“We’re not in Kansas anymore, Toto, are we?” – Paul Plsek, Paul E. Plsek & Associates, Inc.
As Fishbowl Panelists emphasized, it takes a village of multiple stakeholders to spread an innovation. Engaging multiple stakeholders will require innovators to venture beyond their familiar clinical worlds to first recognize and then actively leverage the complementary roles multiple stakeholders can play. These roles may differ depending on factors such as the nature and setting of the innovation, the stage of SUS, and the scope of SUS plans.
Multiple stakeholders and their roles include:
- Public and Private Sector Funders: Federal, state, and local governments as well as private sector entities such as foundations, venture capitalists, and others play key roles in developing innovations for spread and enabling more ambitious spread plans. Both the public and private sectors may identify areas in need of innovation and supply seed money for their development. Foundations, for example, can be both a source of capital and expertise at different stages of development and dissemination. The public sector, in particular, can play a powerful role in fostering spread by changing payment methods, providing incentives, or passing laws and establishing regulations that, in effect, create or expand a market for innovations and incentives for their spread.
- Payers: Payers such as insurance plans can also play important roles in spreading innovations by, for example, reimbursing innovative activities, such as disease management interventions, that reduce health care costs. However, payers will often require strong evidence of cost savings and quality improvement. For example, Adam Zavadil observed that “some of the savings may be illusory” from discrete innovations since savings gained in one area of care (e.g., disease management) might be offset by increased prices in another (e.g., increased cost of testing).
- Hospital/Health System C-Suite: The development of hospital/health system- based innovations by its nature requires executive-level commitment to provide the organizational resources and flexibility needed to investigate alternate interventions, reassign or recruit staff, provide equipment and other supplies, measure achievements, and refine the intervention. Spread, in turn, requires additional C-suite support in the form of endorsements and resources. For example, as Innovations Exchange Expert Panel member Ted Eytan noted, C- suite administrators of organizations considering adoption will examine the degree of C-suite support for the original innovation. As innovator Bruce Leff observed, the C-suite may also supply seed money for initial spread activities that can attract the attention of potential backers. His home institution, Johns Hopkins University School of Medicine and its affiliated hospital system, supported spread activities that attracted media coverage in publications such as the Wall Street Journal.
- Professional colleagues, especially physicians: Professional colleagues can be invaluable sources of support, according to Joseph Skelton, particularly if they believe the innovation addresses an important clinical need they confront in their practices. Enlisting the support of physicians may be particularly important if their role is central to an innovation’s successful implementation or if they are gatekeepers to spread. Dr. Skelton noted the importance of physicians who refer patients to treatment by innovative programs. In addition, as Tom Graff observed, an innovation is likelier to have “long-term staying power” if the professional experience of delivering care is improved and disruptions to preconceptions of professional roles and relationships (e.g. by introducing a care coordinator, or by demanding new ways of working in multi-professional teams) are anticipated and managed.
- Patients and families: Susan Edgman-Levitan, an Innovations Exchange Expert panel member, observed that “I’ve never seen anything we do in health care that hasn’t been vastly improved by engaging patients and families.” Patient and family input can be critical to improving the quality and effectiveness of innovations that directly affect patients and improve their performance on a range of metrics, which in turn can help to build the business case for spread. A patient steering committee may be helpful in this regard. Community organization expert Sharon Schindler Rising noted that patients and families can also help market innovations by informing their networks. Their role may be particularly important in helping an innovation gain acceptance as it spreads into a new community.
- Communities: Development of successful innovations can require deep knowledge of the community context, including demographics, culture and values, health-related challenges, and wrap-around services. As Joseph Skelton explained, his innovation developed a family navigator component to link patients and their families with essential community resources, allowing them to better prepare themselves for treatment.
- Connectors: Innovators benefit from “connectors” such as advisory boards that have networks that bridge different stakeholder communities. Connectors can make it easier for innovators to make the contact needed to assess initial multi- stakeholder opinion on their interventions and the ways in which they need to be refined to speed adoption. Innovators can also tap connectors for help with forming spread teams and eliciting support from funders, payers, and other key stakeholders. As foundation executive Amy Berman advised Linda Wick, a national advisory board could “help you think through the market, the industry, pay for performance, quality indicators.”
- Consultants: Consultants are also connectors with particular skill sets such as business plan development that are essential to spread. As Lisa Suennen advised Linda Wick, this kind of assistance can be more accessible and economic feasible than innovators might realize: “Go to the University of Minnesota’s business school or whatever the closest equivalent is and find somebody in the MBA program that focuses on health care or the master’s of public health program and ask … there are students who will write these plans for you. They need the credit. You need the plan.”