Challenges in healthcare risk management driving innovative, evidence-based solutions

Despite some monumental efforts and tremendous advances in practices and technologies, medical errors remain a widespread and persistent problem.

Indeed, a 2013 study estimated that even at the lower threshold, 575 deaths per day are associated with preventable medical harm in the U.S.

In the context of risk and safety management, Douglas Hubbard, author of The Failure of Risk Management: Why It's Broken and How to Fix It, has linked such systemic failures in part to a lack of evidence-based practices that measure the effectiveness and efficiency of risk strategies. The antidote is to pursue innovation in risk management, develop evidence-based practices, and merge them with effective solutions. So how can we foster innovations (such as communication and resolution programs) and make changes that will save lives and also bring competitive advantages?

Deciphering relationships

Innovation is a process, and it needs a social structure to succeed. The Rogers Innovation Adoption Curve provides a set of evidence-based categories and personality attributes that offer a useful framework. Consider these three types of players:

  • Innovators: Bold, visionary and willing to take risks, innovators bring new information and knowledge, a new perspective and big ideas to the discussion. For example, Stanford anesthesiologist Dr. David Gaba spearheaded the application of hands-on simulation training (mannequin-based, fully interactive simulations of operating rooms and EDs/ICUs) for delivering anesthesia—an approach that had never before been applied in the field of anesthesiology.

  • Early adopters: Open to change, early adopters respect and value fresh ideas. They range from those who are eager to embrace different approaches, to those who must deliberate carefully before accepting them. They move innovation forward, turning ideas into daily practice. A good example of this is the work of Dr. Atul Gawande, who leveraged the safety culture of commercial aviation and processes from the military in the adoption of checklists and debriefings for use in the peri-operative setting.

  • Late adopters: Doubtful about new approaches, the late adopter is often motivated to accept change only by peer pressure or direction from leadership. They range from individuals who dislike change to those who actively oppose it.

    Healthcare generally falls into the last category in terms of developing innovations to “Uberize” organizations (i.e., personalize and streamline through new technology).

    Understanding how these personality types interact with each other will help drive innovative endeavors. Seeking out and building relationships between innovators and early adopters is vital for these efforts to gain momentum.

  • Putting structure in place

    There also must be a space and structure in place to test innovation through data and evidence collection. Processes to develop, evaluate, apply and monitor the successes and failures of new ideas need to be implemented.

    “Design thinking” is one example of a useful process for this. In healthcare, systems too often emerge as a result of available resources rather than with the end user in mind. Design thinking facilitates the creation of systems targeted to the specific needs of patients and providers. By developing a deep level of understanding with the end user, testing and adjusting new solutions, and tracking their progress, design thinking can help healthcare risk managers find solutions that are predictive, rather than simply responsive.

    Bringing everyone on board

    Ultimately, to achieve success, innovation must reach all partners on an individual level. It is paramount to make clear the value of an innovation to the stakeholders' specific needs—which may have nothing to do with cost avoidance or generating revenue, but rather relates instead to personal or professional goals. Understanding the opportunities and costs for all players will enable a collaborative effort that endures.

    By building relationships, testing promising ideas, and creating buy-in for these efforts, we can improve risk-management and safety practices in healthcare. We can develop transformative, evidence-based solutions that not only improve quality of care and reduce costs, but save lives.



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