{"id":22094,"date":"2021-10-04T09:15:16","date_gmt":"2021-10-04T13:15:16","guid":{"rendered":"https:\/\/participatorymedicine.org\/epatients\/?p=22094"},"modified":"2023-02-20T11:06:39","modified_gmt":"2023-02-20T16:06:39","slug":"innovation-local-persistence","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2021\/10\/innovation-local-persistence.html","title":{"rendered":"Innovation, Local Persistence"},"content":{"rendered":"

Innovation is not like switching on a lightbulb for the world. Rather it’s local iterative, persistent steps. Thoughts from the Patient Experience Symposium. Listen to the podcast here https:\/\/health-hats.com\/pod144\/<\/a>
\n<\/p>\n

Proem<\/h2>\n

As I left the Patient Experience Symposium<\/a> in Boston, (Yes, an in-person conference. How weird!) I felt schizophrenic. On the one hand, has the healthcare industry progressed at all hardwiring the improvement of patient experience? On the other, OMG, so much innovation! I listened to dedicated, diehard patient experience professionals teeming with frustration at the setbacks occurring during COVID-19 days. Families excluded from the bedside; people dying alone; active, engaged, mature patient-family infrastructure canceled, dying on the vine. I also sat rapt, hearing diverse community representatives inspired by collaborative local COVID-19 problem-solving. In this episode, I will muse about healthcare innovation, while trying to stay positive.<\/p>\n

Thanks to the Society of Participatory Medicine<\/a> for subsidizing my attendance at the conference and my team, Kayla Nelson and Joey van Leeuwen, helping me make these podcasts better than they would be.<\/p>\n

<\/a>Oy, the noise in my head<\/h2>\n

During the Patient Experience Symposium, the voices in my head cycled a cacophony of emotional questions. Isn\u2019t innovation the human condition – always adapting, trying something new? Yet, we seem to live in a negative feedback loop \u2013 I can\u2019t. I\u2019m not good enough. I can\u2019t. I\u2019m not good enough. How does innovation occur in healthcare? Can institutions sustain innovation in the face of crises?\u00a0 Wait, inspiring innovation occurs in communities seeking solutions to their local problems with community members leading. Inspiring! What can we learn from crisis-limited innovation in institutions and from innovation arising from necessity? Can we study or research innovation?\u00a0 Can we measure it? Does research itself limit innovation, do institutions by their nature curb innovation?<\/p>\n

<\/a>Let\u2019s start positive.<\/h2>\n

There\u2019s enough discouragement. At the conference I listened to Ifrah Ahmed, a Children\u2019s Mental Health Case Manager in the rural Kansas Somali community of Garden City, COVID-19 Through the Eyes of an American Refugee: A Story of Engagement<\/a>. COVID-19 has shined a bright light on the widening disparities that exist between rural and urban America. These fractures were especially evident in areas such as southwest Kansas, one of the most remote and culturally diverse regions in the United States. The refugees from 30+ countries who worked at the world\u2019s largest beef packing plant were unable to isolate themselves from others at work and home, making them some of the most vulnerable Americans during the spread of the pandemic. Hundreds of these essential workers were infected in the same apartment complex. I hope to bring Ifrah to you in a future episode.<\/p>\n

Kirsten Meisinger<\/a>, Regional Medical Director and Director, Provider Engagement, at the Cambridge Health Alliance<\/a>, told the story of Co-Designing Telehealth with Patients<\/a>. Telehealth has taken off because of the social distancing requirements during COVID, while simultaneously community and religious organizations also converted their interactions to virtual spaces. With the need to communicate regularly about public health information as well as how to access care, these two new virtual spaces have been learning how to interact and complement each other. The session outlined successful and unsuccessful interactions between the Cambridge Health Alliance and partner community organizations. Dr. Meisinger will join us here soon.<\/p>\n

Dr. Darlene Tad-Y shared her experience with Hospitals Collaborate to Ensure COVID Care for Every Coloradan<\/a>. During the COVID-19 surge in the winter of 2020 in Colorado, hospitals in the state voluntarily collaborated to create the Combined Hospital Transfer Center (CHTC). The CHTC allowed hospitals to seamlessly move patients from one hospital to another when acute and critical care capacity limits were reached in any one hospital or region. Transfers of patients occurred bidirectionally between urban and rural hospitals.<\/p>\n

Ok. Now the negative. Oh, forget it. Let\u2019s skip the negative.\u00a0 I up to the brim with negative.<\/p>\n

<\/a>Research and innovation<\/h2>\n

Research is made up of institutions and bureaucracies just like hospitals, health systems, and insurance companies. Bureaucracies and institutions favor safety, precedent, and inertia and protect against risk – risk as reputation or cost. Not a value judgment, it\u2019s the nature of the beast. I\u2019m most familiar with comparative effectiveness research or CER.\u00a0 CER means A is more likely than B to work for this specific population under these specific circumstances. CER, comparative effectiveness research, needs the comparators, A and B, to have some evidence that they work.\u00a0 Innovation, by its nature, might not have evidence yet \u2013 no research has yet been completed to show that it works. So, it\u2019s hard to get funding to compare innovative interventions to current practice. You ask, what\u2019s an intervention? An intervention might be a drug, a procedure, a teaching tool, a service, a means of access to services.\u00a0 What kinds of services are we talking about \u2013 hospital, clinic, community, neighborhood social services? Got it?<\/p>\n

<\/a>Prioritizing innovation \u2013 limits<\/h2>\n

Some organizations prioritize innovation. For example, Kaiser Permanente funds community health innovations<\/a>. Even these organizations struggle to scale innovations within their organization (think Kaiser\u2019s Southern California, Northern California, Colorado, Hawaii, Mid-Atlantic regions). How hard it must be to generalize the innovation to other organizations?<\/p>\n

<\/a>Innovations in engagement \u2013 innovators need innovative settings<\/h2>\n

Researchers, clinician and patient-caregiver leaders spend much effort advancing provider engagement with patients. Yet how can clinicians working in an unempowering setting and empower others?\u00a0 If they can\u2019t control the time they can spend with patients, how can they do the work of listening?\u00a0 PCORI, the Patient-Centered Outcomes Research Institute<\/a> just sent an RFI, Request for Information: Science of Engagement Funding Initiative<\/a>. If you\u2019re a researcher or patient-caregiver working with researchers check it out. Potential for innovation!<\/p>\n

<\/a>Reflection<\/h2>\n

So what? Where does this leave us? Some people regularly strive to adjust, to innovate. Some people hear a negative feedback loop of I can\u2019t, I\u2019m not good enough<\/em>. More communities than we can possibly know, do the hard work of innovative problem solving led by members with passion and drive. Some organizations hardwire innovation yet struggle to generalize outside the innovation hub. Many institutions resist change and favor safety, precedent, and inertia. You\u2019re never there<\/em> with innovation. It\u2019s not the end of the road. It\u2019s always a next stop.<\/p>\n

Perhaps the sweet spot combines all of this: in healthcare, hardwiring the engagement of users \u2013 patients, caregivers, and point-of-care clinicians at all levels of organizations and processes. This engagement is similar to communities solving their own problems with community members leading. Engage users, stakeholders in governance, operations, learning, wherever. Another thought: Innovation is not like switching on a lightbulb \u2013 Eureka! I\u2019ve got it. Rather innovation is iterative, persistent small steps, moderate steps \u2013 key word: persistent. That\u2019s where people with chronic illness may have an advantage. They keep trying stuff, works or doesn\u2019t, try again, go back to the beginning. Persist. These observations break no new ground, rather they are the foundation of success, performance improvement, user-centered design. Push on folks. We have work to do. Thanks for listening to my rant.<\/p>\n

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