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Commentary

Building a Culture that Fosters, Rewards, and Spreads Innovation

There continues to be mounting pressure for health systems to deliver high-quality care on the "customer's" terms, while improving the overall health of the populations they serve—our nation's Veterans deserve nothing less. To achieve this, the concept of the health system as a purpose-driven learning and improvement organization has recently taken hold.

We believe a learning health system is one in which information from each patient-provider encounter and experience is used to globally advance clinical care and operational processes, positioning the health system to deliver patient-centric care that is safe, timely, efficient, and equitable. Building such a health system requires a culture that values and practices continuous improvement, learning, and innovation.

In the past, the importance of fostering an innovation culture in health systems has often taken a back seat in favor of more traditional improvement methodologies, like Lean and Six Sigma, as tools to drive organizational change. While improvement infrastructure is necessary, it remains just one piece of the puzzle to realizing a learning health system. "People-focused" methodologies are equally important. Components of human-centered design, health informatics, entrepreneurship, change management, and the constructs of implementation science are essential building blocks to a well-designed learning system. Health systems must equally invest in the capacity to identify, scale, and spread innovation and evidence-based best practices, which often take years to reach patients.^1-2

Building a culture of innovation remains challenging for health systems, with the opportunity cost of change, tendency to cling to the status quo, limited resources, lack of influential champions, and the complexity of innovations all hindering the growth of an innovation culture and slowing the spread of adoption.^1-3 The VHA Innovation Ecosystem is proactively changing and achieving progress, reducing and eliminating such barriers.

At the core of the Innovation Ecosystem, the VHA Innovators Network and Diffusion of Excellence Initiative (DEI) operate at distinct stages of the innovation cycle but together form the connective tissue of an ecosystem that is building a culture of learning and innovation. These two initiatives create opportunities for VHA staff to ideate, test, and spread both innovations and best practices through financial support, frontline empowerment, and a collaborative network of peers. Through a shared vision, this network is making innovation actionable and impactful. Both initiatives have visible support from senior leadership, a crucial aspect to building or changing any organizational culture.

We believe there are five key elements to replicating and sustaining an innovation culture.

1. Empower the Frontline

We believe frontline employees are the most familiar with VHA's challenges and best positioned to solve them, but aren't always the best equipped. Innovators Network and DEI proactively support employees who drive innovation by providing training, resources, and networking opportunities. To date, 448 VA staff have implemented projects through the Innovators Network, and close to 4,000 frontline staff at over 140 medical centers have helped implement DEI practices.

2. Exercise the Innovation Muscle

The Innovation Network's Spark-Seed-Spread Innovation Investment program encourages field employees to submit solutions that address high-priority Veteran health outcomes in new and sometimes unconventional manners, such as a practice focused on 3D printing for pre-surgical planning. The program has funded 185 projects to date. Through the VHA Shark Tank competition, the DEI offers an engaging and meaningful opportunity for frontline employees to "pitch" their ideas to VISN and medical center directors, who then bid resources to implement. It is a source-agnostic model for merit-based selection and enterprise replication of promising practices submitted by field employees. Across three competitions, the VHA Shark Tank has identified 36 promising practices out of over 1,000 applications. More than 600 applications have been submitted for the ongoing 2018 competition.

3. Design to Fail Forward, Scale Big

Supporting employees and identifying innovations is critical, but it is also important to test small, fail small, and scale big. The Innovators Network and DEI scale resources and support for innovations and promising practices as they are validated. In addition, we focus on early problem validation to ensure innovations are solving the core problem, and not just a symptom.

For instance, through the Spark-Seed-Spread Innovation Investment program, VHA employees can receive different levels of funding to design, develop, scale, and spread their innovative practices based on the practice maturity, with larger awards for practices with a demonstrated potential. Meanwhile, the DEI provides a small step-up in dedicated resources for a six-month facilitated replication of promising practices to test the feasibility of spread.

4. Build Collaboration and Connection

Collaboration is pivotal to driving organizational change that is required for the successful adoption of innovation. The Ecosystem leverages internal and external partnership models to develop and spread innovations, decrease cost and time to market, with demonstrable outcomes and impacts. Collaboration also supports the co-design of solutions with the key stakeholders from the beginning in order to co-ideate and co-create innovative approaches and solutions.

Internal collaboration includes partnerships with relevant national program offices or VHA change implementation groups such as QUERI, whose work is vital to developing an innovation culture. External collaboration includes alliances with other agencies, private sector entities, or academic institutions to bolster expertise, support, and resources, and promotions for VHA innovation. For instance, Innovators Network has an ongoing relationship with human center design experts from the University of Virginia.

5. Celebrate Small Wins that have Big Win Potential

In addition to collaboration, we understand that acknowledging the efforts of frontline employees to improve VHA and the care that Veterans receive is vital to sustaining an innovation culture that encourages and supports fresh ideas, learning, and, ultimately, transformation. Leadership recognition of frontline VA employees for their time, effort, and challenging work is integral to creating ownership and an attitude for success. For example, Innovators Network practices have impacted around 124,900 Veterans, employees, and caregivers since the network's inception in 2015, and generated $3.3 million in cost savings to VA in FY16. DEI practices have produced cost savings of more than $22.6 million and engaged over 96,000 Veterans.

A culture of innovation and learning must be fearless, risk-taking, and willing to take on the toughest challenges. Building this culture is challenging but also critical to fostering a learning healthcare system that ultimately delivers better care to its patients. While it continues to evolve, the VHA Innovation Ecosystem is proactively creating a culture that values discovery, promotes and accelerates innovation, and keeps our customer, the Veteran, front and center in terms of measurable impact.

References

1. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academies Press, 2001.
2. Berwick DM. "Disseminating Innovations in Health Care," JAMA 2003; 289(15):1969-75.
3. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidoi O. "Diffusion of Innovation in Service Organizations: Systematic Review and Recommendations," Milbank Quarterly 2004; 82(4):581-629.