Pioneering Ideas

More on the Innovation Divide

I appreciate the two thoughtful comments from Elizabeth Ellis and David Racine. Although from different perspectives, both comments address the question “Why is there a health care “innovation divide?” and suggest possible paths for addressing it. I was struck by Elizabeth Ellis’s comment “I see opportunities daily”, which highlights the need for innovation to be grounded in the everyday practice of caring for patients. (By the way, a useful resource for working on everyday issues faced in Emergency Departments is urgentmatters.org). Equally important is a corresponding knowledge base that includes an understanding of financing and care delivery, a main point of David Racine’s comment.

Perhaps I am over-interpreting, but I detect a streak of frustration with our current situation in both comments – a sentiment I share. It is striking how second nature this innovation divide is, how accepted it is, and how many people are frustrated with our inability to make progress. On the other hand, we need to recognize that any substantial progress would alter many current arrangements, and hence threaten those who derive benefits from how things are. I am reminded that when economist Joseph Schumpeter introduced the famous phrase “creative destruction” to describe what happens when radical innovation occurs, he recognized that some organizations lose value. How we move to a new set of conditions that fosters ongoing constructive change in all of health care will not be easy – but the chances for getting there may be enhanced as the collective frustration with the status quo becomes deeper and more widespread.

Pioneer Invites 11 "Disruptive Innovations" Entrants to Apply

The competition on Disruptive Innovations in Health and Health Care was the first time that we intentionally used the Changemakers open-source competition model to scan the field for ideas that the Pioneer Portfolio might wish to invest in directly. Not knowing how the challenge of disruptive innovation would play out using this type of competition model, we were astounded by the response — more than 300 entries — and really impressed by the creativity and quality represented in the mix of innovations proposed.

We're happy to announce that Pioneer staff have completed their review of the full set of entries. We had some spirited discussions about the ideas that flowed through these entries — they stand to really shake up established ways of doing things in health and health care and trigger big gains for consumers. So, while it's taken us some time, we're happy to announce that we have invited 11 entrants to compete for grant funding, if they so choose. Many you will recognize as finalists and winners, while others were included because we were excited about the pioneering approaches they presented.

These entrants will be asked to demonstrate how RWJF funding could be used to further the development of the work represented in their respective Changemakers entries — either through demonstration, scale and/or replication. The total amount of grants made under this phase will not exceed $5 million.

All of us at RWJF continue to be inspired by the ideas and energy contributed to this competition, and we're grateful for the participation of the global community of entrepreneurs who entered, commented or spread the word about it. We'll keep you posted on future funding decisions stemming from the Disruptive Innovations competition.

The 11 entrants invited to compete for RWJF funding are:

Business Week: Better Care Through Design

Business Week has an interesting article on "Designing the 'Care" in to Health Care."  The writer points to a coming age of user-centered mobilization:  "What lies ahead is an opportunity to design a health-care experience that reflects our nation's desire to help itself be healthy. Let's call it the 'Age of Empowerment,' when we innovate to create healthful experiences that can save money, support better clinical outcomes, and improve patient quality of life. Design thinking can lead us there."  This will play out in several ways:

• Empowerment through self-care -- e.g., home-based dialysis or smart glucose monitoring systems
• Empowerment through service innovation -- e.g., company-run health clinics that are wellness-driven; retail health clinics
• Empowerment through Web innovations -- e.g., PHR-targeted platforms like HealthVault; utilizing e-mail, instant chat -- even Twitter -- for meds regimen updates

Also, note the Nov. 15 special "Inside Innovation" report on mapping crowd patterns of activity to enhance corporate -- and now medical research -- strategies.  It highlights the accelerated research model of Myelin Repair Foundation, which Theresa Kanter has blogged about previously.  MRF used advanced mapping software to ferret out which research centers and scholars were working on common issues, and it helped them connect the dots more quickly and effectively in order to make it possible for scientists to collaborate across institutions and projects.

Guest Blogger: Traci May Lamar on Improving the Patient Gown

We are pleased to have this guest post from Traci May Lamar of the College of Textiles at North Carolina State University, Pioneer’s grantee in its Down with the Gown Project that Rosemary Gibson has posted about in the past. We asked Traci to tell us more about the work that’s taking place to improve the patient gown, and she responded:

“The patient gown commonly used today was originally designed in the 1920’s. It gained widespread acceptance due to its simple design, low cost, low maintenance and accessibility for health care providers. When we think of how radically medical care has changed since then, it isn’t surprising that the current design does not begin to meet even the most basic modesty and privacy needs of today’s patients. There may even be a link between patients’ dissatisfaction—affected by the negative feelings created by this undignified garment—and their ultimate recovery.

Intense literature and patent research has shown that there have been, and are now, attempts to introduce patient garments which meet the needs of patients and caregivers. This work has been primarily driven by the needs of patients and has resulted in the introduction of some truly wonderful designs for specific patient applications.

But these designs have not resulted in wide-spread use of new patient garments. Our work to date suggests that this at least partially results from the needs of all stakeholders in the healthcare supply chain not being met.

The initial phase of our project, is developing a comprehensive set of requirements for a patient garment that will meet the needs of patients and also all the other “gown stakeholders:” suppliers, manufacturers, buyers, clinicians and others. We’ve made important discoveries in terms of requirements for a successful new garment. Among those:

Why Games Matter: Competition Results

The results of the Why Games Matter competition were announced recently and can be found here. I was lucky enough to be a judge for this competition—here’s what I took away from looking over the field of entries:

• The entries, finalists, and winners show without a doubt the richness of the “games for health” field.
• We had entries (and winners) from all over the world—which demonstrates how interactive video games can be adapted to fit a variety of cultures, geographic locations, and interests.
• We also had entries from different industries and sectors of the economy, and these looked at many different components of health and health care—from HIV/AIDS, to violence prevention, to physical disabilities, to community health, to the transformation of the health care system. We saw that there’s a place for games across all of these.
• Many of the entries included a research component. What a great beginning for the work of Health Games Research, as Abbey Cofskey described for you here.

Save the date for the Change Summit, which will take place at the annual Games for Health Conference on May 8-9, 2008. We’ll be taking another look at the competitors and how they’re doing, and I, for one, can’t wait!

King Kong and Revolutionizing Health Care Quality

Several days after we announced our grant to Archimedes to build the ARCHeS online interface, Risa Lavizzo-Mourey and David Eddy appeared together on a panel at the Health Affairs 25th Anniversary Summit in Washington, DC. Risa moderated the panel on improving health care quality, and David spoke about the role that mathematical models like Archimedes could play in triggering big advances in our learning and in our ability to provide the right care to patients at the right time.

Here is a link to his slides, but I really recommend you download the Web cast to watch and hear David talk you through them.  His talk was at once compelling, funny, sobering and really inspiring. And you'll understand how King Kong factors in to all of this, curiously enough.

David tells the story of Archimedes far better than we ever could. And his co-presenters, Don Berwick of the Institute for Healthcare Improvement and George Halvorson of Kaiser Foundation Health Plan, were stellar as well. It's worth checking out.

Announcing Health Games Research

Today marks the Foundation’s official launch of Health Games Research, a new national program to support research to enhance the quality and effectiveness of interactive games that are used to improve health. Debra Lieberman, communications researcher at UC-Santa Barbara, will direct this new initiative.

Pioneer has been exploring the potential for games to improve health and health care and has been working with Games for Health to forge connections between the games and health fields. We’re now looking to build a body of evidence that helps demonstrate how a game – used alone or in combination with other innovations – can improve people’s health. We hope it shines the light on specific design elements and strategies that are demonstrated to benefit health among those playing the games, and that can be applied to an ever-growing array of health-related games in the future.

The first Health Games Research call for proposals will award up to $2 million to support studies that investigate principles of effective health game design. The proposal deadline is January 29, 2008.

This new program will foster some very exciting (and fun) research.  The total grant size is $8.25 million; beyond fostering new research, these funds also will sustain and expand the work of Ben Sawyer’s Games for Health Project to bring folks from the games and health worlds together to learn, share best practices and bring the field to new levels.

Thanks to those, namely Ian at Kotaku, Leigh at Gamasutra and Dean at The San Jose Mercury News, who have already engaged in what will certainly continue to be a very interesting conversation.

The Health Care "Innovation Divide"

Last week I attended the Health Affairs Health Policy Summit in the nation’s capital. It was a stimulating day of presentations on quality improvement, CEO perspectives, and health reform views from a panel of presidential candidates’ health policy advisers. But the most intriguing session for me was the opening set of remarks on the value of innovation.

The ideas presented and the dominant theme that emerged are especially salient for RWJF’s Pioneer Portfolio, which promotes potentially ground-breaking innovations in health. Every speaker commented on some facet of what can be called an “innovation divide” in health care. Innovation thrives in one part of the health sphere and languishes in the other. Let me illustrate with some examples.

Elias Zerhouni, Director of the National Institutes for Health, set the tone by noting that innovations in therapies, products, and devices are robust and have life cycles, and the health care system needs to respond to these cycles. But he noted that while innovation in medical research and clinical investigation is thriving, the care and financing systems struggle to respond to these new developments.

Ronald Williams, Chairman and CEO of Aetna, Inc., continued the theme. He reported that in his discussions with business leaders around the country, they see excellent innovation in clinical work, but innovation in health care delivery and information technology is lacking.

The innovation divide was described in various terms. Mark McClellan, Senior Fellow at the Brookings Institution, drew on his Health Affairs editorial Board experience and talked about coverage and technology as two spheres with low and high attention to innovation, respectively. Jamie Robinson, new editor of Health Affairs, talked about “the product side and the management side,” with much innovation in the former and little innovation in the latter.

Finally. . . the Finalists!

There's one week left in the voting for the Why Games Matter competition.  To review the 14 finalists and vote for your favorites, please visit http://www.changemakers.net/node/725/.

When you get to the competition site, you're going to find an eclectic collection of finalists, and I think some may surprise you--these entries are not just for kids playing stationary consoles.  At the outset of the competition, Debra Lieberman, health games researcher and Games for Health advisor, defined a game as " 'a rule-based activity involving challenge to reach a goal.'  As soon as a goal is involved and the activity is bounded by rules, it becomes a game."  The finalists for Why Games Matter do a lot to bring context to this definition, and challenge some traditional expectations of video games.   

The most obvious challenge is that the target audiences for many of these games aren't young, and in some cases aren't even patients!  Among of the finalists are exergames, or games in which exerting physical activity is a rule to reach the goal.  And, while people often think good games come from big budget technology companies, that definitely does not apply to most of these finalists. There are plenty of unexpected entries in this competition.

Please remember, the final day for voting is November 7!