At Massachusetts General Hospital and Brigham and Women’s Hospital in Boston, the approach to fostering internal and external innovation is deliberate, thought out, and informed by years of experience. At HXD 2018 in Cambridge yesterday, Julia Jackson, managing director of Massachusetts General’s Healthcare Transformation Lab and Josie Elias, program manager for Brigham’s Digital Health Innovation Guide, broke down some of the most important lessons they’ve learned.

1. Be smart about internal vs external innovation

“A lot of what we talk about with enabling and empowering is about creating really interesting cross-system partnerships,” Jackson said. “Payers, providers, digital health startups, biotech, pharma--whatever it might be, no individual area of healthcare is doing a bang-up job of fixing it alone. So where do we think we need to go? These really creative partnerships.”

Brigham and Women’s and Massachusetts General both work with Pulse@MassChallenge, a Boston-based healthcare accelerator with a partnership-based model. They still foster internal innovation, but Jackson says she’s careful to investigate a matchmaking approach first.

“I have a pretty high threshold if you want to build something from scratch because I say ‘Well that’s awesome, but have you looked at the market?’” she said. “It’s innovating in digital health like crazy. And if you can tell me beyond a shadow of a doubt that this is really something the MGH, whose core competency is not computer science, should be building, great. Let’s go for it.”

And in between external and internal, at a system like Partners, is making sure there’s open communication from one hospital to another.

“How can we share what we’re doing?” Elias said. “Because I have the same problems [Jackson] does. I guarantee half of you in this room can name the same top 10 items we face every day at your institutions. So why are we doing that independently?”

2. Make innovation easy

When Massachusetts General does seek innovation internally, it does so through a process designed to make it easy for busy doctors, nurses, and administrators to start the process without taking too much focus from their day job.

For its Etherdome Challenge, the hospital seeks ideas in two rounds — the first is a simple “tweet-length” submission of a pain point and an idea for a solution. Then those pain points are crowdsourced to the whole hospital, who can vote on which pain points resonate with them. The top 20 submitters are then encouraged to put a little more time into a formal proposal.

“We’re soliciting in a broad way what needs to be fixed and then we’re going to go after it,” Jackson said. “So if every ambulatory clinic in that hospital says ‘where is Expedia for exam rooms?’, we’ll build Expedia for exam rooms next year.”

3. Have the right buy-in and the right support

Jackson says that most hospitals are starting to realize that a project needs a strong clinical champion, but that’s not all it needs.

“If you do not have an administrative champion in a hospital you will never make it into an operating budget,” she said. “Do not do an innovation project without an administrative and a clinical champion.”

Elias added a third essential person — the project manager.

“A clinician who is really busy is great for developing ideas, but they are not project managers,” she said. “We see more projects that get lost due to lack of resources on that front in the actual implementation of the work that has to be done, than any other [reason].”

4. Guide projects through the journey

At Massachusetts General, Jackson said, projects were falling through the cracks when they had completed successful pilots but hadn’t worked out all the kinks for enterprise scaling.

“If you give your shiny new thing to the enterprise, it will squash it. Hands down it will. So we’ve actually created this thing called an extended pilot team at MGH and it’s an innovation in and of itself,” she said. “It’s basically a team which will take it through it’s second year, when we’re not ready to kick it out of the nest but I can’t manage it anymore.”

In other cases, guiding a project means putting in extra effort to manually communicate between a system and an EHR while the project is still in pilot mode.

“Rapid, lightweight tech integration is a very nice way of saying ‘fake the technology during a pilot if you need to’,” Jackson said. “Do not die on the hill of integration until you need to. Until we saw that it works, we’re not going to use our precious few asks of integration on an experiment.”

5. Have a plan for success

“How many of you work in hospitals and it’s like pilots til the cows come home?” Jackson said. “Like everyone can run a pilot. No problem. Ask yourself, next time you start an innovation project, ... what happens if it works? Do you have the infrastructure, the processes, the people, the champions, the administrative buy-in, the finances, and the creative legal team to actually take it to scale if it works?”

Jackson’s approach to that problem is to set a high bar for starting a project, not starting it without answering those questions first.

At the Brigham, that process has been codified into a Digital Health Innovation Guide, which is a program that takes new innovators through the paces of meeting with different important stakeholders ahead of time.

“The piece we’ve started to focus on is the next step of how do you take that process, what are the things you need to think through, who needs to be involved from day one to actually have that pilot move to operations?” Elias said. “It’s a whole different set of people.”