An unsuccessful pilot is nobody's first choice, but it gives organizations a chance to address their shortcomings and improve their next attempt.

Innovation is risky — have a concrete plan to avoid, learn from failed implementations

By Dave Muoio
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Meaningful change never comes without a bold first step, and healthcare’s innovators, much like hockey players, will miss 100% of the shots they don’t take. But while The Great One’s mantra lauds those visionaries unafraid to take a chance, the reality is that any meaningful changes within a healthcare organization come at the risk of patients’ lives and millions — possibly even billions — in expenses.

“Innovation in itself is inherently risky, so why introduce additional risk by changing your process every time you try to innovate?” Neil Patel, president of Healthbox, a HIMSS innovation company, told MobiHealthNews. “Try to make your process as clean, clear and transparent as possible and let the risk be in the solution you’re trying to introduce — not the way you operate.”

Although much of the industry would agree that having a process set in stone to control risk is ideal, the fact is that many organizations are piloting novel technologies and interventions without a proactive strategy to limit and learn from failures, Dr. Joe Kvedar, VP of connected health at Partners HealthCare, explained. Even if the damages from such experiments are few, not enough is being done to plan for and prevent a misstep.

“At its worst, when [a bad pilot] occurs, there’s a lot of finger pointing and a lot of bad feelings. At its best, there’s sort of a post-mortem process that’s disciplined and thoughtful, where people say ‘what can we do differently?’ And with the right corporate partner or vendor, it’s possible that could even happen with a vendor where they would use the experience to solidify the product and bring it back.” Kvedar told MobiHealthNews. “I don’t think we have great discipline about that, and it’s uneven across the system.”

An opportunity to learn

Every organization is bound to encounter a roadblock when pursuing innovation. While these outcomes are certainly discouraging, setbacks such as a failed pilot often house an opportunity for providers and vendors alike.

“Even in that situation where you have all the pieces and that pilot doesn’t work, that in itself is a great piece of information that can be informative not only to us but to the startup or company that we’re engaging with,” Dr. Haipeng (Mark) Zhang, medical director of Brigham and Women’s Hospital’s Digital Innovation Hub, told MobiHealthNews. “It may be that the fit is just not right, or it may mean that the timing is wrong. Maybe the implementation just wasn’t the right implementation.”

Every implementation is unique, and so are their potential stumbling points, Zhang and Rebecca Kaul, chief innovation officer at the University of Texas MD Anderson Cancer Center, stressed. Before an organization can learn or recover from an innovation failure, it’s vital that those in charge identify the where, when and why of their headaches.

“In these situations, I don’t think there’s a direct next step. I think it’s all contextual,” Kaul told MobiHealthNews. “It all depends on the situation, the pilot, the context whether we try it again in a different approach, because maybe it’s just so obvious what was wrong that it deserves another chance. Or, maybe it’s very clear that it didn’t work, that it wasn’t a good fit, and we stop.”

Know when to stop, and how to correct

One of the few things worse than encountering a failure is sticking with a sinking ship. It isn’t uncommon for a project’s champion to continue pushing for one more chance, Kvedar explained, or for others with skin in the game to downplay major issues.

“It’s often you get people who — on both sides, the founder or executives of the company that possesses the innovation — are incredibly hungry for sales, so they’re stating positivity right up to the point where they not crossing the line of being a falsehood,” Kvedar said. “But they’re close to it, they’re pushing as hard as they could on the positive side, and they might find someone who’s also eager to make a name for him or herself as an innovator, and that person is excited to bring that innovation in, let’s try it. Before you know it, there’s a fairly inexperienced lot of people trying to prove something’s success."

A key strategy to avoid this outcome is to establish clear, objective metrics that can signal early on when a project’s validity is starting to dip.

“You have to have your early warning signs so you’re not catching anyone by surprise. You never want to have your status reports go green-green-green-green-red,” Emily Kagan-Trenchard, VP of digital and innovation strategy and Northwell Health, told MobiHealthNews. “You want to be flagging things as yellow as early as possible so you’re giving people the opportunity to course correct, but also so you can create a shared definition of when there’s no more course correcting to be done and we should all just be pencils down and say ‘ok, we tried, it didn’t work.’”

Stakeholders must remember that pilots and other risky ventures are inherently a gamble, and should be made aware from the get-go that a shutdown could be necessary if things don’t pan out, Kagan-Trenchard continued. This applies to clinicians or others who are hands-on with the project just as much as it does executives, as the latter in particular must be ready to give these projects the axe.

“You have to have a strong stomach. You have to be willing to call it and not get caught up in the sunk costs,” Kagan-Trenchard said. “You have to be willing to say ‘Look, we went down this path and we thought we were going to get it, but at a certain point it isn’t working.’ So, you have to have executive leader backing on that, so that everyone is going into a pilot with the full expectation that it might fail. It’s expectation setting."

On the other hand, if a stuttering project can be salvaged, amendments should be focused on the heart of an issue. Nick Dougherty, managing director of MassChallenge HealthTech, warned that stakeholders may lean toward overcorrecting the failures of their solutions and, effectively, neutering their potential.

“What I’d caution against is over-engineering your solutions or creating additional red tape when something happens — like, genuinely understanding the problem and the likelihood that it’s going to occur again,” Dougherty told MobiHealthNews “You should get more comfortable pushing the boundaries and innovating, but you often see when a problem occurs, you’ll see all these weird and random regulations on companies because of something that happened once and they’re like ‘we’ll never let this happen again.’”

Plan for both failure and success

While healthcare organizations and startups alike should be open to a retrospective, identifying and planning for potential issues upfront will go a long way toward preventing headaches down the road. Key to this, Kaul said, is staying focused on the issue at hand from start to finish.

“One of the things that we proactively do to increase our chances of success is design the experience, the processes, the operations around the solution to ensure that we are in fact solving the right problem, because that tends to be the biggest fallacy in innovation: getting distracted by interesting solutions and not being thoughtful about whether that interesting solution is truly solving the right problem in your institution,” Kaul said. “So I think if you are thoughtful up front, you’re increasing your chances of success, and if you’re not successful, you need to understand why that was the case and not, say, immediately blame the solution.”

But not all planning needs to be for the worst case scenario. If an innovation surpasses the risks and ultimately proves its value, this same level of thoughtfulness will keep systems and startups alike from stalling out when they finally have a winner on their hands.

“If I were a company — and I’ve advised many companies on this — I’d start asking the champion that you’re working with: what if this works?” Kvedar said. “What is our path to scale? Before we even sign an agreement to do a pilot, should we talking to other executives, should we be running it up the flagpole? They, as you know, can run into multiple pilots that go nowhere and that can be frustrating since you end up spending capital. So, I think being a bit more scrutinizing about what that path looks like internally can be helpful for both parties.”