People
Everybody Is an Innovator
Cleveland Clinic is the brains, hearts, and hands of more than 43,000 people. Our brand of mission-driven innovation is all about people, because it comes solely from people—people who have devoted their lives to making others well and to improving their results and experience.
This chapter is about how the elements we have built and collected are employed to identify, motivate, reward, and inform innovators so they can come up with new ideas to take care of patients and solve problems. It’s a privilege to serve these innovators, and Cleveland Clinic Innovations (CCI) takes seriously its charge to be the caregiver of their ideas.
Mission-driven innovation parallels the doctor-patient relationship. We’re entrusted with something sacred—not health in this case, but cherished ideas initiated by the inventor, who may be coming to the relationship with a variable level of understanding of the technology transfer process. Some seasoned veterans of the innovation journey are well-versed in the steps (and vicissitudes) of commercialization, while others may not have had prior exposure, or simply want to return to their “day job” and “pass the baton” to the innovation professionals. We must balance executing fiduciary responsibilities and representing the inventor with maintaining commitment to mission and representing ourselves and our institution with high integrity. Doing well and doing good embodies mission-driven innovation.
What Our Innovative People Have Done
Throughout the book, I talk about process, metrics, outcomes, and physical assets like devices or drugs. I want to share some insider information: when we describe one of the innovations we are developing on our campus, we almost always use the inventor’s name, along with the technology—“That’s Dr. Johnson’s stent,” or “Dr. Green’s new molecule.” Just as these groundbreaking discoveries are aimed at helping patients, they also emanate from the brilliant minds of colleagues with whom we develop intimate relationships. Both parties, the inventor and the innovations specialist, care deeply about delivering on the promise that innovation holds for mankind.
Rising from the Cleveland Clinic Fire
In May 1929, highly volatile nitrocellulose x-ray film was ignited by steam from a leaky pipe in the basement of the original Cleveland Clinic building, which still stands. The ensuing explosions and poisonous gas billowing throughout the entire building resulted in the worst fire-related disaster in the history of healthcare. Of the building’s 225 occupants, 123 perished, including one of the four founders, Dr. John Phillips.
The tragedy motivated development of safety standards for hazardous material storage, improved hospital procedures, and innovations in firefighter safety and ambulance rescue. The surviving founders leveraged their personal wealth to rebuild Cleveland Clinic and maintain operations when circulating money all but disappeared in the Great Depression.
At Cleveland Clinic, each obstacle is met with vigor and vision, every advantage is explored and exploited, every failure and challenge is pivoted for later success. Our competencies are then multiplied by the power of partnership and unanimity of thought around one mission—improving and extending human life.
Battling Colon Cancer with Computers
“You can choose your friends, but you can’t choose your family,” goes the old adage. But its serious side is genetically transmitted disease. If you inherit the gene for familial adenomatous polyposis, you have a 100 percent chance of developing colon cancer, and it usually manifests at younger than age 45.
Cleveland Clinic colorectal surgeon James Church collaborated with software engineer Valera Trubachev and computer scientist Elena Manilich to develop software, commercialized as Cologene, to support the largest hereditary colorectal cancer registry in the world. Not just a passive archive, Cologene has evolved into a complete decision-support and information-sharing tool. Cologene constructs family trees, coordinates testing and treatment, sets up screening plans for patients at high risk, and facilitates education. In addition, the data supports clinically important research on inherited colorectal cancer. Cologene has been lauded for ease of use, as well as robustness attributable to more than a dozen years of data collection and system enhancements.
Cologene is being used all over the world, has been translated into French and Japanese, and is available as a mobile app. Even more promising, the technology has been reconfigured to support several additional hereditary disease registries, among the world’s largest.
Navigating Solutions for High-Risk Heart Patients
Imagine being able to fix heart problems while avoiding the surgical trauma of open-heart surgery, a large risk for the sickest patients. Cardiovascular surgeon José Navia recently invented a self-expandable stent and delivery system to treat mitral valve regurgitation, a disorder in which blood leaks back into the left ventricle. This serial innovator created a novel solution to the technically demanding and morbid traditional mitral valve repair that requires cracking open the chest.
His NaviGate system instead punctures a leg vein and navigates a device into the right atrium, through the septum, and down into the diseased mitral valve. Currently, the device is being tested in animal studies and is being prepared for first-in-man studies in Europe, which will be followed by U.S. clinical trials in three to five years.
Dr. Navia is among our engaged and visionary innovators who aspire to develop game-changing technologies for patients. A spin-off company, NaviGate Cardiac Structures, Inc., based on Navia’s technology, has been formed to help move the innovation back to the bedside to help high-risk patients.
Everybody Is an Innovator
The innovative spirit and innate core of creativity resides in everyone. Nobody knows the job better than the person performing it. Through immersion and repetition, you find efficiencies. You associate with other experts, inside and outside of the work environment. Your vocation permeates your thoughts, and even your dreams. How many times have you been showering and you came up with an idea that made you long for pen and paper or a voice recorder? In some disciplines, you engage in scholarly discourse and contribute to the literature in your field. As such, you’re in the pole position regarding what needs to be changed, can be changed, and would result from change. These are the major elements in the formula of innovation at any organization.
At Cleveland Clinic, we have developed ways to capitalize on the innovator inherent in caregivers at all levels of the institution.
Opening the Aperture as Wide as Possible
We have thousands of experts roaming an international collection of campuses—it’s like a ready-made innovation laboratory where caregivers are exposed to the largest and most complex healthcare subject matter. When CCI was started, we spotted these wonderful attributes and a legacy of creative leadership. We simply had to determine how to get ideas from the bedside or lab bench to the bank to help countless others around the world. In addition, we needed to recognize that innovation was occurring in all corridors of our organization.
In the normal course of human endeavor, we often invoke axioms to help explain natural phenomena. One of the most popular is the Pareto principle—the “80-20 rule,” used to describe the distribution of causes and effects.1 However, there’s a tendency to invoke the Pareto principle in evaluating sources of innovation and determining where to place resource “bets,” which can translate into an artificial limitation on innovation output from an organization. There is a CCI corollary to the Pareto principle.
We’ve observed that when resources are scarce, institutions tend to preselect the 20 percent who they believe will contribute the most innovation and concentrate resources on them. That’s not illogical—the 80-20 rule describes that 20 percent of individuals will likely contribute 80 percent of the innovations. However, we’ve experienced that 20 percent of those doing any job throughout the entire enterprise will be the innovators. By limiting access to innovation support by following Pareto, you artificially limit your innovation potential to 20 percent of the 20 percent. Whereas, if you follow the CCI corollary, you continue to stimulate and receive creative solutions from all corridors, and the effect of innovation success “goes viral” much faster with greater sustainability.
The reality is that when you’re establishing an innovation entity like CCI, your intellectual bandwidth and human and financial resources will be stretched. Despite challenges and barriers, democratize your IP development apparatus as soon and as much as possible. Instead of focusing solely on one set of high-volume surgeons or a few well-published scientists, start with as wide an aperture as possible and never stop expanding it.
For example, the AppointmentPass™ innovation didn’t come from the C-suite or even the clinical enterprise. It came from John Bona, a midlevel administrator who just thought creatively about the frustration of patients checking in for their visits.
One of the best examples of this insight about innovation potential comes from our early days working with Northwell Health (formerly North Shore-LIJ Health System), New York’s largest healthcare provider and a member of the Global Healthcare Innovations Alliance (GHIA), our collaborative network of healthcare systems, academic institutions, and corporate partners.2 Heavy, unwieldy privacy curtains separating emergency room bays in 80-plus locations frequently were wrestled down and washed in the hospital laundry. You can imagine the time-consuming manipulation of the curtains and the associated financial and environmental costs. Lorenz “Buddy” Meyer, associate director of environmental services, and Christopher Boffa, director of support services, had the idea to check the curtains for bacterial counts. They dropped to negligible levels past a narrow band at the entry aperture. Meyer and Boffa devised a vinyl panel that can be affixed to the frequently touched portion of the curtain, easily disinfected between patients, and removed and discarded when worn. This innovation was shared across our alliance, with its four large healthcare systems representing literally hundreds of emergency departments.
In short, if you want to unite a large and diverse constituency, while multiplying your organization’s innovation potential, go wide and deep. As much as you can, open your policies and practices to everyone, not just your high earners or big name practitioners. Yes, the veteran may produce more synthetic thought than the rookie, but don’t exclude the latter from the assets.
Let Ideas Speak for Themselves
One of the great characteristics of sport is that it’s a meritocracy. There’s an absolute measurement against which an individual’s performance is judged. Your gender, race, creed, nationality, or any other personal trait doesn’t influence the outcome of contests in which success is determined by how far you throw or hit, how fast you run, or how much weight you lift. Innovation shares this trait, in that the quality of an idea determines how far it goes.
Let innovative concepts speak for themselves, not the business card of origin. CCI objectified the process of innovation by developing proprietary, multivariable technology scoring instruments so that we could concentrate on the quality of the ideas. Use of these tools also disengages the inventor of origin from the technology at the decision point regarding technical or clinical merit. This helps preclude one of the fatal errors in innovation: burning scarce resources on dead-end projects because the inventor has “favored-nation” status with administration. Talented doctors and genius scientists have ideas destined for the trash bin mixed alongside their treasures. It’s your job to determine which ideas have traction, not just forward all the ideas from some and disregard the promising ones from perceived lower-echelon inventors.
The intended consequence of maintaining such a disciplined methodology is the strength of decisions to kill a technology. It’s exceedingly difficult to tell an inventor that his or her “baby is ugly”—that the cherished idea fails in terms of technical feasibility or market relevance. When you have proven instruments that reveal invention shortcomings, it’s easier for your staff to deliver the disappointing news, plus you’ve identified how to possibly remediate the concept so it still has life in the commercial world.
Through broad collaboration with our alliance partners, we’ve undergone a small but significant change in the way we view our innovation portfolio in terms of determining absolute value. We used to see our job as finding the best ideas at our institution and navigating them to the marketplace. Now we believe we should simply seek the best ideas to help humankind. Wherever they grow and whoever contributes them, locate the best ideas and find a way that your organization can help shape them.
This may mean that your own institution’s ideas take a subordinate role or smaller fraction. Development may result in your receiving a smaller percentage of the financial reward—so be it. If you’re truly a mission-driven innovator, you realize that there are ways you can help to raise all boats by supporting the best ideas, even if they are not yours. Look for these opportunities and be prepared to stand in the shadows on some, and be cognizant of the shadows you cast when you receive the majority of the sunlight.
Just as gravity influences all bodies, the marketplace will be the ultimate arbiter of whether an innovation is worthy. It’s the responsibility of innovation leadership to give an idea its best chance of survival and success. There are few disappointments greater than unrealized potential. Do everything possible to avoid this pitfall by keeping your mind and doors open to all innovators.
Carrot or Stick: Can You Make Someone More Innovative?
There is a nature-versus-nurture debate within innovation circles, just as it exists in broader society. Those who believe creativity is innate and instinctive are always poised for battle with structuralists who believe the surrounding environment is what extracts innovation.
In building Cleveland Clinic’s innovation competency, we integrated the thinking of authorities Clayton M. Christensen and Tom Kelley. Two of their works focus particularly on the innovator as a person.
In Christensen’s classic, The Innovator’s DNA,3 the modern master of disruptive thinking and his coauthors nimbly dance between arguments for innovation abilities being innate or learned. In the end, nurture trumps nature. Citing their own research and multiple replicated studies, they show that 25 to 40 percent of our innovation capacity is genetically endowed. Thus, innovation is a learned skill by a two-to-one margin. The authors identify five discovery skills, but one reigns supreme: associational thinking. Skills like “questioning, observing, networking, and experimenting” activate this capacity. But structured socialization can often determine whether disruptive innovation will result.
Kelley, in The Ten Faces of Innovation,4 assigns “personalities” to the individuals and teams engaged in innovation. He articulates “learning personas,” “organizing personas,” and “building personas.” The simplicity of Kelley’s masterpiece makes it an effective tool for leading innovation. One quote that remains with me is, “The personas are about ‘being’ innovation rather than ‘doing’ innovation.” Perhaps the most valuable message from Ten Faces is that the roles can be adopted by almost any person in an organization and then switched when opportunity or necessity arises.
These robust frameworks do a great job in identifying reproducible personal characteristics that have led to innovation or enabled leaders of innovation. However, until now in innovation literature, there were very few examples from healthcare or a mission-driven innovation perspective.
At CCI, we believe you can make somebody (or an organization) more innovative. According to Christensen, “A critical insight from our research is that one’s ability to generate innovative ideas is not merely a function of the mind, but also a function of behaviors.… If we change our behaviors, we can improve our creative impact.”5 To “behaviors,” I’d add the environment and partners that reflect or direct our behaviors, because mission-driven innovation is such a team game.
When addressing groups from other academic medical centers who’ve asked CCI to help them evaluate preparedness for innovation, I often ask, “How many of you are innovators?” Even clarifying that I didn’t say inventors, I’m still shocked with the paltry show of hands.
CCI eventually figured out why our constituents were so ill-prepared to classify themselves as innovators: they lack creative boundaries, innovation infrastructure, and rewards. We held a mirror up to this set of problems to distill the transformative elements: calibrating creative focus, participating in a structured innovation process, and participating in reward related to creative thought.
Calibrating Creative Focus
We’re all problem solvers. In both our personal and professional lives, we identify and rectify challenging situations multiple times a day. These are the hurdles right in front of us, sometimes demanding our full attention. Even if somewhat out of the ordinary in content, they’re usually defined in scope and timing.
The reason some individuals fail to engage in innovation is that it lacks boundaries. The grand challenges, such “cure cancer” or “provide better healthcare in third-world countries” are just too expansive, even for the most capacious thinkers. Innovation leaders can address this barrier by helping their colleagues learn focus around creative thought.
Innovation by limitation sounds like an oxymoron. But it is helpful to remind the creative individual that “eating the elephant one bite at a time” is often the only way to accomplish the most daunting tasks. Innovators naturally feel limited by the encroachment of their “day jobs” or even the anticipated length of their careers. We can assist them by steering them toward manageable projects or elements thereof, then introducing the power of innovation partnerships.
Participating in a Structured Innovation Process
Every time we bring in a new member of our GHIA and provide access to our structured innovation function, there’s a flood of pent-up disclosures. The problem identification and creative solution wheels were turning, but the assessment and development function was missing from the new partner’s innovation milieu.
For example, MedStar Health, our first global alliance partner, registered no disclosures from its nearly 25,000 caregivers in 2010. During its first full year of operation in 2011, our alliance tracked 111 disclosures. Our friends at MedStar didn’t become innovative all of a sudden. The switch got flipped when the organization was made aware of the process.
We still debate whether simply having a robust innovation capability makes individuals or an organization more innovative. We subscribe to the belief and practice that you can stimulate meaningful innovation—not by simple reward and certainly not by looming penalty for those who do not take part in idea development. Basically, it is through extraction of the innate creative capability by surrounding it with the apparatus that innovation is augmented. But without infrastructure, not much progress will be made.
We have found that you must make your constituents aware of the innovation apparatus that is available to them. It is too easy to “default” to subjugating new ideas when the rigors of the day intercede. Educating your talented creatives about the services available to them overcomes the initial attrition of potentially promising concepts.
Participating in Reward Related to Creative Thought
There may be no more hotly contested debates in academic innovation than whether innovators should be rewarded for creative contributions—and if rewarded, by what mechanism. Summarized below are some of the key realities. Several are contentious and will receive more attention.
No inventor reward policy is mandated by law in either the private or public sector.
Under U.S. law, all patents are considered owned initially by the inventor; however, prevailing employment agreements often assign intellectual property (IP) rights to the employer.
The assignment mechanism and the reach of the employer into the creative work of its employees outside of the employment environment are determined by individual policy and contract.
The reward policy is likewise determined between the employer and its innovator-employees.
The concept of reward varies—monetary compensation is the most obvious inducement, but advancement (including academic tenure) is also considered a form of innovation reward.
Institutions variously value innovations that reach different stages of maturity—for example, disclosure, patent application, granted patent, and commercialization.
Financial rewards include, but are not limited to, internal bonuses or prizes for innovation competitions, royalties from licenses, and company equity.
A growing number of academic organizations celebrate their inventors with campus-based ceremonies, plaques, banquets, etc.
Many institutions, including Cleveland Clinic, struggle with determining whether an innovation was developed in the normal course of executing the employee’s vocational responsibilities.
There’s both an academic and a practical debate whether financial reward creates incentive or disincentive for innovation.
Innovation Versus Expectation
While each of these 10 realities deserves attention, the final two create the majority of debate and are the most ambiguous. The Pareto principle strikes again!
Accepting the assumption that everyone’s an expert and has the capability to innovate, it follows that both incremental improvement and disruptive advancement will result from normal daily work. The innovation leader is challenged with how to recognize and reward the innovation that stems from the inventor’s “day job.”
Whether an innovation is eligible for compensation according to institutional inventor policies is often determined by one test—was the idea conceived (and built) during the individual’s vocational engagement. This determination is not always straightforward at Cleveland Clinic and often requires adjudication by our Innovations Governance Advisory Board. Let’s recount three common situations:
Scenario A: Mary Jones, an orthopaedic surgeon, develops a new implant to stabilize fractures, resulting in a patent-protected device. A large manufacturer purchases the license for the implant, and royalties are negotiated. Dr. Jones’s real job is to see patients and do surgery. Although she may have been stimulated or inspired by the clinical material she encountered during her job, she was not originally hired to develop next-generation device solutions. The result is that Dr. Jones can participate in the upside, according to Cleveland Clinic’s inventor and distribution guidelines (40 percent of the net proceeds of any divestment and ongoing payment stream, with no limit on the absolute amount or the time over which the inventor receives rewards).
Scenario B: Bill Johnson works in the office of the CFO. He is tasked with developing new software to gather and analyze patient billing data. Due to his position, Bill controls institutional funds that he directed into accelerating the project. These software advancements would not be classified as an innovation for which the creator would receive direct financial consideration. Bill could get rewarded through our annual performance review process or some other institutional recognition, but would not participate in a royalty or equity position. His case is even clearer because he was able to direct funds to a project, usually an automatic disqualification from participating in revenue streams.
Scenario C: Jack Green is a postdoctoral fellow in the bioengineering lab and also participates in co-innovation with Dr. Jones, our orthopaedic surgeon. Dr. Green is expert with the prototyping machines on which Dr. Jones’s new implants were developed, and he made the first 5 to 10 mock-ups. He suggested a slight modification that ultimately was incorporated. In this case, Dr. Green was acting in a technical support role, which would not qualify him to receive remuneration. Where it gets more challenging is determining whether his scholarly contribution substantively influenced the design of the implant. Our rule of thumb is that if the individual has contributed enough to be listed on the patent, then he or she probably deserves financial consideration for the intellectual components.
The Influence of Rewards on Innovation
Cleveland Clinic’s inventor distribution policy is a 60-40 split of net proceeds of a commercial license. Inventors receive 40 percent, while the remaining 60 percent is equally divided between the inventor’s clinical institute of origin, CCI, and Cleveland Clinic’s Lerner Research Institute.
This distribution scheme clearly recognizes the contribution of the inventor. Obviously if there’s co-innovation, the primary innovator(s) are determined. The 20 percent to our research institute was designed to recognize the contribution discovery scientists make to most advances. Despite some projects developing without influence from our research infrastructure, the research institute remains worthy of our support, especially in today’s challenged fiscal environment.
There’s no misperception that all innovation happens in the off-hours. Physicians, scientists, executives, and others rarely turn off their brains, so substantial innovation is being accomplished during office hours or operating room block time. Instead of quibbling about how much light, heat, and water an innovator may have utilized while ideating, or insisting upon a time accounting of when ideas were conceived or developed, compensating the unit of the innovator’s origin has proven highly successful for us. Usually, institute leadership deploys the monies received to perpetuate the innovation infrastructure, specifically by providing seed funding to emerging projects and participating in committees that screen innovation merit.
There are some who argue against financial rewards for innovation in an academic setting.6 The prevailing sentiments range from apprehension about misjudging the value of creative thought by existing standards to more theoretical concern about contaminating the academic mission with financial inducement. It may be valid that incentives are built around what we already know and understand how to measure. But our viewpoint is that reward for innovation activity enables rather than contradicts the academic mission.
To date, CCI has distributed over $90 million to on-campus inventors. According to our IP and inventor policies, we have no maximum to the distribution, nor does the time during which an inventor may benefit from his or her invention expire. We write six- and seven-figure checks to our inventors and have never regretted our policy. This motivates not only the recipients but also those around them to continue to pursue innovation.
We are all on one-year contracts at Cleveland Clinic, and there is no bonus structure. We do get compensation adjustments after the annual performance review, but those follow for only another year. The ability to enhance independent wealth generation by participating in royalty-bearing licenses or equity stakes in companies created from ideas is a strong differentiator that attracts and retains top talent in Cleveland. It’s gratifying to be a master clinician in itself, but when one adds the role of inventor, job satisfaction increases.
Every year, CCI bestows the F. Mason Sones Award for outstanding contribution in healthcare innovation. Examples of winning innovations include Vincent K. Tuohy for breast cancer vaccine research and Irene Katzan for development of our Knowledge Program, a new way to integrate patient feelings and outcomes into the electronic medical record. The Sones award is accompanied by a $50,000 check presented at our CEO’s annual State of the Clinic address to employees. Judging by the growing number of nominations, this mechanism also increases the awareness of and participation in innovation.
The tenured environment presents difficulties in terms of incentives for innovation. Measures such as number of papers, grants, or graduate students mentored can be tracked and weighed in tenure decisions. But how about contribution of groundbreaking technology with positive cultural and commercial outcomes? There’s growing appreciation that innovation resulting in commercialization should be considered in tenure decisions. While Cleveland Clinic is not an institution that grants tenure, many institutions like the University of Pennsylvania or our GHIA partner, the University of Notre Dame, are bringing innovation into the tenure discussion.7
Combating the Tyranny of Sequential Activity
I often ask inventors why they consistently pursue new solutions, while I simultaneously assess my own motivations. The answers are rarely about remuneration; innovators seek significance more than success. Attempting to synthesize the answers, I repeatedly hear about the primary frustration that almost every physician experiences during his or her career: We can care for only one patient at a time. I’ve heard this called the tyranny of sequential activity.
Once you’ve achieved a certain level of experience and expertise, you feel a responsibility to share it as widely as you can. That’s just how most colleagues think about distributing the gifts they’ve been given to help people. One way to extend yourself is geographically; many noble colleagues do mission work or practice in underserved areas. Unfortunately, even these individuals are still limited by the tyranny of sequential activity once they arrive at their destinations around the corner or around the world.
The alternative for physician-inventors is immersion in the challenges and rewards of innovation. Although they may be capable of touching only a limited number of patients in a day—those right in front of them—some instrument, device, or technique they create may touch dozens or hundreds around the world.
Contributing IP that can be scaled and distributed is the way to multiply yourself. It’s like dispensing knowledge through books or exposing larger communities to music through recordings. Inventing techniques and technologies that put capability in the hands of trained colleagues worldwide is one of the most rewarding things you can be engaged in.
The greatest satisfaction for my co-innovators comes from the highly personal and unique gratification that comes from multiplying themselves by mastering scalability.
One of my favorite Appalachian aphorisms is, “When you go to the fancy-dress ball, you dance with who brung ya.” There’s a pearl in that statement about the value of loyalty, but another interpretation is to stick with the set of attitudes and aptitudes that got you this far. In the field of innovation, it means that people will likely contribute in their particular field of specialty, so do everything in your power to surround them with infrastructure and interaction.
When your creatives start wandering off into territory that belongs to others and their ideas are consistently off the mark, nudge them back to doing what they do best, to “dance with who brung ’em.”
Building the Cleveland Clinic Team
At CCI, we seek ultimate team players who have the capability to be team captain. We seek individual high achievers with a deep commitment to advancing the art and science of both medicine and the process of innovation.
Another required trait is unwavering service orientation. It’s not an understatement that inventors think about their ideas consistently, some constantly. As an inventor myself, I am equally guilty, knowing personally how often my wheels were turning about some minute detail of an invention disclosure or where my submission was in the development or transaction process. Managing hundreds of inventors requires people passionate about facilitating the arduous path from bedside or lab bench to bank.
Of course, all of our interactions hinge on adept communication skills. This may range from distilling sophisticated business terms for a scientist to delivering bad news about finding prior art that bursts another innovator’s bubble to involvement in a delicate negotiation over equity or investment for a first-time inventor.
Our colleagues at CCI are seasoned professionals, with the insight and capability to divine the merit of ideas in absolute terms, while considering the attractiveness to investors or market impact of the fully formed offerings that may result. We sometimes jest that the best candidate for a position at CCI holds MD, PhD, JD, and MBA degrees and is a notary public. Frankly, now that we have many team members who hold several or most of those degrees, it’s no longer a joke!
Once a group is assembled, instincts take over that are similar to those who are creating championship organizations. The best coaches know where to place individuals to bring about both individual and team success. I credit CCI’s senior leadership with much of the insight that has placed our stars in positions in which they can excel, while ensuring there are robust professional development pathways.
Not all players have the same gifts; shortstops have a different skill set from pitchers or catchers. While the same holds true in the innovation business, I’m consistently impressed with how proficient everyone at CCI is as a utility infielder. They may have deep domain or industry experience, but they are sufficiently open-minded and flexible to provide insight across our portfolio.
This invokes Kelley’s “I-shaped versus T-shaped” people concept from The Ten Faces of Innovation.8 Kelley captures what most of us innately recognize: that there are people who achieve a level of expertise and success but limit themselves to their domain of engagement. These he calls I-shaped people. There’s absolutely nothing wrong with that. In fact, it really reflects one of the strengths of vertically oriented care-delivery systems like Cleveland Clinic. Extreme focus allows extraordinary expertise.
You can’t imagine how many times I was the butt of jokes about whether I operate on only the right hand or the left, because hand surgeons are known for being super-sub-subspecialists. It’s a luxury to explore the depths of one pursuit, but it does have a drawback: it can prevent the type of benefits that come from connectivity or association.
While we don’t exactly advocate the jack-of-all-trades philosophy, we do see the merit of the “T-shaped” person, who has deep domain expertise permitting understanding of intricacies and who maintains a current Rolodex of key players in the related development, investment, regulatory, and legal fields. And although such an individual may be the medical-device development guru, he or she also knows what’s going on in pharma or health information technology (HIT). This is especially relevant, because some deals have elements that directly overlap, especially with HIT, which seems to touch almost everything.
The additive effect of cross-pollination, so important in organic innovation, is precisely why the professionals of CCI inhabit a singular facility. The benefit is the water-cooler conversations that facilitate information exchange and the final puzzle pieces being found from sources outside the domain work group. The other thing that hiring T-shapers does is foster respect among colleagues—they come to understand that others face and surmount similar challenges. Help on a deal may be no further than two offices over.
Of course, we don’t rely only on chance meetings when our mavens get dehydrated. One of the most important tools is our quarterly business review (QBR). During the QBR, each of our domain incubators (medical device, therapeutics and diagnostics, HIT, and delivery solutions) presents its in-progress deals. Technologies and commercialization or investment approaches are detailed. We walk away from the QBRs with deep respect for the capabilities of teammates and usually leave with something clarified or with leads in our own spheres.
The QBR is also the time when we discuss our strategies for CCI. All teams work best when communication is at its most robust, and CCI is no exception. When we have our entire roster of colleagues gathered, we get the chance to reaffirm our core mission, while also revealing where we believe the puck is going. We follow with a completely open Q&A session. This level of transparency is one of the elements that accelerate innovation, while enfranchising our valuable contemporaries.
We’re also sure to celebrate successes at the QBRs. Recognizing triumphs publically has a favorable effect on individuals who participate directly in the achievement and sends a message that we rejoice in the good fortune of others. Everybody in the room anticipates when they’ll next share the spotlight. We don’t avoid critical analysis during these sessions, but we lean much more toward positive public recognition of teams and instead deal with individual challenges in more private settings.
Our “minor-league” development mechanism is our internship program. This structured experience brings energetic and intelligent young men and women to CCI for three or four months and is heavily oversubscribed each year. We hire over a dozen promising scholars, ranging from high schoolers to those about to graduate from JD/MBA programs, who have a keen interest in innovation and entrepreneurship.
Interns are the gift you give yourself. All of us need to replenish our energy, thoughts, and enthusiasm. Frankly, it also doesn’t hurt to be reminded that your job is cool and attractive to the best and brightest coming up through the ranks. We get as much as we give to the interns. Because they’re unencumbered by the scar tissue of failures or seemingly insoluble problems, interns can provide insight that breaks stalemates and defuses standoffs.
You must allow interns a voice. When you carry the same title in medical training, you inhabit the lowest rung and aren’t really called upon to provide more than the fruits of perspiration, not inspiration. When life and death are at stake, seasoned professionals sometimes don’t want to waste time and energy on the opinions of those not yet acculturated in the field.
We look at it a little differently. The intern probably spent considerable time with the inventor, heard from every consultant, and had just enough knowledge to discern the nomenclature, but not so much that bias crept in. The intern is precisely the person to ask, “What’s the next step?” or simply, “What do you think?” Listen to them. They’re often the closest to the action and, if made to feel comfortable, could provide critical insight into inventors and industry.
We’ve hired a great many of our interns. They get to know our people and our culture. They’ve taken the time to learn what mission-driven innovation is and to understand its intricacies. They’re as enthusiastic about the pursuit as the product. They remind us how important it is to teach and live innovatively.
I conclude with a simple reality of managing people: Your staff will be recruited by other organizations—some will move on. What else would you expect when you’ve attracted bright and creative people, then tasked them with critical responsibilities on which they performed splendidly?
We’ve seen executives take one of two roads in dealing with that eventuality. Some immediately assume that an employee entertaining an attractive job offer is disloyal, while others celebrate that their people are sought after because of their contribution to a leading organization. Take the high road.
Besides the fact that we should all rejoice in the good fortune of others, the innovation community is a “small dance floor”; we have an interdependence and level of connectivity that puts us in frequent, if not constant, contact. I’m so proud of our team at CCI and truly believe that, as servant leaders, we work for them, not the inverse. However, we’re also proud that former CCI employees now head the innovation functions at Johns Hopkins University, Partners Healthcare, and Vanderbilt University. Just as a university or residency training program celebrates the accomplishments of graduates because the diaspora expands the scope and identity of the alma mater, Cleveland Clinic has become known as the cradle of innovation leaders.
There is no shortage of good ideas. It’s a noble pursuit to empower and align the most experienced professionals in the industry to develop and divest them. This dedication brings personal success, honors institutional identities, and helps patients. In the final analysis, it’s good to remember that it wasn’t just the drug or device that helped the patient. It was also an innovator—a person who cared deeply and leveraged intellect and skill to positively influence the lives of others.