In the past, surgeons working at the Cincinnati Children’s Hospital in Ohio had to undergo something called M&M or ‘Morbidity and Mortality’. It was a weekly quality assurance meeting in which participants were expected to present the problems they faced at work. “It was daunting because after you presented, for example, a patient who had certain complications, the rest of the surgeons would start questioning you, ‘why didn’t you do that?’ It was punitive,” recalls Dr. Todd Ponsky, Director of Clinical Growth and Transformation at Cincinnati Children’s Hospital.
Dr. Ponsky wanted to change all that. So, when he took over the responsibility of spearheading innovation in the department of surgery at Cincinnati Children’s, M&M became MMI. “We called it Morbidity, Mortality and Innovation,” he explains. “It became an uplifting seminar. Surgeons continued to present what had gone wrong in their practice and what could be done differently. But before they finished, surgeons would also be asked to think of something that hasn’t existed yet but could have solved the problem”. If everyone in the room was then equally interested in a particular proposed solution or idea, it would then be moved onto RSI.
RSI normally refers to rapid sequence intubation, a procedure that requires a physician to quickly put a breathing tube into a very sick patient to prevent further deterioration. But for Dr. Ponsky, RSI means rapid sequence innovation. A week after MMI, a separate meeting would be conducted to collate all the interesting solutions or ideas. Clinicians involved in this meeting undergo two-hours of “systematic inventive thinking” to select the best solution or idea for prototyping.
Following a week of prototyping with the engineers and another week of reviewing, a brand-new product would emerge. “So, we have turned innovation into a conveyor belt,” exclaims Ponsky. “Within a month, we were able to move from an idea to a product. What’s exciting is we don’t just do it with devices but also for processes.” For example, Dr. Ponsky cites how a young patient with a blocked feeding tube ended up with a complication. The team of surgeons generated two ideas that not only solve this problem but also others that they wouldn’t have thought of initially.
Dr. Ponsky believes this is what healthcare needs to innovate; “Not only surgeons and physicians but many frontline workers are not given time to innovate. Unfortunately, they tend to be the ones who see most problems and have constructive ways to overcome them. Unless we give them a chance to put things together, these solutions will never go anywhere”.
However, challenges remain. “The hardest thing is breaking fixedness,” says Ponsky. “It was the same with Henry Ford and horses. People just wanted to make horses go faster and not something new to replace horses. Likewise, surgeons will get offended if you tell them to do things differently. A lot of effort is needed to break those fixated mindsets.
“The other challenge is what I would call the ‘good-enough principle’. When the person who invented the digital camera showed it to Kodak, they didn’t like it because it wasn’t as good as the camera photo. What these people at Kodak didn’t realize was these digital camera photos were good enough and most people would just be fine with them. It is the people that want exactly what they had before that stopped them from innovating.”
In the same way, Dr. Ponsky hopes for a day when surgeons can be trained differently. “We were taught safety in the operating rooms; so much that it becomes an instinct,” he says. “I want innovation to be an instinct too. At the end of the day, innovation is all about mindset. We need to set the culture right, so the right people will come together. Once people see that this works, everyone will want to join the process”.