Welcome, my name is David Asch. I'm a general internist at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania, and Director of the Penn Medicine Center for Health Care Innovation. I'm here with Roy Rosin who's going to introduce himself in a moment. And together we're going to have a conversation that will introduce you to the aspects of the course and the goals that we have. So with that, Roy, why don't you introduce yourself. >> Sure, so Roy Rosin, I'm the chief innovation officer with Penn Medicine and work with David to lead the center. And it's been about five years that we've been working together, building innovation programs across the school of medicine and the health system. Taking in a lot of the types of techniques that have been developed across all kinds of industries that help people test new ideas and do things in new and hopefully creative problem solving types of ways. >> So this course is about applying techniques and innovation that have largely been developed outside of the healthcare space and deploying them and bringing them into healthcare systems and healthcare organizations. And so the conversation we want to have today is one about how we take lessons that largely have been developed elsewhere and apply them to an organization and an institution with a set of conventions and rules that's really quite different. And so we're going to have a little conversation about that and maybe I'll just start from exactly that point. So five years ago, you were working outside of healthcare. You came into the healthcare space with an immense amount of knowledge about how to deploy innovation, let's say, in a software company. And then you see healthcare for the first time as a non-patient, right? All of us have had some experience in healthcare as patients, or as family members of patients, but now you're inside. And so what what surprised you? What was the a-ha that you saw when you moved into healthcare? >> A lot of what I hoped for was there. In the opportunity to work with truly mission-driven people, who are very, very smart and very scientific in their approach to problem solving. A lot of what we have developed in the software world is really geared towards start ups. And the reason some of these techniques for innovation came out of the start up world actually applied really well to healthcare. The reason being that it worked for start ups, because they were cash constrained, and they were time constrained, and they were bandwidth constrained. In other words, I have some ideas, I'm really excited about, and I have to figure out really quickly whether I'm right or I'm wrong. I don't want to keep running really fact in the wrong direction, that's not very productive. So without a lot of time or bandwidth, I need to figure out as quickly as possible if I'm going in the right direction. When I came to healthcare, it was similar. People are very busy, there's nobody sitting around with extra time on their hands. And while you may not run out of cash and go out of business the way you would if you were a startup who doesn't get it right quickly enough. It's a similar situation that I don't have a lot of extra budget lying around, I don't have a lot of extra time on my hands. And I have these ideas I'm really passionate about and I want to see if I'm right, or if I'm wrong. And I think one of the things that I saw quickly was that, there were tons of ideas. People are on the front lines. A lot of our care givers and our clinicians, nurses, doctors and others, are on the front lines, with insights. Like that doesn't work so well, or that's not the best way to do this, or that's not generating the outcome that I want. And they have an insight, but that stays as an idea. It doesn't go anywhere. It doesn't start to progress. And a lot of what we'll talk about, I think, in this course is that front end of innovation. That how do you go from an idea to some type of forward motion? And of course, one of the things I saw was a lot of risk adversity. There was for good reason, we don't want to harm patients. But I also think there was maybe, a carry over from areas that were truly dangerous. Where a patient might really get harmed to things that were just operational improvements and just better ways of doing things didn't have a lot of risk. And I don't think that the industry is as different as everyone says in some ways. For example, I came out of the financial services world, in financial software. And when I'm handling your tax data for Turbo Tax, or your payroll data, or your payments data, there's a tremendous amount of compliance issues that need to be addressed. It's just a matter of how do I do these experiments in this kind of creative problem solving, safely. >> Yeah, so I want to pick up on that last point because, it probably doesn't matter what industry you're in. You always think your industry is special, your particular knowledge is magical, the rules that are on the outside can't be applied to you. And I guess of course I was guilty of that myself. I'm thinking no I'm sorry but healthcare special, I've got this magical stuff, I've got a license. This is high stakes, people can die, it's highly regulated, it's capital intensive. All those things that you learned in your important but largely meaningless software company don't apply to healthcare where life and death hangs in the balance. So I am guessing that some of what I just said is true but a lot of it isn't. What did I just say that is true and maybe more practically, how do you deal with someone like me who is so stuck in thinking that I'm special, and you have nothing to offer me. How do you work with me? >> Yeah, well, that's difficulty. [LAUGH] >> Not me in particular, I'm a metaphor. >> People like you. So, it would be naive to, first of all, say that healthcare is not special, because the patient's safety issues and the regulated environment you work in are fairly unique, frankly. But they're not unique from a, it's risky, and we have to be careful. So there are certain things, like the IRB. Okay, we need certain permissions from the IRB, or I'm doing medical devices and I have to work with the FDA. I'm not going to change the FDA rules, and so there are certain kind of posts that can't be moved. They're staked in the ground, and I have to figure those out, the same way we had to figure out in other industries those stakes that couldn't be moved and still be nimble. I think that a lot of getting credibility and starting to do innovation work with doctors, nurses, and other clinicians is first of all being human is recognizing that they have a tremendous amount of expertise. That there is a tremendous amount of subject matter knowledge and that there's a lot of pressure that the caregivers and the clinician are under. And that you don't come in knowing everything. It's not like I know how to solve your problems. I have some principles, some techniques, some approaches that might be useful. And I think that the faster you get to applying some of those ideas and sort of doing collaboratively with that interdisciplinary team, including the doctors, nurses and others, the faster they see that it works. In other words, a lot of what we do, is scientific method, where you have a hypothesis, or you at least have a lot of ideas and assumptions, and you try to craft it down to a clear hypothesis, and make a prediction, and design an experiment. That's obviously not something that is new, to doctors and nurses, they understand the scientific method. In fact, they do it very, very well. And so when we talk about techniques, and we tell stories and we give examples of how might this look. You're trying to get patients in faster or you're trying to get them home so they don't come back or you're trying to reduce this infection rate. And we start to give examples of how these techniques might look in their context and in particular engage them, like what have you seen? Like tell me your story, share your expertise. I can't do this without your subject matter expertise. There's literally no way for some guy or girl who's done innovation, but doesn't know healthcare to come in and do it alone because you just don't know enough. So it's really the intersection of methods of super fast experimentation methods and subject matter knowledge and expertise. And both sides frankly bring in the scientific methods of how do you test these ideas quickly. >> So I want to follow up on that. I've been around healthcare long enough to have had seen some other examples of things that are similar to innovation. One would be the move to create quality improvement departments in healthcare. Another one was a little bit after that, a movement called evidence based medicine. And both of those cases I guess I had the impression that there was a group that said we're in charge of quality or we're in charge of evidence-based medicine. And the people who were already working in health care were saying what do you mean, I've always been in the quality business. Or, are you saying that if you're in charge of evidence-based medicine, the stuff we were doing was not evidence based? And I do have the sense that the innovation stuff in health care has a little bit of that problem, but not so much. In other words, at least I think that you've been successful at counteracting what might be a naturally protective sense of, well, I was doing that already. But you came in and said, I'm an innovation executive from Silicon Valley. And you manage to help people see that you are on their side as opposed to somehow defining their limitations. So what was behind that? >> So I think there's a lot of things that I've learned from other leaders that I've worked with that worked really well. So actually, let me give you credit before I even start getting into some of these ideas. One of the first things that you said was that we are the center for innovation and not the center of innovation. And I think that that statement you made was a brilliant statement because it said, look not all the innovation happens within this small group of people defined by our organizational structure. So the idea that you're this center for innovation means that your goal, your job, your charter is to make it easier for everyone else trying to do good things to do those good things. So as soon as you come in with the mindset that you're there to help the helpers, right, I'm not clinical. People who are doctors I think are phenomenal, they're creating new cancer remedies, they're creating new therapeutics, they're creating new devices that change lives, they're trying to create experiences that help people. So to me, the best I can do is help them. And so I think that when you in with this idea that I'm a center for innovation, and I'm a enabling person, I'm going to get things out of your way, I'm going to look through areas of friction, I'm going to try to reduce that friction. I'm going to try to celebrate things they already doing that are innovative. One of the best things you can do to start an innovation program is to literally shine the spotlight on innovative work that's already going on somewhere in the organization. So Penna's been innovative for hundreds of years before I showed up. Maybe a hundred years before you showed up. [LAUGH] >> [LAUGH] >> And the reality is there's incredible things going on across the hallways up and down every lab and in every hospital. And so if you can give people credit for great stuff that they're doing, right? And actually say I want more of this, this is classic change of management, I want to celebrate the behaviors I want to see more often. And I want to get those friction points out of the way to let you do great work. You're not really coming in saying, I know better than you, because I don't. I don't know better than anybody. But one of the things that you can come in and say, I see what you're trying to do. Hey, have you thought about this? Here's a way that maybe you can test that idea faster. Maybe we can isolate what that fundamental belief is, that insight, and say, well okay, you believe that if you do this, those people are going to do that. Hey, maybe we can test that in a few hours or days instead of a long, or maybe a more vigorous methodology. So I say I understand what an RCT is, and I understand kind of the gold standard of testing. I wonder if we can do something the next few days or weeks to get a little bit smarter. So we don't blow an arm of the RCT or spend a year doing something that's not maybe ideally tuned. Let's work together on this to get a little bit smarter, get a little bit of evidence. And then, we can go back to the methods that are really proven for a good reason.
