A Sylvatic or Syncretic Approach to Healthcare Innovation?

June 2022 Vol 15, No 2 - Editorial
David B. Nash, MD, MBA
Editor-in-Chief, American Health & Drug Benefits, and Founding Dean Emeritus, Jefferson College of Population Health, Philadelphia, PA
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I am sure some regular readers are running to the dictionary to gain a better understanding of the title of this editorial. Hang in there with me; but first, raise your hand if you have been assigned to an interdisciplinary team within your organization that is charged with innovating around a particular operational challenge. Better yet, raise your hand if your organization’s commitment to innovation is prominently displayed on its website. Finally, raise your hand if you harbor some deep concerns that all of the energy going toward innovation is actually another example of corporate head spinning, and you would rather not participate. Of course, no one is going to tally the number of raised hands, but my educated guess is that most of our readers have a visceral understanding of these issues.

Sadly, I believe that many healthcare organizations have a sylvatic approach to innovation, ie, running from one new problem to another like wild animals in the woods, barely surviving without fundamental change in their ecosystem. What we all desire, however, is a more syncretic approach, ie, one that combines different forms of belief or practice into something more constructive.

We all want healthcare innovation to reduce medical error, which still kills approximately 100,000 patients per year.1 We also want it to address the fact that our system consumes 20% of the US gross domestic product2 while falling short of delivering true improvements in health. Many of us are certain that we are unprepared for the next pandemic and that systemic racism is real. I could go on.

The COVID-19 pandemic resulted in a major financial crisis in the healthcare system, but the crisis is moderating.3 Accumulating social science and engineering research is beginning to shed light on the sylvatic versus syncretic struggle surrounding innovation within the healthcare system. I will present 3 recent commentaries intended to allow you to draw your own conclusions about the state of innovation in your organization and our industry at large.

Researchers from the Massachusetts Institute of Technology, led by Dr Christopher Magee, noted that the real engine propelling innovation is actually physics. In an article published in The Wall Street Journal, Magee was quoted as saying, “The underlining driver of this improvement is that all technologies, even software, are ultimately governed by the laws of physics, which over the long run, determine just how far and how quickly we can get them to evolve.”4

This Wall Street Journal article also reported on related research into innovation from the University of Oxford in England.4 The lead researcher, J. Doyne Farmer, noted that “viewed across decades, individual technologies change at a surprisingly steady rate. This rate is due to the underlying physics that any given technology is built on, and not to any particular genius, or single breakthrough to which we might usually attribute technological advances.”4

Simply put, that organizational whiz kid who might currently be leading your innovation efforts is still limited by the laws of physics. Over time, improved tools, such as artificial intelligence and the algorithms embedded within artificial intelligence, will help us make more informed predictions about the future. That charismatic organizational leader ought to read more about physics.

I am sure you have also heard an earful about the need for your organization to pay attention to platforms. “Platforms are the future,” say all innovators. Perhaps they should read a recent book titled The Platform Delusion, Who Wins and Who Loses in the Age of Tech Titans by Jonathan Knee, which was reviewed in the New York Times Review of Books in September 2021.5 This outstanding review of Knee’s book by Reeves Weideman makes it clear to me that platforms are not the be-all and end-all that they have been portrayed to be in the popular media. According to Weideman, “Knee’s book is filled with business-school case studies that might be a bit in the weeds for general readers….But for aspiring entrepreneurs, these stories offer a primer on the delusion Knee has identified, and show how to avoid the two primary misjudgments that cause it. The first is a belief that platforms emerged with the dawn of the internet….[T]he delusion’s second symptom…involves a blind faith in the supernatural powers that digital platforms supposedly possess: ‘network effects,’ ‘big data’ and other buzzwords that have kept audiences nodding at TED talks for years.”5

Knee argues that this blind faith is misplaced, as platforms have weaknesses just like any other business, yet technology innovators continue pushing a facade of invulnerability to actively discourage potential competition. What I took away from the review of Knee’s book is that platforms, although important, are not the cure-all. Therefore, one should be wary of any organizational innovator who argues that your delivery system should build a new platform, connect to an existing platform, or worse yet, invest in a platform that is not proved!

Another important stream of research comes from prominent business schools such as Harvard and Stanford and explores forces that can constrain management processes.6 Atkinson and Singer studied interdisciplinary teams charged with implementing healthcare innovation activities and devised a paradigm called the constraint management process (CMP). Within the CMP are 2 types of organizational constraints—heterarchical and hierarchical. “Hierarchical constraints often surfaced as directives from upper-level managers that affected team activities, while heterarchical constraints surfaced as organizational professional groups [that] resisted team efforts due to conflicting priorities.”6 In another words, top-down forces versus lateral forces!

When engaging in a team approach to innovating a particular process, it is best to pay attention to the constraint management process you might encounter. Atkinson and Singer noted that even if an interdisciplinary team has achieved some level of innovation, sustaining those gains is difficult.6 Once again, I am sure our readers appreciate the take-home message from this business-school–based research team: “In particular, at this stage [sustaining innovation], upper-level stakeholders caused teams to experience feelings of powerlessness in procuring needed resources and support to give their innovations long-term sustainability. The teams used tactics to deal with hierarchical constraints, which enabled them to position the organization to sustain efforts in the longer term.”

I am heartened to learn of the work being done at Massachusetts Institute of Technology, the University of Oxford, Columbia University School of Business, Harvard, and Stanford. It is a relief to see that so many smart people are tackling the innovation ecosystem and applying rigorous social science and business research to the dilemmas we face.

So is it sylvatic or syncretic in your organization? Will physics win out as it usually does in the universe? Or will hierarchical and heterarchical challenges continue to make your head spin?

As always, I am interested to learn more about the pace of innovation in your organization. Certainly, we all agree that in the hoped-for postpandemic era, innovation will enable us to reduce waste, improve safety, and adequately prepare for the next pandemic. As always, you can reach me at This email address is being protected from spambots. You need JavaScript enabled to view it..

References

  1. Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. Updated 2022 May 1. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; January 2022. www.ncbi.nlm.nih.gov/books/NBK499956/. Accessed May 23, 2022.
  2. Centers for Medicare and Medicaid Services. www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Nationalhealthexpenddata/NHE-Fact-Sheet. Accessed May 23, 2022.
  3. Michelson D. The greatest comeback in the history of healthcare. Fortune. January 22, 2022.
  4. Mims C. New research busts popular myths about innovation. Wall Street Journal. September 18-19, 2021.
  5. Wiedeman R. Nosedive. Why does every company want to build a ‘platform’? Review of the book entitled The Platform Delusion. Who Wins and Who Loses in the Age of Tech Titans by Jonathan Knee. New York Times Review of Books. September 26, 2021.
  6. Atkinson MK, Singer SJ. Managing organizational constraints in innovation teams: a qualitative study across four health systems. Med Care Res Rev. 2021;78(5):521-536.
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