By Vivek Kumar
Peer Reviewed
As healthcare workers, we learn about the most intimate factors governing patients’ lives. We learn about their fears, goals, and motivations on a daily basis. We are on the front lines and see the cracks in the system that prevent optimal health. With all of this privileged knowledge, healthcare workers should be at the forefront of medical innovation. Surprisingly, however, very few physicians engage in entrepreneurship, despite the significant need and variety of roles available [1].
In the current medical entrepreneurship landscape, external innovators ask doctors what they want or need in order to improve patient care. They then try to build products without much firsthand experience with the problems physicians face [2]. While this gets us some solutions, firsthand knowledge would make things far more efficient. Just imagine how much more smoothly things would have gone if we had designed, instead of beta tested, the EPIC electronic medical record.
So why are we letting people outside of the healthcare field innovate for us? Innovation can be evidence-based and follow the scientific process that healthcare workers are well versed in. More importantly, innovation originates with individual physician inventors collaborating with their peers with support from their institutions [3]. It’s important to dive into innovation. Ideation, collaboration, and prototyping are three essential early steps in the process.
- Ideation: Identify an Unmet Need
This could be finding something that is broken and needs fixing, or it could be finding something that works well and can be expanded. For example, we know that dietary behavior modification is difficult to achieve. The Fruit and Vegetable Prescription Program is a preventive medicine intervention that allows patients to redeem vouchers worth $1 per day per family member at local farmers markets [4]. The program, and related research, has seen positive health outcomes and increased participant consumption of fruits and vegetables [5]. The founders of this program identified the unmet need of patient access to fresh fruits and vegetables as well as the barrier of cost.
- Collaboration
Peer, institutional, and cross-disciplinary collaboration provide effective ways to improve on individual ideas and assess the viability of implementation and dissemination of ideas. For example, Julio Palmaz invented the Palmaz-Schatz coronary artery stent, a million of which are used yearly. When interviewed about his experiences in developing the stent, Dr. Palmaz recalled the importance of early collaboration with an engineer to prototype his device. He also talked about talked about the utility of brainstorming his ideas at professional meetings [3].
- Prototyping
The lean startup is a method that highlights the creation of a minimal viable product or MVP. Creating an MVP is essential in the prototyping phase because it allows rapid adjustment of the product based on feedback. For example, the Embrace baby warmer is a low-cost sleeping bag for low-birthweight babies who would otherwise not be able to maintain their body temperature [6]. The invention involves an insert that is warmed and keeps the bag at a constant 98.6 degrees for up to 6 hours without the use of electricity. Despite the simplicity of this concept, the Embrace warmer underwent 60 iterations during field testing to increase adoptability.
Call To Action
It is common knowledge that the medical profession is not an early adopter of innovation [7]. We pushed back when asked to make handwashing a regular practice during patient care and pushed back when asked to adopt electronic medical records. Our slow diffusion of innovation makes sense because, as scientists, we want to see the evidence supporting a change prior to implementing it. The problem with this approach is that it can result in innovation fatigue and slow healthcare progress. Our slow diffusion of innovation is part of our culture and I don’t expect it to change anytime soon. It is important to innovate despite this culture. Not everything will work, and not everything that works will be adopted, but we can avoid innovation fatigue by focusing on our patients. They can highlight medical problems and motivate us to solve those problems.
As healthcare providers, we have privileged information that needs be applied to improving patient health. Our current healthcare hurdles require innovation, and it is our responsibility to our patients to create solutions. This can be achieved by diving into the process of innovation, starting with identifying unmet clinical needs.
Commentary by Dr. Robert Glickman
Vivek Kumar’s essay makes a persuasive case that physicians, with their direct patient care experience, should be a voice for innovation in order to improve patient care. Certainly, most physicians would strongly agree with this concept but would correctly point to the obstacles in the way of accomplishing this: an ever-busy workload, the impenetrable administrative structure of hospitals, not knowing where to share their ideas, and a feeling that their ideas may not be listened to. Certainly exercises such as morbidity and mortality conferences, root-cause analysis of poor outcomes, and legal actions resulting from patient injury are all exercises, albeit retrospective, to analyze and improve patient care. It certainly would be more effective to develop a prospective approach to improve care and decrease negative outcomes.
To be most effective, the size of the problem cannot be so large that major financial or reorganizational changes are required. It is hard to make major changes in large institutional programs (eg, electronic medical records); however, smaller changes are possible. An institution could convene a standing group of physicians and nurses to meet on a regular basis and serve as a sounding board/idea-generating body for innovative ideas. The best ideas could be advanced for institutional or outside support. In addition to improving the sense of institutional participation, I anticipate that a significant number of innovative, actionable ideas would result. In addition, ideas would also come to the committee from other physicians in the institution, with a large magnification value.
Vivek Kumar is a 4th year medical student at NYU School of Medicine
Peer reviewed by Dr. Robert Glickman, Medicine, NYU Langone Medical Center
Image courtesy of Wikimedia Commons
References
- Meyers A. Roles and goals for physician entrepreneurs. http://sopenet.org/blog/entry/uncategorized/roles-and-goals-for-physician-entrepreneurs. Published February 19, 2014. Accessed February 19, 2014.
- Chakma J. What role can physicians play in innovation? http://www.marsdd.com/2009/09/15/role-of-physicians-in-innovation/. Published September 15, 2009. Accessed February 19, 2014.
- Kesselheim AS, Xu S, Avorn J. Clinicians’ contributions to the development of coronary artery stents: a qualitative study of transformative device innovation. PLoS One. 2014; 9(2):e88664.
- Fruit and vegetable prescription program. Wholesome Wave. http://wholesomewave.org/fvrx/. Accessed February 19, 2014.
- Buyuktuncer Z, Kearney CM, Ryan CL, Thurston M, Ellahi B. Fruit and vegetables on prescription: a brief intervention in primary care. J Hum Nutr Diet. 2014;27 Suppl 2:186-193.
- Thrive Networks/Embrace.The Embrace infant warmer is a product with a mission. http://embraceglobal.org/embrace-warmer/2014. Accessed February 19, 2014.
- The Economist Healthcare Unit. Doctor innovation: shaking up the healthcare system. http://graphics.eiu.com/marketing/pdf/Philips_Shaking_up.pdf. Published 2009. Accessed February 19, 2014.