Using a systematic approach to strategic innovation in laboratory medicine to bring about change

Abstract

There is a growing mismatch with regard to demand, supply, and affordability in healthcare systems in developed countries. Innovation is required to address this, but roadmaps for innovation in laboratory medicine are largely lacking. Advances in process and instrument digitization are driving a revolution in medical laboratory practice but changes are not strategically focused on improved patient care. Laboratory services therefore largely remain transactional so that customer access and experience are suboptimal, especially for vulnerable populations. Laboratory medicine must be integrated back into clinical care pathways, thereby transforming services to be more responsive to end-user needs. Healthcare trends show that patients, physicians, and allied healthcare professionals will increasingly dictate what and how services are provided. Laboratories will be pressed to restructure to address these healthcare trends. Since the primary goal of ambulatory practice is to prevent expensive hospital admissions for patients with complex chronic diseases, specific services (e.g. ambulatory clinics, surgeries, deliveries, procedures) that could be safely provided in the community are moving out of acute care hospitals. This review addresses the existing barriers to innovation faced by medical/scientific and managerial services as well as outlines a systematic approach used by other industries to bring about transformative change. Enabling disruptive innovation that improves the clinical and economic effectiveness of laboratory practice is critical to sustain clinically relevant services as an essential cornerstone of patient care within the healthcare systems of developed countries.

Keywords:

• Innovation
• practice change
• laboratory medicine
• disruption

Disclosure statement

No potential conflict of interest was reported by the author(s).

Box 1. Major emerging trends in healthcare driving innovation

1. Depleting resources adding pressure to healthcare systems

2. Changing demographics

3. The empowered consumer

4. Rising prevalence of chronic diseases and conditions

5. The distrustful consumer

6. Mobile health – increasing accessibility, speed, function, and cost through mobility

Box 2. Tactics used to undermine organizational decision-making

1. Everything must be done through the proper channel. Short-cuts are not permitted to expedite decisions.

2. Personnel are allowed to talk as frequently as possible and at great length, even if discussions are “off topic” and defocus the decision-making process.

3. Irrelevant issues are brought up as frequently as possible.

4. All decisions are referred to committees for “further study and consideration”. Committees are made as large as possible to be completely representative.

5. Precise wordings of communications, minutes, and resolutions are continuously disputed, even seeking legal approval before publication.

6. Personnel are encouraged to refer to decisions made at earlier meetings to re-open the advisability of the decision.

7. Personnel are encouraged to advocate caution and avoid haste in decision-making, which might result in embarrassment or difficulties later.

8. Personnel are encouraged to worry about the propriety or authority of any decision as well as repeatedly question whether a contemplated action lies within the jurisdiction of the group or whether it might conflict with higher echelon policy.

Box 3. Innovation in healthcare: an agenda for action

1. Recognize the risks and costs of innovation, including the disruptive effects of beneficial change.

2. Develop robust programs for diffusion of innovation, including the accreditation of technology use beyond regulatory approval of a product/device.

3. Embed adoption and implementation studies using high-quality social science methods and theory alongside trials for optimal diffusion.

4. Establish clear lines of independent authority for innovation but use institutional authorities to mediate and adjudicate conflicts and demands of frontline workers, patients and their advocates, and industry.

5. Study innovation while it is occurring so that clinical and economic outcomes data can be attributed to new interventions both intended and unintended.

6. Adopt the clinical trial Phase I model for new offerings to identify common problems with innovation studies and delineate best routes for diffusion before full-scale testing and implementation.

7. Improve training of healthcare professionals to deal with innovation challenges through design thinking and change management toolkits.