Brigham Health, based in Boston, is home to innovative science, medicine and digital health technology. But like many large institutions, it also has its fair share of systems and processes that are relics of the past.
Healthcare delivery is filled with cumbersome, redundant and generally inefficient activities and processes, said Santosh Mohan, managing director of Brigham Digital Innovation Hub, also known as iHub, at Brigham and Women’s Hospital.
“Many of us can think of at least a few work-related tasks that inspire unnecessary grief,” he said. “From still being stuck on paper in the digital age to being slowed down by too many clicks, these struggles can often lead to frustration. In addition, the resulting burden of this administrative waste can potentially take away from being able to focus on the patient and the moment of care.”
There are limited opportunities to share and act upon these pain points, he noted. In both small and large institutions, bureaucratic processes also exist that tend to discourage employees from surfacing these issues – and organizations from solving them, he said.
“Brigham leadership recognized these problems and aimed to address them by: improving the Brigham employee experience by empowering all staff to present ideas and contribute to innovation, process improvement and operational efficiency, and 2) ultimately decreasing the amount of time employees spend on administrative tasks and ‘everyday problems,’“ he said.
A technology solution alone was not going to resolve the aforementioned problems, since very rarely can technology alone solve such comprehensive challenges, Mohan said.
“We were inspired by Hawaii Pacific Health’s Getting Rid of Stupid Stuff Program, which focused on reducing documentation burden for clinicians,” he explained. “HPH invited staff who interacted with the system’s EHR to identify practices and processes that should be eliminated or modified, with a commitment to quickly address as many of the suggestions as possible, when not in place due to regulatory requirements.”
The engagement from staff was impressive, and the resultant time savings for employees equally so, he observed.
"For innovation departments that are overseeing initiatives, innovation-management software also saves enormous amounts of time and email/administrative burden."
Santosh Mohan, Brigham & Women’s Hospital
“Our team was also motivated to borrow from the KonMari Method to take inventory of things that didn’t ‘spark joy’ for our staff and patients,” he said. “We needed to collectively think about, not just tackling healthcare’s moonshots, but also solving the everyday problems to get rid of our most time-consuming, expensive, burdensome, inefficient and ‘stupid’ administrative work.”
With guidance from the senior leadership team and support from Dr. Adam Landman, Brigham Health’s chief information officer and digital innovation officer, Mohan and his team determined that they wanted to design and launch an idea-crowdsourcing program that would foster an inclusive community of creative, insightful thinkers and doers striving to improve the Brigham experience for all.
They also wanted to ensure that this approach could be replicated, scalable and sustainable for the organization – whether used at the team, department, facility or system level.
They engaged Healthbox, the innovation arm of HIMSS (which is also the parent company of Healthcare IT News), to advise on the design and development of the program.
“In the early design and development, it became clear that a technology platform would be required to facilitate idea-collection and evaluation in an efficient manner,” Mohan recalled. “Together the iHub and Healthbox outlined the technology-platform requirements that aligned with the long-term program objectives, and went through a comprehensive sourcing exercise for innovation-management technology software.”
The technology solution needed to emphasize employee engagement, support multiple languages and offer ease of use for busy staff members to contribute ideas, in the moment and while on the move, without needing them to create separate accounts, remember passwords, fill out long applications, and allow for flexibility in challenge design, he said.
Ultimately, he explained, they wanted to:
- Enable all employees to participate.
- Solve problems that employees and departments cared about.
- Select ideas that could be implemented and done quickly.
- Thoughtfully triage all ideas that staff members were not capable of solving on their own.
MEETING THE CHALLENGE
With a focus on operational efficiency in the pilot year, Brigham launched an organization-wide innovation challenge called DO IT (Decrease Operational Inefficiencies Together) on February 19, 2020, with a goal of uncovering the most inefficient, duplicative and outright unnecessary work-related tasks and technologies that caregivers must wrestle with on a daily basis, and fixing them with simple, nimble and creative digital solutions.
From February 19 through March 18, 2020, the DO IT Challenge invited all hospital employees, regardless of department or role, to submit their ideas for digital solutions – including ways to improve the EHR – to stop inefficiencies in their tracks.
“All members of the Brigham community were also invited to comment and vote on their favorite ideas,” said Caroline Coy, innovation strategy manager at the iHub.
"One idea that was implemented was improving search functionality for the information systems help desk incident management system to make it easier for staff to quickly add their location when electronically submitting IS support issues."
Caroline Coy, Brigham & Women’s Hospital
“Our goal was to crowdsource at least 100 ideas for using digital technology to improve processes and decrease administrative burdens. In support of our fiscal year 2020 goal to advance innovation, the best and most popular ideas chosen were to be matched with resources and support to transform them from idea into reality.”
The focus with Healthbox was first and foremost on thoughtful program design and development.
“Once the objectives, scope and workflows for the pilot year and long-term vision were set, we ultimately decided to move forward with Databox, Healthbox’s proprietary innovation-management software for the program,” Coy said. “It comprehensively addressed our tool requirements and additionally allowed for simultaneous, multigroup evaluation of submitted ideas, improving speed to decision-making.”
Some key features of the challenge design and development:
- In order to promote the challenge, iHub staff went on a roadshow – with broad hospital-wide marketing efforts, as well as meeting staff members representing diverse groups where they were (breakrooms, huddles and meetings), first to learn about their problems and later to promote the DO IT Challenge.
- Knowing that they wanted to solve problems departments cared about, and that staff would only be selecting ideas that could be implemented and done quickly, allowed the iHub to be crisp in its messaging to employees and judges (the decision-makers). iHub staff explicitly shared examples of what was and what was not in scope to employees and used a quantitative rubric for idea-selection criteria.
- iHub staff developed a thorough process to evaluate, triage and categorize ideas leveraging existing channels/committees/mechanisms. This was key, because staff minimized adding meetings to leadership’s calendars.
- iHub staff members were intentional about acknowledging every idea that came in and planned for how they would accomplish that.
In total, 240 ideas were submitted in just under four weeks. Many offered creative suggestions regarding how to make any number of those arduous and repetitive tasks in their workflow far more efficient, while some had ideas for moving an inefficient paper process into the digital age.
“Whatever the Eureka moment was, DO IT uncovered several digital solutions to creatively solve cumbersome problems,” Coy said. “Among submitters, 83% sat outside of leadership or management positions. Fifty percent of ideas were about improvements to our EHR, and the remainder of idea categories covered improvements to facilities, food services, clinical departments, ancillary services, research and communications. We acknowledged and responded to every single idea.”
When the COVID-19 pandemic hit in early March, many priorities, including the evaluation and subsequent execution of suggestions from the DO IT challenge, had to be shifted.
“We had to pause our full evaluation, selection and ultimate implementation process due to COVID-19 onset and surge,” Coy explained. “However, we identified some opportunities to secure quick wins and plan to resume the initiative with additional selections and implementation when the time is right. One idea that was implemented was improving search functionality for the information systems help desk incident management system to make it easier for staff to quickly add their location when electronically submitting IS support issues.”
As part of the pandemic response, Brigham Health established a Safe Care Commitment, making the health and safety of patients, families and staff the top priority. As part of this broad initiative, iHub staff wanted to better understand opportunities and ideas to provide the safest possible care environment from frontline staff.
In a matter of days, iHub staff were able to leverage and reuse the same innovation infrastructure that was built for DO IT to stand up a new challenge by using Databox to broaden staff engagement and crowdsource approaches for COVID-19 reopening plans.
“Building on the experience and lessons learned from DO IT, we crowdsourced creative ideas and innovative approaches that could be implemented across the Safe Care Commitment focus areas of WE SCREEN, WE CLEAN and WE PROTECT,” Coy said. “The platform was made available in both English and Spanish to ensure inclusivity and equity when soliciting and capturing staff ideas.”
iHub staff received a total of 75 ideas over the course of a three-week submission period leading up to the Phase 1 of reopening, ranging from how to improve mask distribution and employee symptom-screening to disinfection of shared spaces and other operations deemed necessary for a safe workplace.
“Suggestions were received from a diverse group of staff and shared with hospital leadership for implementation,” Coy said. “Many of these ideas and suggestions were addressed and implemented immediately. We enjoyed a strong partnership with the Brigham’s environmental services staff, who did an excellent job responding to suggestions in a timely manner.”
For example, the environmental services team used the feedback to adjust the frequency of disinfecting high-touch surfaces and to place dispensers with disposable, disinfecting wipes in common areas.
ADVICE FOR OTHERS
Mohan offers some tips to his peers at other healthcare provider organizations looking to solve problems in a similar manner:
- Innovation needs to come from all directions (top, down and across).
- A simple and nimble innovation platform allows one to act fast and capitalize on opportunities surfaced by employees.
- Inclusive and creative communications campaigns motivate diverse groups of staff to participate in innovation activities.
- Even when unexpected external factors impact plans, an innovation infrastructure can facilitate new opportunities.
“There are many healthcare provider organizations that already run innovation programs, challenges, contests, etc., and do so without a dedicated technology solution,” he observed. “While this is entirely feasible, Brigham and Women’s recognized its long-term goal of overseeing scalable, yet still incredibly efficient challenges, would require a nimble software solution. This sense was reinforced when thinking of the stakeholders involved in an innovation challenge.”
Take for example challenge judges, stakeholders with very little extra time, who are often in leadership positions at provider organizations, he said.
“Innovation management solutions ensure an efficient use of time when evaluating the ideas,” he said. “It was important to the iHub that the technology solution did this in both a quantitative and qualitative way. For innovation departments that are overseeing initiatives, innovation management software also saves enormous amounts of time and email/administrative burden.”
Ultimately, for any technology solution to be successful, it must be paired with a well-thought-out implementation strategy and roll-up to an explicit department or group to ensure accountability, he advised.
“We’re excited about the promise and potential of this foundational capability that is now part of our innovation stack,” he said. “We were intentional about designing the program and approach to be a demand-based, reusable and stackable capability to leverage for future initiatives, which, by agreement, the Brigham would retain intellectual ownership of moving forward.”
Whether staff submit an idea or simply vote for one, their participation will be essential to multiply intelligence and ensure that innovation is focused on “jobs to be done” and on solving problems that make a difference with real, tangible impact, versus merely fueling aspirational conversations, Mohan said.
“Our vision is to expand and extend the foundational infrastructure built in this pilot year to make this available for future department and hospital-wide granular and themed challenges,” he concluded.
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