we’ve come to known it over the past 50, 60 years is not the lack of innovation. It is the slow speed of Innovation Adoption.
Continuing our series on “Innovation in Healthcare” we are moving from the notion of “Accelerating Innovation Adoption” and “The Innovation Prioritization Funnel” to where the rubber meets the road: how to get from an Idea to Deployment.
From Idea to Prioritization
The first phase in this process is mostly about whittling the field of potential ideas down to a vital few concepts that will be further evaluated.
Ideas can take many different forms — a clinical or administrative problem, a cool digital health technology, a concept for a new service, etc. Ideally, though, ideas are urgent, costly, and pervasive problems that the organization needs to address with the help of a digital health solution.
After the idea has been recorded, the next step in the process is the analysis and Evaluation of the proposed idea. This step is about gathering more information about the idea in order to be able to properly prioritize it. This includes research into the size of the problem, or the relationship to current strategic priorities, a first cost-benefit analysis, etc.
The Evaluation step can also be used to combine the proposed idea with other, related or complementary ideas to form a synergistic concept that in its totality may be more valuable than the individual ideas implemented separately.
All this information gathered in the Evaluation step can then be used to prioritize the idea. For the Prioritization I’ve long been using a simple 4-point scale with the following levels of priority:
- Critical (red): non-negotioable
- Essential (orange): important, but negotiable to some extent
- Conditional (green): valuable, but not important
- Optional (blue): pursue as needed
Other priorities can include Not Assigned (white) or Out of Scope/Irrelevant (purple).
Once the ideas have been prioritized, those that received a high mark, can be moved into Verification.
Verification: Do we have a winner?
The next phase, Verification, is about making sure that the idea is of value to the organization. This typically means to study the idea through three different lenses: strategic, financial, and clinical.
In today’s complex healthcare environment, the implementation of virtually any new solution requires a lot of heavy lifting when it comes to managing the resultant organizational change. And organizational change can only succeed when it has support from the leadership team of the organization — who mostly (should) verify that the scarce resources of the organization are focused on achieving the organization’s strategic objectives.
Thus, to make it past this stage, a Strategic Case has to be constructed that explains how well the idea addresses the organization’s current strategic objectives. A great, valuable idea will actually be able to move the needle in the right direction on multiple strategic objectives. For example, one great idea is to invest in telehealth, which we have found in our work with clients can contribute to achieving over 90% of an organization’s strategic objectives.
But fulfilling the strategic priorities of the organization is not the only thing that leadership cares about. What is increasingly more important, is that new ideas, new services, or new investments also have a strong positive return on the investment. Which is why the team must also build a Financial Case to lay out not only the estimated implementation cost, but also project the value that the idea will generate. This could be in the form of revenue, or cost savings. This could be about gaining or protecting market share or increasing loyalty among patients — or (given the current high levels of physician burnout and staff shortages) loyalty and satisfaction of clinicians and other staff.
Since ultimately everything we do in healthcare must serve the patient, every idea should also be tied to a clear Clinical Case: How will this idea make care better – more efficient, more effective, more safe, better outcomes, better engagement, etc. For virtually all ideas that involve Digital Health solutions, make sure you involve a clinician early on in the process. Chances are that clinicians will be instrumental in making sure this new idea gets used and you want to have the clinical support and buy-in on your team as early as possible.
After you’ve developed the Strategic Case, the Financial Case, and the Clinical Case it is time to present those to leadership for consideration, approval and funding before you move on.
Solutionization: What would this look like?
This next step looks at the design of what the idea or concept would actually look like in real life at your organization. This may include designs and considerations around workflows, support structure, training, rollout plans, changes to the technical infrastructure, key users/stakeholders that must be considered in the change management, etc.
This step is not just about the acquisition and installation/configuration of the solution, but about the whole “before, during and after” of deployment.
One key challenge about the design of the solution is that a lot of the decisions are made “behind the scenes” and not on the front lines. This means that the team will make a lot of assumptions (oftentimes unknowingly) and since we know what they say about “assume”, we need a safe space to make sure that our assumptions are valid.
Proof-of-Concept: Validating Assumptions
As another saying goes — “sometimes you gotta move slow to move fast”.
This is where a proof-of-concept phase is very helpful for the Validation of the idea. The purpose of this step is to make sure that before we deploy the solution to many clinicians, service lines, or locations that all the I’s are dotted and all the T’s are crossed: Do the workflows make sense? Is our training adequate? Can we demonstrate the financial value as laid out in the Financial Case? Is the clinical efficacy of the solution good? Do we understand what it will take to manage the change? Etc.
As I laid out in more detail in the article “Are you still using Telehealth Pilots?”, the launch of a proof-of-concept phase starts with the identification of the assumptions and the identification of metrics through which the correctness of the assumptions can be validated.
Then the proof-of-concept is launched — typically with only a very small number of primary users and a small number of locations. Oftentimes during this first rollout, many improvements are made to the workflows, training documents, and the change management approach.
The proof of concept phase ends when all critical assumptions have been validated.
Now it’s time to start the Deployment of the solution, which I will cover in more depth in a future article in this series of “Innovation in Healthcare”.
From Idea to Validation
There is no shortage of problems to be solved and — with over $10 Billion dollars of venture money going into digital health innovation over the past 10 years — also no shortage of proven digital health solutions. The biggest challenge that healthcare organizations face is thus not the lack of innovation, but the difficulty of adopting this innovation.
The process I described here is universally applicable to a multitude of digital health and non-digital health ideas, solutions, problems, etc. The value of following a systematic process like this is that the team shepherding the ideas through this process, will over time get very good and very fast at it.
Almost no cowboy could drive a herd into town in their first week – yet we are often asking individuals to follow this approach only one time for their own idea, vs. putting resources in place that can help to bring an idea to life — if it is an idea that should see the light of day!
In my next article in this series, I’ll dive deeper into the planning that needs to go into a superb deployment experience – including workflow training, technology training, and change management.
Is your organization following a similar process? Do you have a team assigned to help proponents of new ideas to make it through this process quickly? Let me know!