LEDI 85 | Innovation In Healthcare

Jennifer Strahan will be joining the Leader Dialogue co-hosts on the Oct 17, 2022, podcast. The podcast topic is Innovation: Pragmatic Approaches to Innovation During Challenging Times

Some of you may already know Jennifer from the key insights she provided on this LeaderDialogue podcast during the height of the pandemic, including advice and guidance on how to best manage through that emerging crisis. Jennifer is considered a national industry thought leader and operational executive. She has extensive knowledge of healthcare strategy and operations gained by leading hundreds of organizations to successfully strategize priorities and achieve targeted results across every domain of healthcare. Specific areas of expertise include end-to-end patient flow, physician practice and hospital service line optimization, strategic facilitation, and integrating performance excellence with technology and enterprise intelligence. She has years of experience working in consulting and professional services as a System Executive Director with WellStar Health System, Director with VHA Georgia (now Vizient Southern States), and Consultant with the Advisory Board Company. She has also worked extensively with the Malcolm Baldrige Foundation.

Jennifer will share her perspective and insights on this important topic, providing practical suggestions that can be applied immediately.

Listen to the podcast here

Pragmatic Approaches Of Innovation In Healthcare With Dr. Jennifer Strahan

We had a great conversation with Dr. Jennifer Strahan, a good friend. I hesitate to say old. She’s not old, but we’ve known Jennifer for a while and trust her. She has some great insights, and she did a great job.

I’ll tell you the thing that was a takeaway from me and is a good reason for our show community to read is she gave some practical considerations of how innovation can help improve current performance. One of the thoughts she had is to make everyone in your organization a problem solver. Give them the freedom and culture to do that. It was probably the most powerful thing she said, but there were a lot of nuggets in that discussion.

Just a little teaser here to our audience, we’re not talking about spending any money. This doesn’t have to be a big-budget item. You can do these things now. We would encourage you to get a piece of paper and a pen if you are a dinosaur like me, and that’s how you take notes or on your device. Get ready to take notes on this fascinating discussion with Dr. Jennifer Strahan.

Roger, I had a similar takeaway that you suggested. What Jennifer suggested was something that we can all do within our organizations, and they don’t have to be massive steps. They can be little small things that we look for that can have big impacts on the organization, whether it’s because they get done multiple times during the day by everybody in the organization or these can be small cultural changes or process changes. For me, if anything, it refocused me on the idea that we don’t have to look for massive change. Let’s dig down into our organizations, talk to our people, and find things that we can change on a smaller scale that have a great impact in the long-term.

Readers, get ready.

We’re so glad you’re with us. Thanks for reading. A reminder, this show is brought to you by the Malcolm Baldrige Foundation and our sponsor, ABOUT Healthcare. We’re so excited to have Jennifer Strahan with us. Jennifer is a good friend and an amazing person who knows so much about healthcare. We’re going to take advantage of her experience and insight into what’s going on in the field of healthcare. Let me give you a little background about Jennifer. Jennifer, congratulations to you. We have a new position for you. You are the VP of Operations for ABOUT Healthcare. You are all about healthcare so to speak.

It’s a great new role for you. Congratulations to you and congratulations to ABOUT Healthcare for getting you on their team. Some of you already know Jennifer because of some of the work she’s done in the past, providing insight for the show during the height of the pandemic, which is when we did a lot of work together. That includes advice and guidance on how to best manage an emerging crisis. This has been new for all of us.

Jennifer is considered a national industry thought leader and operational executive, and has extensive knowledge of strategy and operations. She has worked with hundreds of organizations to successfully strategize priorities, achieve targeted results and across all domains of healthcare, which makes her such an interesting person and a great guest for you, our audience. Specific areas of expertise that Jennifer has are patient flow, physician practice, hospital service, line optimization, strategic facilitation and integrating performance excellence with technology and enterprise intelligence.

She has gathered this information and these skills through her years of working with other health systems. She was an executive with Wellstar. Also, VHA Georgia, which is the Vizient Southern States. She was a consultant with the advisory board company and worked extensively in the past with the Malcolm Baldrige Foundation. We have her with us so that’s great.

A little bit more about her other qualifications. Jennifer, congratulations on this. She earned a doctorate from the University of Alabama Birmingham. She has a Master’s degree from Dartmouth College, and a Bachelor’s degree from the University of South Alabama. She’s a lean six sigma master black belt from the Ohio State University and a fellow with the American College of Healthcare Executives and serves as visiting professor at Georgia State University College of Business. I’m out. I’m tired.

I’m fatigued already listening to that.

I can’t imagine. I’m tired of talking about it. Jennifer, you had to do all this stuff. Thank you for taking some time out of your busy schedule to talk with us.

I’m so excited to be here. It’s great to have the band back together, so to speak, from our days during the early parts of the pandemic and excited that you invited me to be here.

We did have some fun when the world was going nuts and didn’t know what was next. We learned some things about how health systems can behave wisely and how systems devolve when they panic and don’t know what to do. We want to get into some of those thoughts that you have. We’re going to talk about innovation and the pragmatic approaches to innovation during challenging times. The granddaddy of all challenging times is what we’re still feeling a little bit of the remnants of. We want your insight into how to optimize our behavior and efforts.

I don’t know how long we’re going to be seeing this and talking about this being one of the most disruptive events in history. It’s going to be a while before something takes its place. All of us talked about this and hopefully, not ad nauseam. Hopefully, it’s still an interesting and relevant topic. I certainly believe it is but we have this pre-pandemic world, post-pandemic world and everyone agrees we’re never going to be the same as we were before.

What do we do with all of this knowledge and experience we’ve gained? It seems to me that there are 2 approaches with 2 groups of leaders. Those who had their heads down and continue to have their head down focusing on operations are like, “How do we get back to some level of both efficiency and financial stability?” Some have somehow managed to put their head up, look around them and say, “It isn’t all dire panic but there are some opportunities.” That’s what I would love to have you talk about. What are you seeing in these evolving healthcare systems as some opportunities to invigorate and help stabilize some of our health systems?

Whenever we would talk about the show in the past, Ben, Duffy and others who were on the show would always tease me about having a book to reference but I’m going to do it again to start things off if that’s all right. When I think about innovation, there are so many resources out there. We talk about innovation in healthcare a lot and a lot of times, it’s more talk than act action. Part of that is because we’ve lived in this comfort zone of healthcare for so long.

We’ve talked about needing to change but I feel like the pandemic is the first thing that’s forced us to put a little bit of action behind our words. There’s a great book that’s one of my favorites out there. It’s called Lead and Disrupt. The concept behind this book is it talks about innovation and organizations that need to be ambidextrous. When it talks about that, it’s referencing being able to do what you do well.

LEDI 85 | Innovation In Healthcare
Lead and Disrupt: How to Solve the Innovator’s Dilemma

Being able to exploit that in your market and being a leader in your market on what you have done and what you continue to do. At the same time, as we know, the pace of the market is constantly changing. I don’t think I’m the only one but I’m excited that in healthcare, we’re finally moving toward consumerism. We’re so outdated as a market that we need to make sure that we are patient and consumer first.

On the other side, it talks about in terms of being ambidextrous and one’s side, exploiting what you do to do it well. The second side is you have to constantly be exploring new opportunities. You have to be listening to problems that you can solve. What the book talks about are different organizations that had to be successful in both domains to be able to have a long-running company. When you think about markets like this, we’re even still surviving the pandemic.

Hospitals are not going to have all of the government financial support that they’ve had over the last few years. There’s a new pressure that we’re putting on health systems. We have to be able to stop and think ahead about not only what we do but what should we be doing. We don’t do well in healthcare. I’m excited to see the disruptive forces that are starting to make us think about that differently.

I love the concept of you have to be ambidextrous. You’ve got to do both.

A great example is the one that we’ve all learned from Blockbuster versus Netflix. Blockbuster is very high in terms of its success at the time. It was approached by Netflix to purchase a large portion of Netflix. It turned it down because they said, “There’s not a market for what you’re trying to do.” What a missed opportunity.

Think about that in healthcare. How many times do we have partnership opportunities where we can explore innovation hubs and look at opportunities? Not just technology but the process, optimization and different things that we come back to. We’re like, “We don’t have time for that. That’s not where we’re going.” Think about the misses behind that. That’s where you see that evident from non-healthcare individual organizations starting to step into healthcare in a much more abundant way like Walmart, Amazon and so on. There are so many that are starting to step in and disrupt.

Jennifer, you’ve brought up some fantastic thoughts. Healthcare is a diverse, widespread field, ambulatory, inpatient, pharmaceutical, you name it. Taking one particular segment, the hospital industry. As a hospitalist, it’s something that I’ve practiced so it’s top of mind for me when I think of the healthcare industry in that segment. Facing tremendous challenges coming out of the pandemic. They’ve had some very difficult financial and operational times with the Great Resignation losing 20% of their staff.

Oftentimes, it’s limited as to how many services or how much or volume of services they can provide based on the fact that they don’t have people to provide them. What are some recommendations that you have? You brought us some great ideas. Rather than trying to do the same thing over and over again or waiting for things to tune up again, where are some areas that they should look?

There’s probably an abundance of opportunities. We think about hospitals in general and I look at their balance scorecard. They’ve got financial areas that they have to maintain their margin to be able to maintain the mission, the heart of their efforts and clinical elements of business providing exceptional care. Operationally, part of care is not just the actual interactions with the clinicians but the process along the way.

I was working with a hospital a few years ago that had transitioned to a new EMR. One of the dialogues I remember having with their executive team was they were talking about using an electronic system to engage with patients. For example, a MyChart if you were using Epic or so on. One of the dialogues in that conversation was, “How soon do we notify or release results to patients?”

It engaged a lot of conversation. It was like, “We can’t instantly give it to them. We need to vet them first and look at the results first.” It started with, “We should be able to release them within 2 to 3 days. That gives us time to do it.” You step back and think, “If our patients have a choice on where they go and they’re waiting on important results for a test, is 2 or 3 days an acceptable response for that?” It’s not. I understand that in a perfect ideal world as soon as they’re released, you would be able to call me. As soon as you had time, we’d talk about it right then.

That’s not the reality because our clinicians are pulled in so many different directions. We have to shift towards not so much where our comfort is but what makes sense for our patients. That’s where that mindset of true consumerism is relatively new in healthcare. That’s also what has been innovative in the disruption of healthcare. I am happy to say that I have encountered and engaged with the healthcare system.

They do release the results at the same time to the clinicians and the patients, which is a huge turnaround mentally in terms of the paradigm shift that they’ve gone through. It’s a very small and simple example to say, “This might be the way we’ve done it in the past but it’s probably not the way we should do it moving forward.” We want patients to have a choice, especially in markets where they do have the opportunity to go to one of many different facilities. Things like that might seem little to the organization but they can be big to the patients.

I want to jump in here before I let Ben ask a question or make a comment. When you talked about this paradox, I think of this being ambidextrous. We talk about all the disruptors that are coming at healthcare and hospitals. With the healthcare systems in the past, the more innovative ones have said, “We’re a healthcare system and we’re thinking like a consumer product company.”

All of a sudden along comes consumer product companies and customer-facing companies starting to think like hospitals or at least thinking about what consumers are going to hospitals for. They’re miles ahead in most cases because our patients and customers are demanding. We’ve talked about this on this show before, the digital front door.

If I can’t access my healthcare or something like that like I access my Prime account, I’m going to be impatient and not be satisfied. It’s a big challenge here. It’s not just Walmart taking doctors and healthcare people. What about our health systems? How do we have to change our thinking and think like consumers? You’ve already answered that but I’ll let Ben jump in here with his question.

I’m glad I went last because the point that I was going to make is the market is ruthless. It isn’t waiting around and encouraging in a kind way for health systems to catch up. That’s not how a market works. The challenge is being able to fail fast. I was listening to John Maxwell and he said, “A good miss is where you make adjustments and a bad miss is where you make excuses.”

He said, “No one organization has ever gone from excuses to success but every successful person organization has gone from adjusting as a result of misses to achieve success.” Jennifer, I know you’re going to probably elaborate on this as we talk about your sweet spot area of focus. The challenge in healthcare is there is a longing for the status pre-pandemic because that was much more stable. Who doesn’t want to go back to that? The market and consumers have moved on. Non-traditional competitors have come into the market and the market’s ruthless. It is what it is. Fail fast. Fail often. Learn from it. Don’t make excuses. Instead, make adjustments. Those organizations that do that will win.

It’s around failing. Fail often and move on quickly. We have to make sure that in healthcare, we’re encouraging an environment that allows for innovation. That’s difficult because of the nature of the work that we do. You’ve got patient lives on the line and unfortunately, mistakes happen. That can be detrimental to individuals.

We have to make sure that in healthcare, we're encouraging an environment that allows for innovation. Share on X

I think about the case that happened in the summer of 2022 with the nurse that had a medication error and was being tried for murder. Think about what processes were in place that allowed that to happen. What mistakes occurred that should have been stopped prior to that? How do you engage and encourage people to step up, fix a problem, anticipate and share that problem openly and transparently if you don’t, as a leader, encourage an environment that enables people to share again and be very transparent?

I think of innovation as solving problems. It’s not about trying to figure out what’s next. There’s a problem out there that has not been fixed or hasn’t been fixed fast enough or whatever the case is. How do we make sure that we’re addressing it? How do we encourage our team and culture to truly engage and share what the problems are so that you can then try to identify ways to solve and innovate?

That’s an example that comes to mind, whether it’s a serious example of innovation or a problem such as a medication error. One of the hardest things that we track in hospitals is being able to truly track near misses with that. At the same time, being able to open in an innovative way to find realistic pragmatic solutions that allow us to pull that in and not just nuances but scale.

I don’t know if you recall Dr. Kalani. I had written a paper and submitted that through Baldridge into their chronicle of leadership management to share some of the findings and the shared learnings from the pandemic. One of the things that you look at is that during the pandemic, we had some innovative solutions that occurred. Being able to repurpose. For instance, a wood mill was able to create opportunities for different materials and supplies that helped. Have other companies that you could repurpose their solution to help support more ventilators.

Some things happened that were unique instances but then at the same time, there were things that we could do that were scalable and repeatable that made more sense that you could support a much broader population when you thought about the problems that were being supported such as the regional efforts or state-based efforts that were occurring. Cross-training staff, some of them are not necessarily the most glitzy and glary things but they made sense. They supported overall care and orchestration of care for patients across facilities.

LEDI 85 | Innovation In Healthcare
Innovation In Healthcare: There were things we could do that were scalable and repeatable that made more sense and that you could support a much broader population.

You and Ben both are deep into process improvement and you’re both black belts. Darin, I don’t know what color your belt is. I’m not even wearing a belt. With the whole idea of process improvement and innovation, are these two concepts opposed to each other or do they support one another? I have my opinions but you’re the guest. What are your thoughts about how these things can support each other?

They go hand in hand. I look at process innovation. To me, it’s process improvement and problem-solving. When you look at lean six sigma, it’s not just about a process. It’s about you having a problem. How do you solve it? How do you use data? How do you use the expertise of the team that’s doing the work every single day? How do you take advantage of these individuals and the knowledge that they have? Sometimes as leaders, we step in and fix the problem because we see it. Sometimes our solutions are not the right solutions whatsoever. They cause more problems than they solve.

Process improvement is problem-solving. Share on X

Being able to create that culture that engages people in problem-solving and saying, “We’re both going through this process and it’s duplicate effort and rework. Why don’t we sit down and figure out which one of us should do it or when and why?” It’s empowering your team to be able to have those conversations. Innovation doesn’t have to be this huge technology or multimillion-dollar product that comes out of something. It could be something simple that shaves 20 minutes, 5 minutes or something like that off of an instance.

That happens 100 times a day across the organization. It adds up. A lot of times, innovation can occur through small-step approaches. That’s where you get the concept of Kaizen, small improvements and change for the better or it can be large things that happen. I’d say they’re both great. It’s not one or the other.

One of the things you said is the key to all of this. You’re right. You have to invest in a bunch of ideation and training. Although, there’s nothing wrong with that. It helps but one of the things you mentioned is people are afraid to fail. The ethos within organizations is very different. Some organizations miss out on so many opportunities because the culture does not accept or tolerate failure.

The idea is through some of your lean six sigma training and process improvement like, “How do we learn from every opportunity? How do we add those things next time? What makes us successful? Let’s make sure we add that. What didn’t go well? Let’s make sure we have safeguards that that’s not going to happen again.” It’s the root cause analysis situation. How do we prevent that? Make it safe to fail.

Sharing your learnings. Not just in your department or across your organization but facilities and networks, even with competitors because at the end of the day, it’s about patient safety first and foremost.

Let’s talk a little bit about some thresholds. If an organization wants to get involved in innovation, are there some ROI thresholds or expectations that they can reasonably have for innovation efforts?

Yes. It varies based on any type of investment. The first thing and the base thing that you should do is to invest in your culture. To me, that is the most critical element. I know it sometimes feels soft to people because it’s hard to measure but it’s palpable. When patients walk into a hospital, you can feel the culture.

You can feel if you’re walking down the hall, a doctor looks at you in the eyes and says, “Good morning,” or if their eyes are down and avoiding eye contact at all costs because they don’t want you to ask which way to the lab. You can feel a culture when you’re walking into a hospital. Employees feel that and live that every day as well. One of the first things organizations should always think about is how we invest in our culture. That’s going to be a huge way to see ROI in your organization, patients and employees who are more engaged.

They’re wanting to be a part of it and problem-solve because they know that they have the capability to help make things better for themselves but also, for their patients. On the other side of that, there is a level of innovation that gets exciting. You have some organizations and health systems that they’re being very intentional with their innovation and investments in innovation. They might be partnering with universities or different technology companies to be able to try to find a different level where they can disrupt the market.

Like any investment, you should always have a business case for it. You can have a business case for improving patient flow and outcomes or increasing your market because patients want to come to you. They know they’re going to have good service there. It’s a brand of an organization when you think about those different factors. It has an impact on the community members that want to partner with them. When you start to think about population health and the social determinants of health, we recognize the need for it. We don’t always do a good job of bringing those pieces in and together. Those are different things that you can have ROI on.

Do you set a certain number for it? That depends on the organization and where and how they’re investing. Some things are worth the investment, whether or not it’s $1 ROI that you’re going to get in return for it such as culture and thinking about those types of investments. For other things, you can naturally expect a very high 5 to 1, 10 to 1 and 100 to 1 on certain things. Be careful not to draw $1 for your investment of ROI, but think about the other aspects that surround that as well.

Thank you, Jennifer. As we close, I want to give you a chance to have the last word here for our audience and share any insights, thoughts or encouragement. I always love to leave our audience with some practical advice. This is something that they’ve invested half an hour or so reading. What can they implement now? What can they do as the next steps?

A couple of thoughts come to mind. One is to do everything you can to learn about innovation. Read different resources. Have blue ocean thinking. Think about how we disrupt. The biggest thing that you can do to support your organization at the frontline and leadership level is to engage the culture and create a culture of problem solvers. If you’ve got people who are curious enough to identify a problem and say, “We can fix that and do that better,” that is the best investment that you can make. Hire the right people who are going to ask that question and have the curiosity to solve problems.

There are simple things you can do. Another very tangible takeaway that I encourage organizations if they’re not on a lean journey or even if they’ve been on it for many years is to have your leaders take a waste walk, as what I call it. You look for the eight types of waste around rework, non-productive time, excessive transportation and motion and all the eight types of waste and say, “Where do I see it?” Go walk. Watch around like on your lunch break. Watch people. Sit down somewhere in a waiting room or where you have an idea of the people who are working and do a spaghetti diagram.

See how many times they’re walking back and forth to the Pyxis machine. Whatever the case is, look at what are the problems. Talk to your team. What drives you crazy every day? You’d be surprised at how much low-hanging fruit there is that we don’t tackle because we’re so busy doing everything else. Those are things that could engage our team members. They can get excited about it because it’s like, “They did something and they listened to me.” That’s where it supports your culture.

What an amazing, brilliant strategy. Listen to your people. Dr. Jennifer Strahan, it’s been wonderful talking to you, and great to see you again. We look forward to having more conversations. You’ve got a lot to offer. We’ve got to figure out a way to get you involved some more with this. I have a feeling that with your new employment, we might do that.

It’s always a blast. I appreciate you guys having me on. Thanks for letting me share whatever I could. It may not be very much of a nugget but hopefully, somebody can take something away from it and say, “I can do that.”

We’ve gotten nuggets. This has been great. You’ve told us about a new book, Lead and Disrupt. I encourage our readers, with your recommendation, to look at that. I know I will. Ben, thanks for your quote from John Maxwell. This is a good one to leave our readers with. A good miss allows you to make an adjustment, not excuses. With a bad miss, you make excuses. With a good miss, you make adjustments. That’s what you’ve been trying to tell us, Jennifer. Thank you.

We make adjustments. It doesn’t have to be anything huge, but have a mindset for innovation and creativity. Thanks again, Jennifer. It’s been wonderful. Thank you, Ben and Darin. Thank you, readers. We appreciate the time you invest in reading the show. We look forward to being with you again when we bring you more fascinating discussions with leaders in our industry. Take care. Talk to you next time.

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About Jennifer Strahan

LEDI 85 | Innovation In HealthcareJennifer Strahan DSc, MS, FACHE, LSSMBB is the Vice President of Operations for ABOUT Healthcare. Jennifer holds her doctorate degree from the University of Alabama Birmingham, her master’s degree from Dartmouth College, her bachelor’s degree from the University of South Alabama, and her Lean Six Sigma Master Black Belt from The Ohio State University and Moresteam. She is a Fellow of the American College of Healthcare Executives, and she serves as a visiting professor at Georgia State University’s Robinson College of Business.

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