Experts say 'insourcing' innovation may be the best approach to transforming health care

May 7, 2014

A group of health care and policy experts from the Perelman School of Medicine at the University of Pennsylvania is urging health care institutions to look more to their own in-house personnel, including physicians and nurses, as a source of new ideas for improving how care is delivered. The practice – referred to as insourcing – relies on an organization's existing staff to drive needed transformations. The team also suggests a four-stage design process which, when adopted internally, may help organizations implement more efficient health care delivery solutions.

In a Perspective piece published in the May 8 issue of the New England Journal of Medicine, the Penn authors – David Asch, MD, MBA, professor of Medicine and executive director of the Penn Medicine Center for Health Care Innovation; Christian Terwiesch, PhD, professor of Operations and Information Management at Wharton; Kevin B. Mahoney, chief administrative officer of the University of Pennsylvania Health System; and Roy Rosin, chief innovation officer for Penn Medicine – argue that too often organizations look to external consultants to create health care change. Lessons from other industries are often "translated into health care" as easily as if they were "translated… into French," the authors write, leading to misinformed recommendations.

"In order to identify and effectively solve a problem, you have to be willing to immerse yourself and try things out," said Asch, lead author on the piece. "Management gurus and experts from other industries can lend tremendously valuable expertise, but it's the physicians and nurses who combine the passion and the knowledge necessary to move ideas into implementation and testing, where the real value lies."

The Penn team argues that copy and paste solutions derived from other settings are not likely to work well in health care because health care is not one problem but thousands of problems. Instead, they urge hospitals and other health care institutions to consider adopting a four-stage design process for use in the specialized health care environment.

The four stages, which together help to identify issues and create more effective solutions in a timely manner are: 1) contextual inquiry: understanding the way things currently work and seeing the nuances others have missed by immersion in the work; 2) problem definition: reexamining what the organization should be solving for in a way that avoids incremental improvement to a current process; 3) divergence: exploring alternatives to initial solutions; and 4) rapid validation: testing critical assumptions and proposed solutions quickly at low cost.

The authors write that each of the four stages of the design process can be applied by people already inside the health care setting. An advantage, they say, is that in contrast to many industries where the thought leaders are secluded in corporate headquarters, many of the thought leaders in , including physicians and nurses, are right up front interacting with the "customers."

"Sometimes organizations think it's easier and more effective to spend a large sum of money on an outsourced shrink-wrapped solution when the expertise needed to identify and solve problems is already in the building," said co-author Roy Rosin, Penn Medicine's chief innovation officer. "Clinicians are mission driven to help their patients, and are constantly thinking of ways to improve . If the focus were shifted toward creating and protecting time for staff to drive change from the inside, we could see the implementation of more successful solutions."

The authors have been working with teams across Penn Medicine to apply the four-step process to a range of delivery challenges, including new patient access and readmission rates. Working on one project that aimed to improve medication adherence among patients discharged after myocardial infarction, the team followed patients throughout their day, which allowed them to see how a long commute without bathroom access kept one patient from taking his diuretic. By immersing themselves in the patient experience, the team discovered the inadequacy of better reminders as a solution to the problem. Along with rapid validation techniques allowing in-house teams to test assumptions in hours or days, such insights enable internal innovators to drive change in health systems efficiently, instead of discovering months or years later that they invested in the wrong strategy.

Explore further: Implementation science can create a workforce equipped for new health care environment

Related Stories

Implementation science can create a workforce equipped for new health care environment

May 1, 2014
The new Center for Health Innovation & Implementation Science at the Indiana University School of Medicine and Indiana Clinical and Translational Sciences Institute is studying how best to prepare the future health care workforce ...

Repeat data breaches among health care orgs down

May 4, 2014
(HealthDay)—Most health care organizations report having at least one recent data breach, but the number of organizations with more than five breaches has decreased, according to an article published April 8 in Medical ...

Rural primary care physicians offer insight into rural women's health care

February 5, 2014
Women living in rural communities are less likely than urban-dwelling women to receive sufficient mental health care, in large part due to limited access to services and societal stigma, according to medicine and public health ...

Rising role seen for health education specialists

April 24, 2014
(HealthDay)—A health education specialist can help family practices implement quality improvement projects with limited additional financial resources, according to an article published in the March/April issue of Family ...

Researchers crack code for 'personalizing' costs to transform delivery of care

May 1, 2014
Providing the best care at the lowest cost has become one of the mantras of health care reform. While measuring quality in health care is understandably complex, surprisingly, the true cost of caring for individual patients ...

CF Foundation and CF care expert partnership yields striking progress for people with cystic fibrosis

March 17, 2014
A decade of strategic efforts to improve care has had a key role in improving quality of life and added years to predicted survival for people with cystic fibrosis (CF) in the United States, according to the editors of a ...

Recommended for you

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Study finds 275,000 calls to poison control centers for dietary supplement exposures from 2000 through 2012

July 24, 2017
U.S. Poison Control Centers receive a call every 24 minutes, on average, regarding dietary supplement exposures, according to a new study from the Center for Injury Research and Policy and the Central Ohio Poison Center, ...

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

App lets patients work alone or with others to prevent, monitor, and reverse chronic disease

July 24, 2017
Lack of patient adherence to treatment plans is a lingering, costly problem in the United States. But MIT Media Lab spinout Twine Health is proving that regular interventions from a patient's community of supporters can greatly ...

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.