Bob Gold heads up Gold Group Enterprises, which includes GoMo health. He is a behavioral technologist focused on developing products, largely using machine learning, to personalize care for patients as a way to increase adherence and improve outcomes.
We recently spoke with Gold in a wide-ranging interview. The first part of that can be found here and deals with the machine learning and patient engagement side of things.
In the second part of the conversation, we talked specifically about how healthcare organizations can effectively implement new innovations. Gold drew from his background as a student of human behavior, as well as his practical experience having worked with health systems to implement products created by GoMo health.
Gold presented three considerations necessary to successfully getting a new program off the ground, ranging from the practical to the philosophical:
1. Contracting Vehicles
This point was presented as part of the foundation to innovation programs. It has to be considered, and in place, prior to any successful implementation.
Gold suggests that having the wrong contracting setup is a common mistake health systems make when they dive into a new project, and it can be disastrous.
Under normal circumstances an organization’s innovation committee (or similar) evaluates an idea, gives the green light for a pilot run of the program and then if it works, the approval to go full scale with it.
That’s all well and good but…
“One thing they have to think about is the contracting vehicle. I’ve been in a few situations where the leading clinicians and even the CEO want to do a program with us. Yet they didn’t revise their master service agreement. So you have to go through these 200 page things and six or eight months of evaluation to do a project that you could do for $30,000 and see if the innovation works.
“If you as an organization say ‘we’re going to do one or two innovation projects a year,’ you need a separate, shorter contracting way to do that to allow for these skunk work things to happen. Otherwise you aren’t going to get there.”
2. Minimize Anxiety
“On the innovation side in general […] change causes anxiety. Even positive change.
“So a lot of times when you're having innovation discussions it's clear to people that…in their minds, [they think] ‘oh this won’t work for these reasons. Because they're trained in operating what they're doing now.”
From there, Gold made an important observation about human nature:
“[I]nterestingly enough, innovation almost has to be stupid because if you think about it, if it wasn't stupid those people would be doing it now. If they're not doing it now it may be stupid.”
When laid in front of us this seems like an obvious tautological statement. People do things that they think will work or are working, and they don’t do things that they think won’t work. If they thought it would work they would do it.
We all get this intuitively when we’re the ones being presented with a new idea. In fact, it’s likely that we get defensive (there’s that anxiety) when people push us to try something because we have real reasons for not doing it. And yet, when we’re the ones pushing the idea, we become frustrated with the person we’re pushing. So it goes both ways; we always think we’re right.
Gold says that part of avoiding this natural response is for organizations to have the right people with the right background and mindset in place to give the go-ahead:
“[Y]ou’ve just got to be careful. You can't put the people in charge of operating - because you hired them with their resume of being good operators - and expect them to be good at change management necessarily.”
He used the example of a health system where he presented a solution for their discharge care coordination. Management then looked to the person in charge of discharge care coordination and said she’d be the one saying yes or no. On the surface that makes a lot of sense. However, Gold pushed back:
“I said well that's not fair to her. And [the CEO] looks at me like, ‘well she's in charge of this.’ And I said yes she is […] but she’s a nurse. She's trained in what she's trained in and it's not fair to her to have her evaluate a behavioral and cognitive science of personalizing patient engagement. She just doesn’t have, not have not only the academic training but the field training on how to do that.”
At that point, Gold pushed the CEO to make a decision about a trial run, allowing everyone involved to test the system, learn about and from it, and then decide whether it makes sense to bring online.
So it’s putting people in a position to succeed and using their expertise appropriately, rather than creating anxiety and by pressuring them to make decisions that are viewed as risky. It’s also making the stakes small for those decision-makers.
Which leads directly into the third point:
3. Creating a Culture of Risk Management
“You need a culture at the top that enables risk management to happen.”
Those trial runs Gold is so fond of are the result of this point. When a health system has an organizational structure in place to rapidly evaluate new ideas, and a culture in which that organization can operate with some freedom, risk is actually reduced.
“You’re not going to bet your whole hospital on [a program]. But that's why you want to do these innovations in small pilots, [to] keep the time and costs down.”
“We were at a meeting [and] one of their guys stands up and says, “well, you need to prove beyond a shadow of a doubt all this stuff before we proceed with you. So I'm like well OK. I was told by your peers that the programs you're doing now are failing, the results are really poor, your outcomes are poor. So why don't you tell me what you're doing today that’s good. That way I will answer you to see if we can match that. And he couldn't answer me. So that's my point, change causes anxiety, but you can't cave to [anxiety] if you're going to really stand up for innovation.”
Gold also used an example of sitting in a room with prospective clients showing data that their existing outcomes weren’t good enough for the money they were spending.
“And I’ll say, ‘OK well here's what we suggest.’ And then they’ll want a year of discussion around it and I'll say, ‘You showed us your costs and we’re 50 percent of the cost of what you're spending today. So even if we’re no better, we’re half the cost […]”
However, in an environment where the entire culture is designed and maintained to allow for innovation, these types of discussion can be much easier because the risk is managed and what remains is understood as part of the process.
“So my point is that culture has to come from the top. There has to be an executive, or the executive team, [where it’s] not just a poster when you walk in - we’re creative, we innovate, we have courage. They really have to have a process to get that done.”
…And if you’re organization doesn’t have that culture in place?
'If in fact your leadership either doesn't buy into it or doesn't institute a process to do it, then you as an individual … you either just bake it into your budget - you don't call it innovation.” Instead, just take a small part of that budget and try something different. “It's just process improvement. Sometimes that name means everything: ‘Okay we're going to do this little process improvement project.’”
In other words, there’s always a way. If you fail, you haven’t committed too much. And if you succeed, you have the data to show that this innovation - excuse me, process improvement project - deserves more attention.
So what’s your experience? Agree with Gold? Want to push back? Leave a comment and let us know.