CHAPTER NINE
Innovation the Mayo Clinic Way
A Prescription for An Experience in Innovation
You cannot transform by amending the status quo.
Ah, there it is. Or there it was. The “P” word, the word prescription. You know we are health care professionals, and perhaps with Clayton Christensen’s seminal work The Innovator’s Prescription in mind, you’ve expected us for eight chapters to “prescribe” how to innovate and to “prescribe” how to change the future of health care. From us to you, written on a small piece of paper and signed (or its electronic equivalent)—a formula for fixing something and moving forward.
We may be employed by one of the top medical practices in the world, and we may be from the top echelons of our professions. But we know that we do not have the exact solution—a “prescription”—for all that ails health care, let alone, an exact solution to bring you success in the oh-so-elusive frontiers of innovation.
For that reason and many others, we’ve held ourselves back from using the “P” word. It’s overused in the medical field anyhow. This isn’t a prescription, or a “treatment plan,” a formula we hand down to you for success. Rather, it is a list of ideas, principles—learnings, lessons, failures that informed our progress, our evolution, ripe for you to incorporate into your own organizational framework to achieve success.
We hope we have given you a clear-eyed view of the opportunity to transform health care, and you’ve seen how we’ve gone about approaching the opportunity ourselves. Your opportunity may or may not be related to health care, but we suspect you face similar challenges in moving your own complex organization forward toward important goals—as obvious or unobvious as those goals might be today.
So rather than a prescription or treatment plan, what we offer is more of a checklist for developing a solid structural and cultural foundation to achieve important innovation in complex environments. It should help you figure out what you need to do, what to do, and it should help you figure out where to invest. It’s more of a plan for innovation health and for innovation team health.
For you, it may start with something that is broken—or it may not. Our goal is to help you build organizational health and vitality so that, in your own innovations, success becomes more of a self-fulfilling prophecy in a way similar to good health becoming a natural outcome for people who follow good health habits. Good innovation habits bring good innovation health, just as good personal habits bring good personal health.
Here, for the record—and to conclude our book—are 10 principles, based wholly from our experience, for achieving successful, transformative innovation in complex environments and enterprises. These principles—above all else—are crafted to help you Think Big, Start Small, Move Fast.
1. Create a Distinct, Embedded Team; Build a Unique Identity
Over and over again we see individuals or small groups in complex enterprises gather some resources “under the radar” to go off to try to move something forward as a skunk works. While this is successful at times, and while this may be a place to start, and while our early beginnings had some of this DNA, we firmly believe in quickly evolving to building a highly visible, embedded innovation “center” literally in the center of the enterprise.
Locating in the center of the enterprise helps your work gain traction by it being clearly visible, and it also helps expand the dialogue, the interaction, the collaboration, and the involvement of the rest of the organization. By nature, people possess an innovative, creative spirit. As IDEO founder and Stanford professor David Kelley summarizes, creativity is not the domain of a chosen few but is inside each of us. We need to help people unleash their creativity, and for those who have lost touch with it, to build up their creative confidence.
People want to move their ideas forward, and when they see a legitimate, funded, resourced entity at the center of their organization carrying this out, they can join in without fear or risk of wasting their time, or worse, stepping in something not sanctioned by the greater enterprise. They get ideas and inspiration from it; and they contribute ideas and testing opportunities to it. By embedding and centering the innovation group, you get the “gains from exchange” not otherwise available. The embedded innovation organization should become a showcase—both physically and intellectually—for the organization. It should be an exciting, uplifting place to visit. It should have an identity congruent with transformative innovation, and it should present well to constituents.
Realistically, you may not have the funding or organizational backing to start in this position; we get that. But you should start with the end in mind—in this case, a formal, embedded, established innovation center. Even hanging an innovation shingle on a wall in an open, collaborative space is an important first step, and in fact, how we got started. Build it, and they will come.
2. Seek Diversity
If you simply bring existing organizational players into your innovation team, guess what? You’re likely to get pretty much the same perspective and style of work already inherent in your organization’s DNA. This isn’t all bad—you need some people who know how to play your enterprise’s game.
But there is so much to be gained from the experiences, intellect, and perspectives of people who enter your organization from the outside. People with different educational backgrounds and skill sets and people who have worked in different organizations and different industries or even on their own bring a fresh, new way of framing and solving problems that usually turns out better results, and more quickly. Fresh insights can be priceless for those who want to Think Big, Start Small, Move Fast.
Especially in our industry, where there is a strong “button down” tradition of how things are done, this is important. If you want a new solution, you need fresh perspectives, and if you want fresh perspectives, you’re best served to bring in smart people and smart insights from a variety of backgrounds. The best mix is a healthy combination of “new blood” and well-established, credible internal performers who know how to navigate the shoals of your enterprise.
We initially built our diversity by engaging with concept champions like IDEO and Doblin, visiting other innovation centers, especially those in other industries, by bringing in interns and other outsiders where we could do so on a modest budget, and by selective hiring.
3. Take an Integrated, Holistic Approach
We know it sounds sort of late-1960s “groovy,” but we’ve found over time that it makes sense to approach transformation—and how we staff and organize to approach that transformation—with a holistic, big-picture approach.
What does that mean? First, as we approach the health care problem, it means that we look at the problem as a whole, “Health and health care, here, there, and everywhere.” We don’t align our focus and our troops to just one aspect of that problem, for example, acute episodic care delivered in the clinic. We look at health care and health care transformation as a system.
The risk, of course, is that we try to “boil the ocean”—that is, we overextend our resources and bandwidth so as not to do any one thing well, or even to completion. That risk is offset by the synergies and benefits we get from applying our learnings and tools to several corners of the problem at once, as we’ve seen by applying Connected Care technologies to both in-facility and remote care. We also avoid the boil-the-ocean thing by carefully structuring programs and projects within the “whole” in such a way to be certain that we start with smaller defined initiatives and make good progress on all fronts with high-return projects. We don’t get lost in the weeds with something too big to handle or too off-center to be meaningful. We truly live by our motto Think Big, Start Small, Move Fast.
The integrated, holistic approach has also come to apply to our people. Most organizations tend to “silo” their employees as project managers, designers, IT specialists, and so forth. We recognize the need for expertise, but rather than creating internal friction by having different groups with different perspectives and metrics interact with each other from under their own secular roofs, we’ve created the Fusion Innovation Model, whereby the three disciplines of design thinking, scientific method, and project management come together as a whole. Furthermore, we’ve organized our group into “villages” around platforms, programs, and projects rather than organizing by our areas of specialty.
As a consequence, our team members have become “specialist-generalists” capable of applying holistic methods to a holistic problem. They have become like small business owners who have to do a little bit of everything to make it work. From our experience, this leads to better, more integrated solutions to problems, and it’s an easier and more rewarding way to work as well.
4. Champion a Clear Vision
We don’t believe any innovation organization can survive—let alone prosper—without a clear vision of where it is going and how that differs from today.
Mayo Clinic has invested a lot to arrive at the “Health and health care, here, there, and everywhere,” the “Always be there for me” vision. We’ve conceived it, worded it, put graphics around it, and spread it through the organization at every possible opportunity. In the CFI we continue to fine-tune it and to personalize it with the likes of “When I need to come to you,” “When you can come to me,” and “When I didn’t know I needed you” slogans.
The 21st century model of care is a complex thing, and nobody knows for sure exactly how it is going to look. Our vision evolves a little every time we start a project, complete a project, go through an environmental change (like the Affordable Care Act), or see something new outside of Mayo. It is organic and iterative. It is presented as a sequence—not just a picture of the future state but a picture of the evolutionary path to getting there (see Figure 3.4 for a refresher).
In sum, good visions are clear, they define something important, and they set an aspiration and destination to facilitate designing a path to get there. They are adaptive and organic, and they are communicated clearly to all parts of the organization. As a consequence, they are top of mind both for the innovation center and for enterprise constituents.
5. Communicate, Communicate, Communicate
It happens all the time. Great ideas, great innovations from great people, great teams with great leaders—but nothing happens! Thought leaders are left scratching their heads. What happened? What didn’t happen? And why?
Chances are, their ideas, their efforts, even their very existence may remain invisible to the powers that be and to the rest of their enterprise.
We recognized the importance of transfusing what we do to our constituency. We recognized the need for clear, appealing, meaningful communications about what we do and what we think across all channels available inside (and outside) the enterprise. We invested in an identity, in pleasing, professional-grade graphic collateral, in multimedia presentations, and in clever, brief updates like i on CFI that regularly feed a clear message to busy people in important places in the enterprise. We treat communication as a must, assigning resources to make sure it happens and having a regular communications timetable, rather than communicating as afterthought when somebody asks a question.
In all, we use communication not only to get the word out but also to accomplish two other critically important purposes. First, high-quality communications add an aura of professionalism to our work. We are not an under-the-radar skunk works but rather a permanent team embedded within the enterprise, and we are to be taken seriously and watched closely. Second, our communications serve not only to inform and motivate our constituents but also our own team. How motivating is it when you see your project go to print in a fine, four-color glossy Mayo Clinic publication?
From what we’ve observed outside Mayo Clinic, innovation teams regularly overestimate what the organization knows about them and underestimate the return on investment for providing excellent communications.
6. Accelerate, Accelerate, Accelerate
In the beginning, we quickly recognized the need to transfuse our evolution, our vision, our works-in-progress, and our successes into the rest of the Mayo Clinic organization, and to the outside as it made sense to do so. As we developed our communication strategies and vehicles, we began to feel another purpose and important element to this transfusion: the dissemination of innovation intellect throughout the organization and to the world outside.
What do we mean by “intellect”? Here, we’re talking about the know-how, the technique, and the inspirations that make innovation happen, that make it work. We also recognized that we hardly have a monopoly on innovative ideas and that we could serve the organization well not only by developing our own innovations but also by fostering and incubating the innovations of others.
As a consequence, the Innovation Accelerator has become the “other half” of our transfusion strategy. Within the accelerator, we collect and distribute ideas and tools about innovation. We incubate and fund projects originating outside of CFI but inside the enterprise through our CoDE program. We lead the health care experience transformation conversation through our TRANSFORM symposiums, which leave a major transfusion of ideas and inspiration in their annual wake. And we develop and implement curricula, teaching modules, and learning venues that provide opportunities for everyone in the organization to improve their innovation competence.
Effective innovation teams in complex enterprises don’t just produce great innovations. They also lead the conversation about innovation and give the greater enterprise the motivation and “muscle memory”—consciously or subconsciously—to be part of the innovation process themselves.
7. Collaborate, Collaborate, Collaborate
From the beginning, we knew we couldn’t do this ourselves.
Transformative health care innovation, in a large, generally conservative medical provider organization was going to be challenging under the best of circumstances, and it wouldn’t be possible without reaching out to others for guidance, resources, teamwork, experimentation, and prototype “test-beds,” and other forms of cooperation.
From day one we collaborated with industry experts like IDEO and Doblin, and we created important alliances with important Mayo Clinic decision-making entities. We also collaborated with others from the outside—for example, Blue Cross and Blue Shield of Minnesota, Cisco, Good Samaritan Society, Philips, and Target, all of whom were looking to extend beyond their walls as well to innovate toward transforming health care.
Most of all, we collaborated and co-created with Mayo Clinic employees to involve them in ideation, design, and especially testing. We knew from the beginning that collaboration breeds involvement, involvement breeds support, and support ultimately leads to adoption. If you break this chain at any step along the way, it’s much harder to get to implementation—if you get there at all.
We spend a lot of time and energy seeking and nurturing our partnerships—both inside and outside Mayo Clinic. We seek the win-win scenario, the relationship that builds the CFI and Mayo image, gets things done, and helps the partner out as well. We believe that modern innovation without collaboration, especially in complex environments, is destined to failure.
8. Start Small and Iterate
We talked about the folly of boiling oceans in item 3 above. It’s easy, when taking on such a “giant hairball” as health care, to try to do everything at once, to, in American baseball vernacular, swing for the fences, to try to hit it out of the park.
We use a different way, and it works. Especially with complex innovations, rather than describe, design, and detail the idea to perfection, it works better to create a small prototype so constituents (and we, for that matter) can see it in action. Rather like many technology products, once we see it, we get a better grasp of the “aha” and the influence on patient and provider experience, and we can build from there. It’s easier to communicate, it’s easier to align support, and it’s easier to visualize what the next steps are.
So rather than create huge projects with massively wired and bulletproof underlying technology, we go for experiments and rich small-scale prototypes. They provide proof of concept, something to see, feel, and measure experience response, and something to build on. We start small and iterate to the larger vision, often weaving pieces of the vision together as we go. Back to baseball vernacular: we hit singles, load the bases, hit a few more singles, and we score a lot more runs than teams inclined to swing for the fences—who miss much of the time.
Naturally, “starting small and iterating,” getting to that first completed prototype, is a big part of our Think Big, Start Small, Move Fast doctrine.
9. Know and Navigate Your Enterprise
In a large, established organization like ours, especially one that delivers complex products and services where a customer’s life is at stake, you’re bound to run into some bureaucracy. It’s inevitable.
We can’t choose to avoid bureaucracy. If you avoid it, you are avoiding the heart of your organization, and you will not effect change. Bureaucracy is inherent in our constituency and our customers. Bureaucracy—and its incumbent processes and process checks—is important. It may seem at times like “1 in 10 syndrome” is at work—for every person advancing an idea in the organization, there are 10 people employed to figure out what’s wrong with it.
We accept all of that—it’s there, and it’s part of our reality. Our mission is to learn how to best navigate through it.
First and foremost, we deal with bureaucracy by trying not to be too bureaucratic ourselves. We try to act like a team, all supporting each other, all friends with each other, with a minimum of process checks and forms to fill out to move forward. We can be formal when we need to be formal, but more often we are informal and go out of our way to be easy to work with, both internally and with our constituents.
Beyond not being too bureaucratic ourselves, we seek to embrace the administration in several ways. As already pointed out here in our 10-step approach, we seek involvement and collaboration. By collaborating with our constituents from the beginning, we avoid rejection from organizational antibodies who seek to find the fault in something they didn’t know about.
We seek to mitigate bureaucracy through the “generalist” approaches identified above, where team members inside and outside CFI are “general” enough to see the other side of the fence. It becomes one’s duty to support a design effort, even if you’re a project manager. It becomes one’s duty to support practice staff members as parts of a team. When they see that you’re supporting and collaborating with them, they will support and collaborate with you. It’s a chain of empathy and unity that goes far to mitigate the “not invented here” syndrome and other tentacles of bureaucracy. We do not rail against bureaucracy. We understand it, and we know it has positive aspects. We feel we have developed a way to know when it is helpful and can lead to institutional change—and when it is less so and should be circumvented.
Next, part of the reason for our extensive investment in continuous communication is to help reduce the negative effects of bureaucracy. We believe in transparency. No hidden agendas, all things shared, all proactive—and no surprises. What you see is what you get with the Mayo Clinic CFI.
Finally, bureaucratic tentacles tend to become the longest and most numerous when you’re taking risks, particularly risks that people don’t understand or accept. We do like to take risks, and we feel that risk taking is important to move forward—and really, to avoid bureaucracy. But we insist on making those risks prudent, and we make them transparent. “Prudent” is one reason we involve the practices and insist on medical leadership in the CFI management structure. “Transparent,” again, comes back to communication.
We’d be naive to claim that we’ve completely avoided the negatives of bureaucracy—or that we’d even want to. Bureaucracy serves its purpose. It is a check on our balance and a balance on our check, and it can often serve to give us ideas and feedback on things we never even thought of, and it may save lives. What we try to do—and feel we’ve succeeded with—is attain some freedom from the extreme negatives—the biggest tentacles—of bureaucracy that would likely envelop us if we didn’t approach it right. In that we’ve been successful.
10. Don’t Stop Until You Get There
This one hardly requires further explanation.
An innovation organization, if done right, should bring energy to the enterprise; so naturally, as leaders, you should bring energy to your innovation organization. How you channel that energy, especially in the beginning, means a lot, for sooner or later, you’ll achieve successes—small at first, and bigger as you go.
Those successes start to supply some of the energy in their own right—innovative energy becomes a self-fulfilling prophecy. Your innovation organization is set in motion and gains momentum. It steers itself for the most part and supplies its own energy through its own desire to succeed and its own pattern of success. Your role evolves more to mapping out where it is going and evangelizing and rewarding the success.
When you get to this point, you know you’ve done the right thing.
