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First why, then what … What if?
In this month’s Progress Notes, we feature on article on Dr. Roy Small and efforts in research and innovation. Long a respected clinician, Dr. Small has taken his clinical background and asked this question as part of his commitment to advancing medical knowledge and delivery. He has linked up with the University of Pennsylvania’s innovation team to learn from both of our efforts in a disciplined and thoughtful approach.
Under the direction of Roy Rosin, Penn Medicine’s Center for Health Care Innovation works in clinical areas like nutrition, mobility and endocrine emergencies. Like research, innovation requires dedicated resources, diverse thinking, de-engineering and importantly, separation from day-to-day operations. New partnerships outside established core competencies can have synergistic effects.
To enrich the design environment and protect initiatives from standard ops and bureaucracy, organizations have isolated their design groups off-site. The “Skunk Works” description came from the Lockheed Martin initiative to develop advanced aircraft beginning in WWII.  It was housed next to a foul-smelling plastics factory in California, which reminded workers of a distillery. LM’s “Skunk Works” accelerated design thinking and development, bringing over 20 new aircraft prototypes into production. Google, Apple and Boeing, among others, have followed this model in their product development but avoided the distasteful smells.  
Innovation does not need to be “a lightning bolt from the sky” or the fruit of years of design and research.  Tim Brown in “Change by Design” recognizes that breakthrough ideas emerge from the challenges we all face in our everyday environment. Seeing the connections between disparate events -- particularly pain points and sacrifices -- can provide the first steps in creative solutioning.  Recognizing the “story” provides insight into why something is important to the customer. In a recent HBR article, Clayton Christensen writes that understanding customer needs and solving their problems is the framework of innovation. These “jobs” are not simple transactions but have powerful social and emotional implications and form the basis of the customer/patient relationship. “What if” can redefine function into purpose.
Even without the luxury of a “Skunk Works,” finding time and space within the tyranny of daily demands can unleash creative thinking. Minnesota Mining and Manufacturing provides up to one day per week for creative work. Google, in addition to its X Lab, provides work space and even play environments to foster creativity.  Even on a small scale, many advocate spending time each day thinking differently, seeing the connections and the opportunity for change. Perhaps an elixir for empowerment and resilience.
As physicians, our patients expect us to heal, comfort, explain, reassure, guide and anticipate, among others. How might we do these in nontraditional ways?
What if…
Live entertainment removed the higher cost, scary, unpopular and difficult-to-transport elements of the show and allowed for performances at multiple venues? Cirque du Soleil
Clothes washing could be done with reduced waste and cleanup, provided with the convenience of one touch, pre-measured? Tide Pods, Procter & Gamble
Feeling extraordinarily special away from home, a hotel empowered every staff member to solve guest problems at the time of occurrence (within $2,500)? Ritz Carlton, two-time Malcolm Baldrige winner
Purchasers of healthcare benefits could directly contract with hospitals and providers to deliver better quality and experience, at less cost? Hmm…
Physicians could complete a patient visit in one click in the electronic record? I guarantee someone is working on that. 
From all of us at Progress Notes and the Medical Staff Office, best wishes for a wonderful holiday season, with peace and blessings in the New Year. Thank you for all you do for our shared patients.


Lee M. Duke II, M.D.
Chief Physician Executive
Progress Notes' Editor-in-Chief

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