Innovating Health for Tomorrow Case Study: Karolinska Heart Failure Day Care Clinic
CAN YOU TRANSFORM HEALTHCARE WHEN YOU HAVE LITTLE BUDGET AND OPPOSITION FROM KEY STAKEHOLDERS?
How Stefan Vlachos and Nina Lahti, past participants of Innovating Health for Tomorrow, took their learnings and applied them to drive innovation in the workplace.
In 2014, Stefan Vlachos attended the Innovating Health for Tomorrow (IHT) at INSEAD with the ambition to innovate healthcare, but facing a tough new job. Vlachos had recently been appointed head of The Center for Innovation at Karolinska University Hospital, the prestigious Stockholm-based hospital, but as an engineer he had little political weight to change ways of working in the prestige-heavy university hospital run largely by high profile physicians. How could he transform the organisation for the better from his unique, low-power position?
While in the IHT programme, Vlachos learned about innovation techniques that can be applied to quickly test and validate new ideas in many industries, including health. Vlachos went home, bought the book discussed in class (The Innovator’s Method) for his entire team, and then together they started to apply the ideas – also to innovation projects already under way.
One of the early puzzles he and his team tried to tackle in an ongoing project was the limited outcomes in heart failure care. Despite significant advances in care and new treatments over the past decade, patient outcomes had not improved regarding advanced heart failure treatment. When the hospital started to investigate, the team recognized that the broader organization was falling into the “solution-first” trap that had been covered at IHT—applying solutions without first understanding what problem you are solving. In this case, medical device manufacturers argued that Karolinska was installing far fewer left ventricular assist devices than comparable hospitals and thus proposed the solution would be to use more devices with patients. But how to identify patients in need of those devices? The physicians inside Karolinska argued that the problem was an information and communication problem, and that they needed to be better at educating staff about heart failure care. In response, Karolinska launched an information campaign, but there was no change in patient outcomes.
After several unsuccessful attempts, Vlachos and his team, including Nina Lahti who led the charge and who attended IHT in 2017, had their chance to try and solve the heart failure dilemma by applying the ideas they learned in IHT. They started, as they learned in class, by first trying to understand the problem (rather than leaping to solutions), through the eyes of customers jobs-to-be-done. When they started to actually watch patients, track them, and talk to them, they discovered some surprising facts. First, the average heart failure care patient interacted with 47 different areas of the hospital, creating immense complexity and expense for the hospital and the patient. Second, patients and physicians had very different ideas about what patients wanted from their care. Physicians believed that patients wanted to be involved in selecting their own care when in fact patients wanted to rely on the expertise of the physician to “fix” the problem. Third, and most importantly, what patients most wanted was not more binders of information, digital apps, or other fancy solutions. They simply wanted a person to call when they felt unsure or had a question.
With this insight in hand the team reached out to the head of cardiac care and proposed a new “heart failure day care” service, that would provide patients access to a physician or nurse by phone, and act as the front line for receiving patients. The head physician listened to their presentation, nodded, and responded that he would not allocate any budget to the project.
Discouraged but not defeated, Lahti and Vlachos looked for alternatives to conduct a rapid experiment to test their assumptions and prove out the idea. They found a few rooms in the hospital that they could use for free to conduct a nine-month trial, they borrowed equipment from other units rather than purchasing it, and they secured a small grant from Stockholm County to secure half a physician’s time and two nurses to test the idea.
What they found shocked them. Expensive and less productive emergency room visits dropped 54% and inpatient days dropped 61%. Meanwhile, less expensive and more productive planned visits increased 84%, and these visits were to the right places for the patient to get care, as opposed to in the past where patients were often sent to the wrong care area. Most importantly patient outcomes improved as did patient satisfaction. Patients who used to be afraid to leave Stockholm due to the complexity of the care process felt empowered to begin enjoying their lives, going on holiday with confidence that they could call the heart failure day care clinic and get expert answers to their questions.
For Vlachos, Lahti, and the team it was a victory in applying the innovation process they learned at IHT, even in the face of obstacles, to make real changes that improve the lives of real patients. They showed that even in demanding clinical environments and with organisational challenges, the power of first understanding the problem and then using low-cost experiments to test their ideas could change perceptions and habits for the better.
Interested in INSEAD's Innovating Health for Tomorrow programme? Have a look at the web page.
Innovating Health for Tomorrow is the result of the Trust’s longstanding partnership with INSEAD to provide management education for healthcare professionals. INSEAD is a Flagship Partner within the Trust’s 2020 strategy and a key component of the Trust’s goal to advance knowledge and innovation in seeking to transform health care systems. The Trust works across the Europe, Middle East and Africa region in making a difference in human health through multiple social impact interventions. Currently within the Trust’s partnership portfolio there are over 70 active programmes run with partner organisations. For more information about the Trust and its activities, please visit www.jjcct.org