The following is an edited transcript of an InForum on Innovation held at Insight Publications on Sept. 26, 2013. The discussion was led by Cheryl Perkins, president and CEO of Innovationedge and included Mary Downs, system vice president at ThedaCare; Mary Maurer, chief innovation officer at Holy Family Memorial; Dr. Michael Miskulin, an optometrist at Valley Vision Clinic; and Elizabeth Much, director of innovation and development at Thrivent Financial for Lutherans.
Cheryl Perkins: What like each of you to do is think a little bit about something that’s been very innovative that really helps us better understand what you mean by innovation. Because there’s a continuum from renovation to innovation. There are a lot of things done operationally to make sure things move cheaper faster, trying to do better with records – all these types of things. What are some of the things you would call innovation that are making you and your teams think differently about it?
Mary Maurer: I was going to start with intentional culture-shaping. Health care, by virtue, is traditional health care, or hospital-focused health care. Twenty-five years ago, everything happened at the hospital, that’s very much not the case (now). But it’s very conventional, very rule-oriented. I guess you don’t want an ICU nurse going, ‘Well, let’s see, could I be creative with this?’ So there are reasons for that, but as the whole model changes to population-based health – not in a hospital bed, but in a home, in a clinic, in an outpatient setting – we’ve had to start by changing the whole mindset. So that’s been really kind of a fun journey, that we really started five-six years ago. And we started with the leadership team, myself and senior leaders, as the first step. We needed to change the way we were behaving, operating. We’re taking a patient on as an experience. It’s part of the whole network – how do we make areas talk to each other, how do we make records talk? But that has been kind of fun and really innovative thing, to take a conservative, kind of approval-oriented workplace, to taking risks, to being one of learning, autonomy, creative thought, going outside the box. I think the biggest thing that we’ve done is really changed from being inpatient to outpatient, sick to well. We still take care of sick people, but we changed our mission statement (which is a huge thing) five years ago, and said our focus and our whole goal is to keep the community healthier. That’s a huge mindset change, and a huge culture shift change, especially to nurses who worked there for 30 years. And that’s been hugely innovative, and we’ve really shifted our whole model of care. So it’s like we’re reinventing our whole organization as we go along. It’s just a huge mindshift, just huge.
Cheryl Perkins: The key stakeholders, especially – not to pick on doctors, but maybe you can build off of this – often they’re very set in their ways, correct? So how have you dealt with the administration? How have you dealt with allowing people to do what they need to do, but also evolve so that they’re more co-dependent? It’s tough, right?
Mary Maurer: It’s really tough, but with physicians, we started with our leaders, top leaders, the general leadership team. We got the employees engaged and really started sharing success stories. And then we’d invite a doctor in to work with us on a project. We kind of identified three top hitter doctors that had a lot of potential to help us lead the organization forward, so we’ve created an associate medical director role, because they’ve been very much champions in this whole process – one that’s particularly focused on changing the culture of the physicians. So it’s just full engagement, and I must say that our doctors can talk the talk like any of the employees. They know that innovation and improvement is a key strategy for us, as well as cultural change. Some don’t come along as quickly as others, but I must say it’s been most impressive. I’ll tell you, the ones that have been resistant are no longer with us, either by their choice or ours. It’s just not a match, if they want a different culture, they want an old school mentality where “My pen rules,” it’s not going to work.
Mike Miskulin: For me as a doctor, I like to see what’s kind of coming out, see where we’re pushing things for the future. I like to embrace new technology, and go with new things. We do it all the time with the contact lens industry. They’re always getting new products out there, better lenses, better things for patients. I always like to use the newest, latest, greatest. There are a lot of doctors who get stuck in their ways, and they’re using lenses that came out 20 years ago, and that’s not good for anybody. But if it’s coming down from higher management, saying well, this is what we want to do, I kind of need to know why we’re going to do that. I can’t just say, ‘Go ahead and say OK fine.” It’s just my mentality. I know a lot of people aren’t like that. I’m not resistant against doing anything new, but I need to be shown why this is better in the long-term.
Cheryl Perkins: So, Mike, we talked about the need to involve stakeholders. So when you have new contact technology, and you have this range of patients, range of demographics, how do you go about involving their thought processes that new technology is actually the way to go?
Mike Miskulin: It’s all about planting seeds. A lot of people have been coming to their same optometrist, or they’ve been hopping around because insurance says you can go here but not there. They’ll go where their insurance dictates, and so somebody has been in the same lens for 10 years. They might be resistant at first, but you put the seed there. Then the next time you see them, they’re like, “Oh yeah, we talked about it last time, let’s give it a try!” Other times, if they’re kind of on the fence about trying something new, something better than what they’re used to, I’ll just give them a sample. “Just see what you think – if you don’t feel that that’s better than what you’re used to doing, then by all means, we can continue where we’re at, but you know, we’re kind of falling behind if we’re just kind of staying the course.”
Cheryl Perkins: What I hear you saying – I think it’s really important in this innovation space – is it’s not one size fits all. Not all solutions, either product or service or culture change, are going to fit. You said the same thing, Mary, so it kind of has to balance who it’s right for and whose engaged.
Mary Downs: Well, it’s interesting, because when I first start thinking about innovation and health care, there’s so much innovation in terms of devices and pharmaceuticals and things like that. But I actually sent Cheryl a note: “Is it OK if I talk about lean as being innovation?” Because a lot of people don’t think about lean as being innovative. Lean is just getting better at what you’re doing, but in health care, that is innovative first of all, because we’ve been doing things the same way for a long time. While there’s great innovation in technology and therapies, that’s only driving up the cost of health care. There isn’t anything that’s going on that’s trying to lower the cost of health care, with the exception of the preventative things that you mentioned before. To me, lean is innovative, because we’re trying to figure out how we remove that waste. How do we serve more patients with fewer resources, faster, better, at a higher level of quality? So it’s taking those principles and really trying to apply to the delivery of health care. For me that was a mindset shift. I never really thought of lean as innovation.
Cheryl Perkins: And within the organization, how has it penetrated that whole influence? Is it throughout, or is it in certain areas? What do you see the evolution needing to be?
Mary Downs: I think it is really ingrained in the organization, and I think it really starts at the top of the organization. So even the first time that I met with the CEO for my get-to-know-you visit, at the end of that, he said, “OK, get me some feedback – what worked well, what didn’t work well, what can I improve for my next conversation?” He had standard work for his one-on-one sessions, and it’s through the whole organization, so the system leadership team, and the people in the ICU, that are working directly with patients, and the physicians. The physicians are actively engaged. That’s how you change the culture. They’re at the table for the problem solving.
Cheryl Perkins: That’s kind of why I asked, because I think any of these programs, if they don’t become part of what you do and they’re a separate standalone thing, then it never becomes who you are, or what you do and it’s not embedded in the DNA of the organization. I think for any of this work, it needs to become part of the day-to-day institutionalized operation, so I think that’s real important.
Elizabeth Much: I would agree with that, but maybe be able to share Thrivent’s story because I don’t think we’re there yet. I actually saw several parallels to your story, Mary (Maurer), of being an organization with a 100-year-old history, very rules-oriented, and an industry that’s highly regulated and has succeeded because we are good at risk management and careful choices and things like that. So a culture of innovation is very different and not always just instantly accepted and embraced. I agree that we all want to get to the point where it is embraced and embedded throughout the organization, but to make that happen it can’t always be this top-down, start-with-the-CEO, and it’s just going to happen.
Cheryl Perkins: Who are the champions and the change agents? I think any successful innovation needs a champion and need catalyst for change.
Elizabeth Much: I think we have pockets of innovation, pockets of champions, parts of the company where it’s very successful and really taking root. Other parts of the company, they’re coming along on the journey at a different pace, at their own pace, because they’re not as focused on innovation. Their job is still to protect the company and make sure that we are here for another 100 years.
Mary Downs: I think what has helped to spread lean at Theda Care was that it started out in a smaller cell trying to solve some specific quality issues that had surfaced. And when they got done and they had made significant improvement in a certain process, they said OK, so we now have about 124 other things on this list that we need to fix, so we need a different way to do this. At that point, I think it became more deliberate about how we spread this, and how the people closest to the work do this. Because you can’t have 15 people or 100 people focused on this, we need all 6,000 people focused on this before we can actually make change. I think that was an “Aha!” moment that helped move the culture.
Mary Maurer: Is your CEO involved, though? Is he engaged, is he a champion?
Elizabeth Much: He is absolutely a champion, and so we have some very strong top-down support. Our CEO has named (innovation) one of the three corporate disciplines necessary for our success in the future. But then, from there, I think it’s sort of not uniform, and we’ve carved out again areas where their day-to-day job is innovation. Part of my role is to help spread that around the company. I’m just trying to point out that everybody’s innovation journey, company is different. And to think that if you have CEO or top-down support that that’s sufficient to spread all through the process – we’re using a top-down and a bottom-up strategy. The bottom-up comes from those success stories, top-down comes from his engagement, his part, his encouragement.
Cheryl Perkins: What are some of the characteristics of someone that you look for that can be an agent for change around innovation? Obviously, either the CEO or yourself spreading this throughout the organization. What do you look for in others, that says, “This person is going to help me change the world in terms of what we’re trying to do here?” Or convince these patients they should use these new contact lens-type things?
Mary Downs: Persistence! Because really, persistence, and you know optimism, and being willing to say “OK, I saw this little much growth today, so hopefully it’ll keep going.” Without persistence forget it. This can’t be a flavor of the month, it just won’t work.
Cheryl Perkins: I think you said something else – I just want to bring the word up – is “influence,” because if you’re persistent, you’re out there, pushing it, you have an optimism. That then creates some influence. The other reality here is in all these roles, we don’t have control of every one we need to influence. So how do we do it?
Mike Miskulin: Obviously, we’re a much smaller organization than what you guys have. We’ve got less than 20 people working at the clinic there – four doctors plus all the employees. Everybody’s pretty specialized.
Cheryl Perkins: Which, by the way, is why you’re here, representing the smaller microcosm.
Mike Miskulin: For my standpoint, if, as doctors we’re not excited about what we’re offering, what we’re doing, it’s going to trickle down to everybody. It’s just going to have a negative effect and everything. I think the employees we have in place right now are fantastic. They are very well-suited for the work that we have them doing, and they’re not just kind of following along. They know how to improve upon their own techniques, and they’re continually investing in what their job is. So I don’t like just have people, who are just going to be like, “Time to work, do the work and go home.” You have to have some enthusiasm for what you’re doing there. With a smaller organization, if it’s not coming from the doctors on the way down, it’s just not going to work.
Mary Maurer: The word that came to mind when we were talking was a “firestarter,” not in a silly way, but somebody who embraces it, someone who’s happy to tell the story, share the outcomes, and can really kind of spark some fires, or the optimism, and is respected within the organization. Sort of an internal thought leader. I think that’s really important.
Elizabeth Much: Those are the characters of the individual. I’d also like to add we’re looking for people who are leading projects that are going to benefit from innovation. That sounds so basic, but to find those success stories is the fuel for these champions and advocates. So we’re trying to approach projects where we think they are developing something new, or maybe where innovation could be helpful to what they’re looking at or working on, and then just by experiencing it, combined with these other characteristics that have been mentioned, strong leaders at Thrivent will be able to carry it forward.
Cheryl Perkins: One thing we look at in innovation and big change, is it’s not only culture, but organizational changes, the need for new roles and a different structure. Organizational structures used to be in place for many years and never change, the roles were the roles, and you find your place in the organization, and you say, “OK, I’m going to do this job to do that job to get this job.” But that’s not the case now. Sometimes organizations are changing multiple times within a year and adding a role here or there. So just think over the last couple years, how, based on the vision and the mission of the organization, have things changed or what types of new chief innovative officer roles or other roles are driving multiple things at once?
Elizabeth Much: I was thinking more about structure changes. Maybe just a little bit more history of Thrivent: When we started on our innovation journey, the structure that we created was to put a group of people together. We sort of walled them off and said, “Within this space, go innovate.” It’s separate from the rest of the company, which didn’t have that culture of innovation yet. They didn’t have the mindset. They weren’t necessarily supportive, and to grab that group of people, and say, “OK, this is your job and we’re going to give you a lot of latitude within this defined space.” Then, on our journey, we got better at that, and the people got stronger at figuring out how you do this, and where you do this. And we started spreading those people into the company, so we took people who were in that core group, and started putting them into different divisions. So that’s been part of our journey. Most recently, we’ve been innovating in different parts of the company, but still within the current operations. This is how we do things, this is how things get done. If you’re going to do this, well, that impacts this.
Cheryl Perkins: Still boundaries.
Elizabeth Much: Right. So what we set up a whole new division and a new company called Bright Peak, and they really were given a blank slate to redesign how they want their new company to work. It’s focused on young Christian families and their financial security.
Cheryl Perkins: Except for the target, demographics.
Elizabeth Much: Right, but they weren’t tied to existing operations and processes and brand standards and all the constraints that somehow are just there, but you almost don’t notice them until you try to innovate. They’re even in their own separate building so they can have some of that latitude. So that was a big structure change for us at Thrivent. That’s sort of how we’ve evolved and changed our structure and our roles.
Cheryl Perkins: There’s two pieces of that. There’s the ongoing innovation that still occurring within the divisions existing in the corporation, but now this whitespace team that has this clean sheet of paper that says, “Here’s your demographic, this is a new demographic for us, we’re not addressing it, come up with the products and services for that demographic,” and that’s kind of what we call the new emerging hybrid model. You do see the need to have innovation, lean, all the way. Renovation, innovation, all those things within the existing organization, but that new whitespace, even your thing of “from inpatient to outpatient,” is same thing. You pushed it out to the clinics that then are little separate. Still, mission-wise they’re still there, but different targets, and trying to come up with this clean sheet of paper around that.
Elizabeth Much: Then it’s enabling them to innovate around the market, the distribution channels, the product, the brand, the packaging, end-to-end. They can do all of that, versus the innovation that is happening within the core company. It’s maybe got a few of those elements, but not all of those elements.
Cheryl Perkins: Mike, as new needs come up and you have to rearrange roles or structure, how has that happened for you to make sure that you have enough resources focused on the new technology and new services? That you’re not just continuing to do what you’ve always done?
Mike Miskulin: Well, I think it’s prioritization. If it’s important for you, always push it. I’ve not been with Valley nearly long enough to know what the long term changes have been at the organization there. Just from what I’ve seen, everybody takes a more active role in everything. That is a big issue for me. For what I like to see, streamlining our care, is another thing that you guys were talking about. There are a lot of times where people come to us with certain problems, or maybe they don’t even realize they have an issue until we see them. Then it’s a matter of explaining it and doing the appropriate testing, and in the past, it’s been just a lot of sending it out, sending it out, sending it out. For us, we’ve got other things in place now where we can do the testing there, so we don’t have to do another appointment, more money, more health care dollars. What I would love to see – we do a lot of communicating among primary care physicians, specialists, things of that nature. We’ve been on electronic health records for a few years now, it’s great as far as communication goes among the doctors and the staff. I’m interested in seeing how things can change down the road as far as tying that all into a nationwide database. We’ve been working on this for a while. Obviously, there are privacy concerns. I would just like to have that information there, and I think patients in general would be appreciative of that as long as the security of information is there.
Cheryl Perkins: You’ve all talked a little bit in your areas about evolution and culture changes in work structure, what you’re doing to institutionalize innovation. This is a tough question, and I’m not expecting all of you to answer: How do you know what you’re doing as a leader is making a difference? Again, most companies are struggling with metrics, because of the cultural changes, the relationship changes, the evolution with so many stakeholders. There’s not just a financial number that you can put often on these things to measure. So how do you know what you’re doing in the innovation space is making a difference?
Mary Downs: I think there are two components. One is we try, as we are starting to innovate around something, is to set some metrics – and not all financial. It might be in terms in access – how long it takes for a patient to be seen, or it might be in terms of certain quality or outcome metrics. So we try to have a balance scorecard that looks at financial, people, patients, quality. But I think there’s also an intuitive sense that when you can see that people are starting to challenge the status quo, or they make a statement like “Wow, I never thought we would be doing this!” or “Wow, I never thought I’d hear that come out of my mouth!” – those are the things that as a leader at least fuel me, in addition to the metrics that are on our scorecard.
Mary Maurer: I was going down the path with the same thought that you had. Green dollar, what impacts the bottom line, and blue dollar, what impacts the customers’ experience. For instance, we just did another employee pride survey. We do them every couple of years, and the feedback to the statements regarding innovation and improvement, is just such an upward positive trend, it’s wonderful. I mean that’s a real, statistical kind of feedback point. Customer service as well, when you know more people have been pleased or more people are rating you more consistently higher, then you know all those kinds of things are making a difference. When I hear people say we should do a VSA on that – value stream analysis – that tells you that you’ve made a change and that people get it, and that it just part of your DNA, as you said before. It’s really operationalized. That is the best feeling, intuitively. We would’ve never heard that stuff 10 years ago.
Cheryl Perkins: Since you’ve commented a little bit about what excites you or gets you motivated as well as what engages your employees, what is the role of storytelling? I think it’s so important nowadays to tell the story – not just about the outcome, and not just focus on the outcome – but the journey. Are you using storytelling success stories to drive the change?
Mary Downs: We’re also using some storytelling to try to create the sense of urgency about why change is important. For instance, so we can look at something like surgical site infections, we could be doing fabulous on that, we could have very very few – point zero zero zero something. But we’re not at zero, we’re not there. We’ve got one story that we have videotaped about a patient who had a surgical site infection, and how it impacted her life, and basically the disastrous consequences that this has had for her. If we ever start saying, “Oh, close enough,” we’re not close enough until we’re at zero.
Mary Maurer: We always say we’re never there. We’re never there, because ‘there’ keeps changing, and you always want there to be bigger and better. And that’s the way it should be. There’s no stop point.
Cheryl Perkins: Mike, you mentioned earlier just a little bit about you personally need to know ‘the why,’ you need to understand things that are coming upon you in terms of needing change instead of being a victim of it.
Mike Miskulin: I don’t like to blindly accept. I have to see the value of it, in order for me to do it. There are obviously ideas that come down, that sound really good in the upper management section, and it’s not going to work down here. And you know, I think that’s the way I will look at things and try to perceive it – is this end value going to be a benefit for how I conduct an exam? Is it going to affect the patient in a positive way?
Cheryl Perkins: Elizabeth, for your specific situation, you have this new whitespace group. You know lots of times, they need time to sort out what they’re doing. At what point do you start the storytelling? Because there’s probably a lot of interest. All the boundaries have been removed. They’re off here innovating, but what are they doing? So where is that time that you start to bring forward some things that are pretty disruptive, probably, and start to tell the story?
Elizabeth Much: I think we’re already telling the story of what they’re doing, and we’re measuring success in terms of learning. So it’s great to share those learnings, because they’re sort of walled off, they have the permission to try things. And the latitude to innovate, even if those things take longer, and have a five-year timeline, or whatever, even longer, before things are really successful in financial metrics.
Cheryl Perkins: Viewing learning as an outcome is awesome.
Elizabeth Much: We’re not walling them off and not sharing. I’m personally talking to them, saying, “Wwhat are you learning already that could be applied over here, even if it’s just a small nugget of this type of messaging works and this doesn’t?” That’s already being shared, so their successes of when you change this, that really helps us.
Cheryl Perkins: So we’ve talked already a little about the role of culture, and the role of leader and change agents with the leader, talked a little about the challenges around metrics and storytelling and things like that. We’re actually at the end of our prepared questions. If there’s something that you’ve learned, what’s one of the key takeaways that you would want to make sure anyone else coming behind you would really listen to?
Mike Miskulin: I would say, just don’t get stuck in the same old stuff that you’ve been doing. I think human beings, in general, are creatures of habit, so it’s easy to get stuck in the same thought process. It’s easy to kind of stick to what you’ve been doing, in no matter what industry you’re with, or what your profession happens to be. There are always different ideas out there.
Mary Maurer: First thing that came to my mind, it is a journey. This is not turn-the switch-and-you-change-an-organization. It’s baby steps, and I’ve learned that you need to be able to tell the story and share and celebrate each small step you take. Some of our best stories have been where we’ve flopped on something that we thought would be terrific. Talk about learnings, gosh can you learn, as long as that’s part of the culture. We’ll have some misses, we know we will, nobody gets axed, life moves on. That tells people that innovation is good and safe to be creative in that sense.
Mary Downs: There’s a saying that every system is personally designed to get the results it gets. While you can have people who are focusing on innovation and really trying to make change happen, you also have to be willing to look at the organization as a whole, the infrastructure, the communication patterns, the rewards, and all of that stuff, and make sure they line up with where you’re going. Because if they don’t, then innovation won’t happen, or it will be painfully slow, or you just won’t move there.
Elizabeth Much: My one takeway from the conversation – there’s so many resources out there. Look at this conversation among the four of us who are in very different business models or sizes of industries. This has been valuable and insightful. There are other organizations out there, different groups that can support you. You can network with other people. You might be on this innovation journey, or be recently dubbed chief innovation officer or whatever it is, and you don’t have to stay within your walls, and you don’t have to stay within your own industries.
Cheryl Perkins: If you stay right within your space, you could become very complacent because you’re only looking at what is in your industry. That’s why I keep pushing companies to say, you have to look outside your space.
Elizabeth Much: We can’t end this conversation, though, without talking about looking at your own customers. Innovation has to start and is most successful when you look at your customers’ needs. To get empathy for that consumer, even to the point of visiting them in their homes and seeing how they interact or think about your product or service, is just absolutely foundational.
Mary Maurer: We do such a better job than we ever have of involving the customers. We frequently have a third of our team be outside eyes, good and bad experiences both. You don’t want a bunch of people who think you’re great, you want people who really have had some issues or whatever with the systems, and man, that’s powerful stuff.