Trickle Up Innovation for Health Care Leaders

All the best ideas come from the big centers, right? Not always, if you believe what you read in Innovation Trickles in a New Direction published on Businessweek.com on March 11. In this article, Reena Jana turns conventional thinking about innovation on its head by describing products developed in third world or remote countries by the likes of General Electric, Microsoft, Nokia, Proctor and Gamble, and the like, that have found their way into wide application in the industrialized world. This must mean something about where and how to look for innovation in health care.

Petri Dishes are Small and Simple by Design

The thesis of this article – that important business ideas and novel products or processes may come from unsophisticated or remote locations – reminds me of the several years I focused my consulting work on Critical Access Hospitals, State Offices of Rural Health and other rural health organizations. During that period the Medicare Rural Hospital Flexibility (“FLEX”) Program funded a large number of initiatives to define and improve health care quality in rural areas. I started with the assumption that my task was to import quality into rural areas from sophisticated urban and academic environments. And while it was true that rural hospitals required training in modern quality methodology and measurement, it turned out that many small hospitals had some significant advantages compared to their better developed and resourced relatives – namely their small size, organizational simplicity, receptivity to improvement, community pride, and a culture of collaboration.

These are elements that ease both quality improvement and innovation. Indeed, when the IOM which consolidated much of the early work we all did on defining and promoting a rural quality agenda, it titled its monograph Quality Through Collaboration presumably to honor that edge. And in the rural communities I was fortunate enough to visit in those days, we not only made progress on quality agendas more often than not, but developed some important quality and performance measurement tools and dashboards that I still apply to much larger and more complex academic centers and community hospitals who find them remarkably useful and refreshing in their utility and simplicity.

Look in Every Corner

So what is the lesson here? Well, I think it’s in the ZIP code of not being afraid to look in unusual places for fresh ideas, techniques, processes, and exportable models. Small and simple may be the better source. In a post earlier this week, Could Outsiders Represent an Inside Track for Health Care Leaders? the blog addressed the related topic of NOT reflexively tapping the usual leadership suspects when change is needed. Perhaps today’s advice is not to be afraid of letting some ideas trickle up.