Scrappy Innovation

Change Your Ideas on Innovation and Transformation by Adopting Simpler Solutions

I spent the first week of June with several dozen chief executive officers from around the country representing hospitals and health systems small and large. I was honored to be the opening keynote and stayed shoulder-to-shoulder with the participants throughout the event. It was fascinating to get a bird’s eye view of all the challenges and opportunities that face this diverse gathering of leaders. I left with two primary takeaways. 1) Indeed, as Drucker reflected, there is no more complicated organization than the hospital (academic). My respect for the CEO role increased ten-fold and 2) Smaller hospitals, forced to innovate and be scrappy, were a good model for their larger peer group. They make do with more simple and less costly solutions and still achieve similar outcomes.  

I came across this concept of “scrappy innovation” when cobbling together the first edition of the 2019 healthcare bestseller, Voices of Innovation. While large hospitals were purchasing ultra-expensive enterprise-class systems to run their organizations, less financially robust hospitals had to make do with what they could afford. Interestingly, patient experience, financial and clinical outcomes were not markedly different. In fact, as the book illustrates, some of these small hospitals were running innovation and transformation circles around their wealthier peers. So, I asked about this dichotomy. While I did not launch a scientific study, the anecdotal research suggested that those practicing “scrappy innovation”, by percentage, did not have the same level of technical debt. In other words, they did not have the same volume of purchased hardware, software and applications to work around. They were not handcuffed to a specific vendor. They were more able and willing to make low-cost investments that yielded similar results.  

The larger hospital CEOs were also asking questions. They shared their frustrations having to wait multiple years for massive system upgrades that frankly lead to a regression to the mean. They wanted to deploy certain features and functions immediately to improve the clinician and patient experience, yet their hands were tied. In a similar conference a few years back, a frustrated CEO stood up and shouted the name of a vendor to vent his frustration. His organization had invested so many resources into a single system that they had nothing left to spend on innovation or discovery.  

The scrappy innovators shared examples how they do not even use the holy grail…apps, and the patients and families love it. Their adoption rates are in the 90% realm, especially with the older population who know how to hit a link, but do not necessarily recall all their passwords and how to navigate multiple apps. My Dad is in this camp 100%. Another example came in where there was a long-analyzed workflow problem and the cost to customize their software was formidable. In 2 weeks, they deployed their own workaround and saved hundreds of thousands of dollars and 18 months before the next upgrade cycle. They now have their own FTE who does nothing but low code programming that yields immediate results. Scrappy innovation.  

In this increasingly competitive environment, I suspect we will see more scrappy innovation emerge and a rejection of the methodologies leveraged in the past with multi-year, multi-million-dollar implementations. We just can’t afford it anymore.