6

ASK “WHAT IF?”

Don’t wait for others in your industry to reimagine how you deliver value.
Fire up your imagination and do it yourself.

In 2020, as Ghana was preparing to hold a presidential election, polling officials in one region faced a difficult situation. With the pandemic raging, personnel manning the polls lacked the masks and protective equipment they needed to stay safe. The polls were scheduled to open in just 48 hours. There was no way that officials could distribute the supplies that quickly by truck to dozens of sites.

Fortunately, the Ghanaian government could turn to a different, nontraditional option: distributing the supplies by autonomous drone. Within those 48 hours, drones had flown over 18,000 face masks and other equipment to 29 sites, making 160 different flights. The polling stations opened on time, with all personnel having the equipment to stay safe.¹

Ghana’s ability to transport medical equipment so quickly owes to the imagination and drive of a brilliant young entrepreneur named Keller Cliffton Rinaudo. During the early 2010s, Keller became fascinated with robotics and automation technology, especially their potential to revolutionize global logistics. Rather than using big, expensive, gas-guzzling trucks to move goods around, he imagined that societies might one day rely on an automated network of battery-operated drones to make deliveries. The result could be “game-changing for humanity,” he says, allowing us to move goods far more cheaply and efficiently and with far less environmental impact.²

Between 2013 and 2015, Keller and several cofounders of the startup Zipline set about designing such an automated drone network. To maximize their humanitarian impact, they focused at first on the logistical challenge of delivering healthcare products. If you’re lucky enough to live in a wealthy part of the world, you can physically access the medications, devices, and other healthcare-related materials you need (affording them is another matter). But due to a wide variety of factors, the largest logistics companies only do a good job serving the wealthier people in developed countries. This inequality amounts to a humanitarian disaster: each year, millions of kids around the world die because they can’t access the basic medical products they need.

Consulting with governments in East Africa, Keller and his team convinced Rwanda to allow Zipline to transport donated blood—a vital medical product often scarce in local areas—via drone. Zipline launched its service in 2016 on a limited basis, becoming the world’s first medical drone company.

As Keller discovered, he and his team had grossly underestimated the challenges of operating a distribution network for a complicated and perishable product like blood. There were many kinds of blood products, and they had to be stored under different conditions. These products also had different shelf lives. For nine months, the team pulled all-nighters, desperately iterating to get the service working reliably. The plan had been to ferry blood to 21 hospitals around the country, but the team focused at first on getting it reliably to just a single hospital. “The government was very patient with us,” Keller says. “What we were doing was totally unprecedented. No one had ever heard of this idea of using autonomous vehicles to deliver healthcare products. And then, one day, it started working.”

Rwanda had taken a huge bet on a promising technology as well as on Keller’s team of “10 nerdy twenty-somethings.” Good thing: today, Rwanda has the world’s largest system of commercial autonomous vehicles and is the first country to put each of its citizens within a 15-minute delivery of any essential medical product. Zipline has dramatically expanded its footprint, serving 2,500 hospitals and health facilities across Rwanda, Ghana, and Nigeria.

Taking our lead from Rwanda, Intermountain is now making its own bet on Zipline. As the company enters the US market, we’ll be one of the first major health systems to roll out delivery via automated drones. Initially, we’ll deliver medications and other products, but in the years to come, we’ll expand the service to cover a much broader range of products.³ Our patients will be able to consult with their doctors virtually and have their medications transported to them in the time it takes their local pizza place to make a delivery— no need to visit a pharmacy. For seriously ill patients or those living in rural areas, this will be a game changer. For all patients, drone deliveries will make healthcare much more convenient, making it easier to stay healthier and out of hospitals.

Skeptics might think we’re a little loopy to pursue drone deliveries of medications. We see it differently. Why not seek out promising new ways of delivering care in service to our mission? Shouldn’t health systems like ours explore emerging technologies that might be relevant and applicable, including not just drones but also artificial intelligence, genomics, blockchain, 3D printing, the metaverse, and more, and take bold risks to pursue them? Shouldn’t we be willing to reimagine every-thing about our core offerings to improve quality, reduce cost, and render care more convenient and accessible?

We believe we should, and it’s a proposition we’d extend to large, established companies everywhere. As good as our present offerings might be, we should still scour every facet of our businesses on an ongoing basis for opportunities to fundamentally redesign and improve what we do. When we come across potentially important technological innovations, we should test and spread them quickly, taking risks and learning from our mistakes. After all, the nimble start-ups seeking to eat our lunch aren’t just innovating incrementally— they’re making quantum leaps, reimagining existing businesses from top to bottom. We can do the same, but only if we’re willing to fire up our creativity with a new sense of urgency. Every day, we must rededicate ourselves to asking that simple but pivotal question: What if?

CULTIVATE THE TWO Cs

In general, finding specific innovations that will revolutionize our offerings comes down to two Cs: curiosity and creativity. We must stay curious about the world around us, constantly scanning the horizon. And we must also think creatively about what we encounter and how we might use it to transform our offerings.

I first met Keller at the Sun Valley Conference, an annual, invitation-only gathering of iconic leaders in technology, media, and sports and one of the most amazing places on the planet to meet smart people. I felt highly privileged to be at the conference that year and excited to learn about new technologies and business concepts. I wasn’t disappointed! Recognizing that we don’t have a monopoly on great ideas, my team and I regularly scour the business media and hold conversations with innovators in our industry and beyond. We stay alert in our personal lives, looking for innovations in other areas that we might bring to healthcare. I especially seek out ideas from unrelated industries and distant geographies, urging others to do so as well. I once even sent a team to India to understand how to develop higher quality care at much lower cost.

We’re not afraid to borrow ideas from others, and of course, to credit them generously. In 2021, we began offering an educational benefit to our 42,000 employees, partnering with a company called InStride to offer tuition support to attend college and obtain degrees. I didn’t come up with that idea myself. Rather, I observed the education initiatives rolled out at companies like Starbucks and Walmart and realized that such programs could make sense at Intermountain, too. Likewise, as we were designing our MyHealth+ digital portal for patients (launched in July 2020), we talked to Delta Airlines about their consumer portal.⁴ Admiring what they’d done, we wondered which elements of it we could bring to Intermountain.

My own habit of staying alert to trends and new ideas the world over is not new. I first awoke to digital’s potential during the early 2010s while traveling in Africa. I’ll never forget going for a run with Masai tribesmen wearing traditional garb and watching as they pulled out their phones to check Facebook. Later, when I became CEO, I conducted a formal study of megatrends and industries being transformed by technologies, seeking to understand how technologies, including digital, might contribute to healthcare’s future.

I also came to envision more specific applications of digital while noticing how companies I encountered in my personal life were enabling consumers to book haircuts or order products on their phones. Why, I thought, couldn’t we create a platform that would allow our patients to proactively manage their own care, booking appointments, checking their symptoms, paying their bills, and so on? Doing so would help patients stay well, as it would empower them to better manage their own preventive care. That in turn would reduce the number of urgent care and emergency room visits, lowering costs for our system. Consulting closely with patients and caregivers, we’ve continued to add new functions to MyHealth+ (more on this later) to make care even easier to access.

I try to pay special attention to new startups in our space, especially those whose innovations might facilitate our move toward value-based care and population health. Early in my tenure as Intermountain’s CEO, we spotted a couple of startups working to allow patients to access care in their own homes instead of in the hospital. That made enormous sense to me. Years ago, when I was Cleveland Clinic’s chief medical operations officer, my team performed a study of patients admitted to the Clinic’s excellent and very expensive main campus to see what percentage of them truly needed treatment there. Our stunning finding: less than 20 percent needed treatment on our campus, and we could have cared for the rest in less expensive settings that, in most cases, were located closer to patients’ homes.

When you think of how much unnecessary expense the nation’s healthcare system is taking on, it’s unfathomable. Research also suggests that people like to heal at home, where they feel less anxiety and experience better outcomes.⁵ And yet, most health systems don’t aggressively embrace the idea of Hospital at Home. That’s because they get paid based on how many people they get to come to the hospital. These outdated financial incentives simply don’t serve patients well, but they still work for generating revenue for health systems. As a result, it’s way too easy to make money doing the wrong thing.

What if you could make money doing the right thing? What if you realigned incentives to keep people well and allow the business to thrive? It turns out, you can. Our population health model pays us more if we keep patients well and care for them efficiently and appropriately when they’re sick. Hospital at Home fits right in with that. Patients achieve great outcomes because our hospital-based caregivers monitor them remotely and our specially trained nurses visit them at home. Meanwhile, it costs us much less to provide this kind of care, so our financial performance improves. The incentives work for everyone.

You might presume that only a few patients suffering from relatively minor ailments would be able to receive care at home. Not so. As of 2021, our Hospital at Home program was operating out of a dozen hospitals in Utah, serving patients suffering from ailments like congestive heart failure, pneumonia, infections, and cancer.⁶ We’re moving quickly to expand the program and keep even more people out of the hospital. Between December 29, 2019, and January 2, 2022, we saved close to 5,000 hospital days for patients by treating them at home. In this instance, we stayed alert to what small innovators in our industry were doing and ran with it ourselves.

I’m not suggesting that all powerful innovations originate outside a company’s four walls. Our current pursuit of digital innovation builds on a foundation of innovation that my predecessors and their teams pursued for decades. And any number of specific innovations my team and I have pursued also predate me. We had been working on telemedicine offerings, for instance, since the early 2010s, developing programs in areas such as critical care or stroke care. My team and I consolidated and expanded these services, opening a virtual hospital called Connect Care Pro comprised of 35 programs and more than 500 caregivers.⁷ Connect Care Pro provides telemedicine at our own network of hospitals and sells services to other hospitals as well, furthering our mission of expanding access to quality care, especially in underserved rural areas.

Another important innovation we’re deploying called behavioral health integration also grew up within Intermountain. Imagine going to the doctor for a checkup, and in addition to having your blood pressure taken or your abdomen palpitated, you receive a screening for depression. Imagine as well that you interact with a primary care team of not just doctors and nurses but also a range of mental health providers. That doesn’t usually happen—but it should.

We’ve been studying and experimenting with folding behavioral health into primary care since the early 2000s, led by a national expert in the field, Dr. Brenda Reiss-Brennan.⁸ As our research has shown, we can keep people healthier by adopting this approach, reducing emergency room visits and hospital admissions. It’s not hard to understand why: by attending to people’s mental health needs, we can often prevent them from abusing drugs or alcohol, and we can empower them to take better care of themselves. It’s an investment for our system to hire more behavioral health personnel and integrate them with primary care providers, but for every dollar we spend, we save over five dollars.⁹

We still have much more to do to fully integrate behavioral health and primary care. It’s a challenge to hire enough social workers, psychologists, and psychiatrists, so we’re also investigating how we might use digital tools to increase access for patients. We’re pushing ahead because we see behavioral health as an important part of our ongoing efforts to make care better by keeping people well. In this case, we didn’t have to scour the world asking, “What if?” Our own people were already doing it.

FORGE RADICAL COLLABORATIONS

Let’s say you’re an Intermountain patient, and you suffer from a significant health condition like diabetes or heart disease. Despite our use of digital technology, chances are still good that the vast majority of your care today will take place offline. The data we collect from our patients remains limited, and it doesn’t flow freely between our caregivers and other companies that could provide you with important healthcare-related services. As a result, we aren’t able to track your health very closely in real time and intervene proactively.

What if we could? One day soon, we might manage a wide range of specific illnesses on a daily basis through smartphone apps, using other digital devices to obtain health-related data that then become part of your medical record. Although many digital health applications exist, imagine if these apps were connected with one another and with any healthcare provider you might consult in a comprehensive way, allowing a team of caregivers to monitor your condition and to intervene quickly and proactively. Imagine, further, if advanced algorithms were analyzing your data, helping doctors spot developing problems and suggesting preemptive action. Our ability to keep you healthy and out of the hospital would improve dramatically, making healthcare much more affordable for society.

If you had diabetes, for instance, an app helping you manage your condition might automatically share data with your care team at Intermountain. When you come in for your annual checkup, your care team could review in detail your interactions related to that app for the preceding year. Algorithms looking at the data could alert your doctor to specific problems they might not have spotted, allowing them to adjust your care.

The algorithms might spot biomarkers suggesting a risk of a certain condition developing, prompting them to test you for it. Or they might notice changes in your behavior—for instance, that your diet has worsened in recent weeks. That might prompt a call from your healthcare team. If it turns out, say, that you’ve been depressed, your health team could send over a behavioral therapist to help you get out of your funk. Instead of your diabetes spiraling out of control or other health issues emerging, we’d be able to catch problems early and address them, keeping you well.

Such close, real-time attention to your wellness would represent a revolution in how we deliver healthcare. Bringing it to fruition isn’t simply a matter of engineering a single digital innovation. Rather, we must put in place a whole network of devices, applications, algorithms, and flows of data paired with caregiver teams. This network would be enormously complex, incorporating numerous innovations. The technical challenges would be more than any one health system could surmount on its own.

As we’ve learned, truly big industry-shaking changes in offerings usually require powerful collaborations. We’re working with two big players in the tech industry—Microsoft and the venture capital firm General Catalyst, an early investor in companies like Airbnb and Snap—to create a next-generation platform.¹⁰ Our goal is to incorporate our existing MyHealth+ app into something much bigger: a true physical and digital health system. This system won’t just revolutionize how Intermountain organizes and delivers care. It could do so for the entire industry.

Do you know how you can go to an app store and download thousands of apps onto your phone? Our platform will have something similar for healthcare systems. We want to create a new marketplace in which tech startups can create and market powerful apps to help health systems manage specific illnesses and run their own operations digitally. This platform will use common technical standards so that health systems everywhere can use them and so that data can flow between these applications. Right now, innovative startups can’t create and market applications because health systems use different software platforms and data is fragmented. Consumers also can’t easily move their data between health systems. By creating a common platform, we hope to unleash a torrent of digital innovation, revolutionize care, and make life much easier for consumers. Rather than having to design their own digital health systems from scratch, as they currently do, care providers like Intermountain will be able to build them quickly on a plug-and-play basis, choosing from among a huge library of applications.

This foundational platform we’re building is immensely complicated—my description of it just scratches the surface. To pull it off, we need a merger of different kinds of expertise. Certainly, we must mobilize our own intimate knowledge of what it takes to care for patients. But we also need the technical ability to design and build platforms that General Catalyst and its suite of companies have. We need Microsoft’s unrivaled ability to build software for large enterprises like ours. And we need the vision and expertise of hundreds or thousands of tech companies to design the specific digital applications for diseases like cancer, diabetes, and heart disease that health systems like ours can download and incorporate.

As managing partner of General Catalyst Hemant Taneja has created billions of dollars of value across industries like fintech, healthcare, and software. As he notes, it’s not realistic to think that technology companies can come in and disrupt an industry as complex as healthcare. You need the participation of healthcare systems as well, not to mention another big player, pharmaceutical companies. A “radical collaboration between technology, healthcare, and pharma” must occur if we are to use digital to fundamentally reimagine healthcare. Further, he notes, “healthcare is too big for any one technology company. You need to embrace an ecosystem of companies that are focused on solving the various parts or components that go into transformative customer experiences.”¹¹

A company called Livongo Health, which Taneja cofounded with Glen Tullman, uses digital tools to empower people suffering from diabetes, high blood pressure, and other problems to manage their health. Another startup backed by General Catalyst, Plume, offers transgender people specialized healthcare, including gender-affirming hormone treatments, via an online portal.¹² Pointing to similar examples in women’s health and elder care, Taneja says that healthcare’s digital transformation will require a whole slew of companies “with teams that have empathy for the different stakeholders and segments of consumers, creating organized care on the Internet for them.” In the years ahead, he believes that healthcare’s wide-ranging digital transformation will lead to the creation of hundreds of billion-dollar companies partnering with traditional health systems like Intermountain.

Think of it this way: Major airlines don’t build their own air-planes. They don’t design and build their own airports. They don’t build their own digital apps for their customers to use. They don’t make their own meals to serve customers on board. They work with a range of partners to help them deliver their offerings. To revolutionize how we care for patients, we in healthcare are doing the same. Large, established companies everywhere can take a collaborative approach, seeking out and building exciting new partnerships in their industries and beyond.

A WORKFORCE OF INNOVATORS

During the early 2010s, when Intermountain oncologist Dr. Derrick Haslem first heard about our telemedicine initiatives, he was slow to get on board. Like many doctors, Haslem believed he could only deliver high quality care if he built a very close, in-person relationship with patients and caregivers. Treating patients entailed “lots of handholding and arms around shoulders and that sort of thing. I thought we’d never be able to replicate that through telemedicine.”¹³

Haslem’s perspective changed in 2014, when his uncle was diagnosed with incurable stomach cancer. This uncle lived in Haslem’s hometown of Vernal, in Utah’s rural northeastern corner. Since the care his uncle needed wasn’t available in Vernal, his uncle had to make a three-hour drive to Provo to obtain it.

During the last six months of his life, his uncle drove round-trip to Provo an estimated 36 times. He would pack a bag because each time he left home he wasn’t certain if his care would require him to stay overnight or if he’d feel well enough to drive back. All of this driving struck Haslem as both sad and tragic. “When someone is in the end stage of cancer,” he says, “and that’s what their life consists of, they’re really missing out on the chance to be at home around the people they love, connecting with them.”¹⁴

Moved by his uncle’s struggles, Haslem decided to give teleoncology a try. In 2015, he and his team began to set up tele-oncology services in local areas. One of the first towns in their footprint was Richfield, Utah, about two hours outside of Provo. Haslem remained skeptical, so when he went to pay an initial visit to the hospital in Richfield that would host videoconferences with physicians, he specified that his team would first see each patient in person to get to know them. To his surprise, not a single patient wanted to make that initial visit in person.

After the first few teleconferences with patients, Haslem realized that they were every bit as powerful as regular office visits. When these patients expressed gratitude that they could dash over to their local hospital and receive treatment for their disease, he was completely won over. “It just dawned on me that people do want the highest level of cancer care, but shortly after that, they want convenience, and they want to be around the people they know and trust. They want to be in their hometown. They want to run down to their local hospital and get their treatment. Then they want to go back to their lives, as normal as they can possibly be.”

Since then, Haslem has played a key role in helping to establish telemedicine oncology clinics, not just within our system but at hospitals outside it as well. Telemedicine, he says, is “much more rewarding than you can possibly imagine. The patient satisfaction scores we get from these patients . . . is just off the charts. It’s a real service that you don’t really get to capture unless you try it.”¹⁵ Haslem is helping to spread the word about tele-oncology’s benefits nationally and has become an evangelist for a more customer-centric approach to healthcare.¹⁶ As he says, “We just have to get past this idea that it’s bricks and mortar and everybody comes to us. We have the ability nowadays to really go out to people and improve that access and take care of them.”¹⁷

When leaders focus on reimagining an organization’s offerings, they unleash others within the workforce to effectuate change as well, even those who initially resist change. As we at Intermountain have learned, it’s important not only to give growth opportunities to people like Dr. Haslem but to engage people throughout the organization around innovation.

An important way that we do that is through Intermountain Ventures, a separate company we founded in 2019 that is dedicated to finding and investing in startups that promise to benefit patients. As managing director Nickolas Mark notes, Intermountain Ventures is “the innovation portal for Intermountain Healthcare.” “What if?” might as well be their motto.¹⁸ Other health systems have venture groups, but because ours is a separate entity, it can move quickly to analyze and pursue prospective business ideas. Our main priorities, among others, include expanding value-based care, reducing total costs of care, providing world-class patient experiences, and achieving health equity objectives.¹⁹

In launching new ventures, we often start by engaging on a regular basis with our clinicians and business leaders across Intermountain, encouraging them to ask the same question: What if? What problems would they like to see solved for the benefit of patients? Our ventures team also engages externally to identify high quality innovation transforming health and wellness and maintain deep relationships with a range of experts in the technology space, including entrepreneurs, academics, nonprofits, investment banks, venture capital firms, and others. During these sourcing efforts, we explore exciting new innovations that we might potentially apply and learn from across Intermountain.

When we pilot new innovations, we rely on our clinicians to provide feedback. Dozens of physicians across our system help us evaluate and implement new innovations, serving as champions of these new technical solutions. As George Hamilton, former managing director of Intermountain Ventures, explains, “The most important component of the pilot work we do is having a clinical champion. We need someone inside the clinical organization to be excited enough about the opportunity to pound the table for it and represent it.”²⁰

The ability to test innovations in clinical settings is vital. Nickolas Mark notes that, “We have this active, living laboratory that allows us to engage and say, yes, this really works in a community-based care organization.”²¹ Our venture arm doesn’t just help us by funding promising startups with the potential to transform healthcare. It also empowers people across Intermountain to stay alert to new ideas and helps us celebrate our collective success.

We also have an internal process in place that helps our clinicians and others within Intermountain to turn their own good ideas into workable businesses. This process—we call it our Foundry program—enables our people to gain financially from their innovations and for Intermountain to benefit as well. The Foundry allows employees to participate in a boot camp experience in which they refine their ideas. We then vet those ideas via a competition that resembles the television show Shark Tank.²² Thanks to this process, a number of promising ventures have emerged from our frontline clinicians. Remember Dr. Brenda Reiss-Brennan, who championed the integration of behavioral health with primary care? Our ventures group started a new company called Alluceo that helps other health systems in our industry bring integration to life.²³

THE VIRTUES OF “FAITH-BASED INVESTMENTS”

We’ve discussed several big innovations: telemedicine, deliveries by drone, revolutionary digital platforms. But what if you simply want to consult with your doctor without the usual hassle of having to arrive early to fill out bureaucratic forms?

Some months after introducing our MyHealth+ app, we added a new service to it that allows patients visiting practitioners at our internal medicine group to check in online prior to their visit. By entering health and insurance information digitally on their smart-phones, customers can cut down the time it takes them to check in by 25 percent. If applicable, the app offers them a chance to consult with their doctor virtually, saving them a trip entirely. On our side, the system simplifies work for our administrative assistants, saving our teams time and money. In our initial test of the system, patients loved it, with 94 percent of them expressing satisfaction.²⁴

Streamlining patient check-ins is just one of dozens of ways we’re using MyHealth+ to improve how we deliver care to patients. Our patients can now pay their bills online, receive reminders to obtain lab tests and perform other preventive care, manage appointments for their kids, access their health records, check their symptoms to see what kind of care they might need, manage their prescriptions, and even estimate how much their healthcare will cost.²⁵ Collectively, these online tools make obtaining care much easier and more convenient. Our patients love it, as evidenced by the speed with which they’ve adopted MyHealth+. Within just six months, we counted over 350,000 registered users.

In bringing healthcare into the digital age, we’re looking at every aspect of the patient experience, even the seemingly less significant ones. Staying ahead of disruption requires nothing less—a lesson that applies to leaders regardless of our industry. To outrun disruption and deliver for our stakeholders, we can’t give ourselves and our organizations a pass on imagination and creativity. We must seek out novel solutions far and wide, as well as close to home. We must lead progress in our industries by building new ecosystems of partners. And we must take steps to engage our workforces in innovation as well.

Leaders at established firms sometimes balk at making these investments, fearing that updating their offerings will disrupt their existing business models. They worry that redesigned products and services might lower demand for their traditional, higher-cost products and services, causing drops in revenue. As we in healthcare know quite well, economic incentives can often discourage otherwise well-intentioned firms from innovating. In the short term, at least, these firms find that they’ll generate more revenue offering products and services that cost customers more and please them less. Taking a short-term financial hit to implement an innovation for the sake of some uncertain future gains seems too risky.

We believe these are risks well worth taking. It’s true that as a not-for-profit health system, Intermountain doesn’t face the intense, quarterly market pressure that leaders of publicly traded firms feel. But we, too, must operate as a healthy, sustainable business over the long term. In this regard, our efforts in pursuit of the innovations I’ve described are, as our CFO Bert Zimmerli likes to say, “faith-based investments.” He’s not talking about religious faith. What he means is that we’re making these investments because we know they’re good for our patients, and we have faith that over time they’ll be good for Intermountain, too.

Rather than pursuing innovation for its own sake, we should do it in ways that serve an organization’s mission and are financially sustainable over the long term. Some might feel tempted to chase innovation simply because it’s “cool,” but we at Intermountain do it with a relentless focus on patients and their families. For each innovation, we ask hard questions about whether our investments will have an important impact on access, quality, cost, and so on. If we don’t like the answers, we drop the innovation in question and move on.

In considering “What if?,” leaders should also ask if potential innovations we’re considering support a viable business model. Intermountain could undertake the innovations I’ve described because over the long term they’ll help us run a healthy business and care for patients better, given our movement toward population health. Transferring patients out of the hospital more quickly and caring for them at home means that in the short term our hospitals lose revenues from procedures, tests, and other services. Implementing the MyHealth+ portal likewise keeps people healthier, cutting into revenues our physicians and hospitals might have earned. But since under population health, we increasingly earn revenues by keeping people well, innovations such as these will ultimately increase our systemwide revenues and are the right thing to do. We just need to sit tight and have faith.

In truth, we must do more than sit tight. Over the short term, we must also ensure that our organization is as well positioned as possible financially to make bets on the future. The process improvements and organizational shifts described earlier in this book are so important because they enable us to run our existing business as efficiently as possible, allowing for more financial stability and in turn more resources to invest in innovation. Stable businesses also allow us to weather short-term declines in revenue while we’re waiting for innovations to bear fruit.

In most industries, leaders are aware of the big customer trends and technological developments. What’s hard is actually engineering and delivering the winning customer offerings of tomorrow. We must constantly strive to redesign how we deliver value to make it more appealing to customers and more aligned with our ultimate mission. We must give it our full focus, attention, and passion, and we must devote sufficient resources. We must move quickly, testing ideas and spreading them as quickly as we can. We must even skip the pilot phase when we know with a fair degree of certainty that a proposed innovation is desirable, necessary, and practicable. We did without a formal pilot, for example, when we decided to reduce opioid prescriptions. We just knew that it was the right thing to do, and it would work, so we began phasing it in across the organization. We were not disappointed.

Our organizations and our stakeholders have so much to gain if we fire up our imaginations and relentlessly redesign what they do. Don’t look fearfully at impending disruption and ask, “Why now?” Mustering both humility and curiosity, look around at new technologies and business ideas and ask, “What if?”