This is a brief post that needs some more thought and input. This week I’ve been attending @TEDMED at the Kennedy Centre in Washington. Naturally a major theme is innovation. Start-ups, entrepreneurship, thinking out of the box and radical re-thinking is being showcased. Successful entrepreneurs were asked to speak about innovation: interestingly it is common that they can’t explain how it is done (or they are modestly protecting the secret). So if innovation can’t be taught then why include it in the ‘Things they didn’t teach in medical school’ series?

Innovation is a fancy name for making things better. This is perhaps beyond quality improvement and extends to recognising there is problem that requires fixing and then identifying a solution. There is no shortage of problems that innovative ideas could fix in hospitals.

When I attend medical conferences one thing I frequently observe is that people (doctors, nurses and other members of the healthcare team) often have great ideas for solving problems. What the real problem for innovation in healthcare seems to be is a large number of artificial barriers, sustainability, reduction of duplication and dissemination of the big ideas.

An example of the barriers is the IT department. When my colleagues first suggest using Moodle (a learning management system) for the purposes of orienting and training our registrars they were blocked. IT wouldn’t let the external site be accessed through the firewall. Later on the hospital actually adopted Moodle for its’ organisational learning program. Another example is new forms required for safety projects might take months to approve though the ‘forms’ committee.

Ofter innovations are led by a champion who has a short term grant to undertake an improvement project. There is short term success and then when funding runs out the champion, by necessity moves on. In the same way you might find exactly the same project undertaken at another hospital.

The other important barrier is a lack of parties willing to provide opportunity. Start-up companies go and look for venture capital. In hospitals, especially in the public sector, there is no equivalent of venture capital. Convincing administrators to invest in your idea is not easy.

Dissemination of innovations has all sorts of barriers put up by organisations – more often than not these objections are based on money, however, one of the problems is doctors and other healthcare professionals have never been trained how to best undertake organisation and behavioural change: perhaps this is the real skill that hasn’t been taught in medical school – and this will be discussed in the next post.