UCLA Health System likes to say that innovation begins with “U.” It’s not just a catchy slogan. The medical center’s Institute for Innovation in Health reaches out to patients and providers to explore their health care experiences and identify innovative ways to improve outcomes, value and satisfaction of patients and staff. Whether it’s bringing on nurse practitioners to coordinate Alzheimer’s care or streamlining pharmacy services for high-risk diabetics – two programs now being piloted through the institute’s Global Lab for Health – UCLA is trying out new care models based on detailed interviews with patients and health care personnel.
The institute also conducts an annual contest challenging staff to identify ways to improve care by “walking in the patient’s shoes.” The institute’s director, Katherine Steinberg, a speaker at the upcoming U.S. News Hospital of Tomorrow Conference, spoke with U.S. News about UCLA’s approach to reimagining and transforming health care. (The interview was edited for length and clarity.)
What does innovation mean at UCLA?
At UCLA, we use innovation as an accelerator to address strategic priorities. Those are driven by our commitment to meeting patients’ needs and our vision of healing humankind one patient at a time. Much of the innovation areas can be described as tech oriented; however, we also recognize the tremendous opportunity to innovate on care delivery models, some of which are supported by technology.
Strategically, when our health system is interested in focusing on innovations around access to care, as an example, we would start by using human-centered design to go out to the patients and understand [that] their pain points are around access. Then we would work to identify potential innovations to address those needs. We would look at [an innovation] objectively and see if it does meet the needs of the patient – and whose workflow would have to change in order to execute it.
Katherine Steinberg is the director of UCLA Health System’s Institute for Innovation in Health.Courtesy UCLA
What do you mean by pain point?
By pain point, I mean anything that doesn’t work optimally from the patients’ and the providers’ perspective. It’s really an opportunity to improve the way care is delivered and the experience that a patient or a family member is having. Around access, we might look at and understand a patient’s needs from a convenience perspective, to allow them to connect with their provider and get questions answered in a timely way. The patient may have a question for their [doctor] – but the provider has a packed day. … How can they get [their question answered] in a manner that’s aligned with the schedule and limitations of the provider? The answer could be anything from email to text messaging, and so forth.
How does your process work?
The role of our innovation institute is to be aligned with the health system’s prioritized needs and to help to identify, design, pilot and evaluate innovative methods of addressing those priorities. We’re partially think tank and partially partner in designing, testing, validating and evaluating the opportunity for spread of these innovations. At the earlier stages of the process, I would say it has similarities to that of a think tank.
We start by understanding what the individual concerns are and identify themes. And it’s not just concerns, it’s also when things are done really well. How can we learn from incredible experiences? And how can those be spread or supported through technology so that everyone can share those experiences?
Are the tools you use in identifying innovations similar to those used for performance improvement?
Some of the tools. At UCLA, we have a LEAN culture [the Toyota-inspired performance improvement program] throughout the organization. The tools that innovation provides on top of that compliment those LEAN approaches, which include such things as human-centered design and bringing business rigor to understanding the return on innovation. It’s not just innovation for innovation’s sake. It’s for the specific goals you set out to achieve. A big part of innovation is defining those goals up front and being rigorous in how you evaluate [them]. Accepting failure is an important part of innovation, too. There’s a real acknowledgement of the learning that’s done when failure’s an acceptable part of the culture.
So, not everything succeeds.
What suggestions do you have for hospitals that don’t have the resources of a UCLA?
I don’t think innovation necessarily requires having access to a significant amount of resources. I actually think a lot of innovation happens where there aren’t resources, because it becomes imperative. If you can articulate the need for innovation and make it a burning platform within your organization, that’s the first step toward creating a culture of innovation. It’s that culture that I believe is the most important part of being able to innovate effectively – to have a culture that’s ready. Readiness … is one of the most [important] criteria for innovating effectively. It means that the operations component of the system is on board.
By operations, what do you mean?
I view operations as the folks that make the wheels turn. They could be anywhere in the institution.
Can you give me an example of how this works?
When we were working with patients [with benign enlarged prostates who need to use urinary catheters] we were looking for ways to improve value for these patients. One thing we learned – which we didn’t expect – was that there was an opportunity to educate and inform patients more effectively about catheter care. We ended up doing something really simple. We created educational videos that are provided to patients at the right time so they aren’t surprised or concerned about how to care for catheters. Our clinicians didn’t always realize this was a point of anxiety for our patients until we dove into the full experience from the patients’ perspective. We really had to take a step back and put ourselves in the patients’ shoes.
How did this occur? Did a patient say, “I don’t know how to deal with these catheters”?
We were focusing on [benign prostate hyperplasia] as a place to work on our value-based care redesign efforts. We went out and interviewed BPH patients who had been through our system to learn what worked well, where they were opportunities for improvement and what their [needs are]. One of the themes was around transparency and expectations in caring for catheters.
Is this something you do, pick a procedure or condition and say, “How can we improve our care and ask patients about it?”
We worked with a design firm to come up with a process for this kind of care-redesign effort. We start by asking [patients] how we can improve their journey and make it best in class. We’re in the process of using this approach – doing in-depth interviews with patients as well as stakeholders within our own system – to understand their needs and [identify] patterns across entire care pathways.
We synthesize this information; we move from the raw data and initial findings to uncovering opportunities to redefine the patients’ journey. Then we prioritize and create action plans. All stakeholders need to be brought in early. That’s how innovation ends up not just being implemented within a system, but also embraced.