Leading Innovation: Nicholas F. LaRusso Interview

Children"s Hospitals Today, Fall 2012

Nicholas F. LaRusso, M.D.
Medical Director
Mayo Clinic Center for Innovation

Editor’s Note: This is the full Q&A with this interviewee. Due to space limitations, some answers were omitted or truncated for the print version of the magazine. Any simplifications or variations in the published answers were vetted and approved by the interviewee prior to print.

Q. Define innovation. 

Innovation has many definitions and perhaps the most universally accepted is doing something new and different. We think of innovation as a verb- it’s taking a new idea to reality or taking an old idea and operationalizing it in a new way. In the Center for Innovation, we define innovation as “discovering and implementing new ways to deliver better health”. Functionally, innovation requires the willingness to be open to non-traditional ways of thinking. It is most evident in individuals who, by nature or nurture, are uncomfortable with the status quo. It is a different way of problem framing and solving! It’s easier to describe what it looks like- it’s a room full of diverse people with different skill sets and perspectives working together in concert to CO-CREATE the best solution…..after adequately framing the problem! They first make sure they are asking the ‘right’ questions in order to know they are solving the ‘right’ problems. It means not rushing to a solution, but rather through purposeful observation and collaboration of an interdisciplinary team, they co-create solutions, allowing the best solution(s) to emerge. They try to avoid becoming more efficient at doing the wrong thing. Having leadership support and building strategic external partnerships is vital to the process.

Q. What does innovation mean in a health care setting?

A. It’s no secret that radical change is necessary to fix the dysfunctional U.S. health care system. The science of medicine has advanced greatly and our ability to understand, diagnose and treat disease has grown exponentially. However, our system for getting these sophisticated and advanced technologies to people in an affordable and equitable fashion and our ability to affect their lives in a positive way is fundamentally unchanged. In other words, the delivery of healthcare has not kept pace with the advances we have made in the science of medicine. Innovation in the healthcare setting means taking the discipline of design thinking and translating what we observe and learn into insights which lead to new and novel ways of delivering healthcare. Innovation in the healthcare setting has the potential to repair many of the problems of the current health care system.

Q. What would you cite as the biggest barriers to strategic innovation?

A. While there can be a variety of barriers, two come to mind; lack of leadership support or buy in and lack of declared focus. They really go hand in hand because when you have a declared focus or mission, leadership is more likely to get on board.

Q. Do you think certain areas of health care are more open to innovation?

The areas more open to innovation aren’t as much dependent on ‘what’ they are doing, rather on ‘who’ is doing it. Areas that have a wide range of diverse perspectives and disciplines by and large are more progressive to trying new things and really asking the right questions, like “why are we still doing it like this and how can we do it better?” These are the areas ripe for innovation. In addition, the climate within healthcare at the beginning of the 21st century is one of urgency for change. There is recognition that the financial escalation of health care costs, now at about 17% of our GDP, is not sustainable,

Q. What advice can you share on how to innovate at different scales (for example organization wide innovation versus departmental innovation)?

A. Leadership support is imperative in order to try new things and think in new ways. Recognizing that innovation is a discipline with a body of knowledge that can be learned is critical. If someone wants to innovate, they must become a student of the discipline of innovation. We at Mayo Clinic are fortunate to have Transforming Health Care Delivery as one of our four strategic requirements. Once you have that leadership support, you will have access to more resources and the infrastructure to support innovation. Communication is a key element also. Making sure you have a dedicated individual or group of individuals who are communicating your work through messages to other departments.

Q. What are some improvements that children’s hospital leaders can make to better leverage innovation?

A. It’s difficult to suggest improvements where you don’t know exactly what someone is already doing. Having said that, I would find out who on their staff are innovative thinkers. This isn’t always easy to do but when you begin talking about innovation in your institution, people within will start coming to you. These are people who are willing to challenge the status quo. Also, be open to external collaborative partners who might have technology or resources that you can team up with. External partners can be as crucial as your internal stakeholders.

Q. What are mistakes are health care leaders making when it comes to innovation?

A. Since the next question addresses ‘lessons learned’, it also talks about what we have learned ‘not’ to do along the way. To be truly innovative, you can’t rush to a solution or answer and you can’t force people to think or behave a certain way. If you don’t have patience and take the time to align stakeholders, you can very well be doomed from the beginning. Not finding out who will be impacted most by an innovation and listening to what they have to say would be a mistake.

Q. Who do you admire as an innovation leader?

A. There are several innovation leaders whom I admire and it would be hard to call out any single one of them. Several that come to mind to me are Clayton Christensen, Larry Keeley, Tim Brown, David Kelly, and Jim Hackett. Mayo Clinic Center for Innovation has an external advisory board made up of significant thought leaders and influencers who are real game changers in their industries.

Q. What lessons can be learned from these leaders?

These are some of the lessons we have learned in the Mayo Clinic Center for Innovation since we began four years ago:

  • Innovation is Hard! It involves changing behavior and this doesn’t happen overnight, but over time. Innovation also means working with a variety of different disciplines that don’t all speak the same language. Gathering and aligning stakeholders takes time also and they have to be brought together in order to join forces and co-create solutions. 

  • Design with, not for. Since change in healthcare comes from individuals changing their behavior, it’s not an environment to tell people how to act differently. You need collaborative partners for co-creating new ideas. It doesn’t work well to be the “expert” and tell people how to work. Better to partner than to impose.

  • Institutional readiness cannot be forced. In a way, innovators are like surfers, sitting in the water, and waiting until the wave comes. Being prepared to catch the wave means doing the research and recognizing that sometimes you can’t force the wave to happen. When leadership is ready, you have to be on your board and ready to surf. Having said that, sometimes leadership has to be pushed jump on board.

  • Have realistic expectations- Be prepared to take a lot of small steps, as these small changes can have large impact. Think Big, Start Small, Move Fast ™. Recognize that the “end goals” may require several iterations

  • Leadership should guide, not dictate. The role of leadership is to set the goal, but not to be micro-managers. A good team of diverse thinkers will know how to get where they need to go. Solutions aren’t obvious but they will emerge and the innovation is not engaging people are being told what to do.

Q. What key advice do you have for children’s hospital leaders? How can they overcome resistance to new ideas?

A. As far as resistance to change, I can only say that if a 150 year old medical institution such as Mayo Clinic can innovate and change the way we are doing things, without compromising on the culture and values on which we were founded, than I think it is possible for anyone to do it. We think the way Albert Einstein did when he said, “the problems we face today cannot be solved at the same level of thinking that created them”. In healthcare particularly, we have problems today and we have to apply a new radical type of thinking in order to solve them and make a difference. There are some excellent books on innovation- The Innovators DNA- Mastering the Five Skills of Disruptive Innovation, by Jeff Dyer, Hal Gregersen, Clayton Christensen; Change by Design by Tim Brown; and A Managers Pocket Guide to Innovation by Richard Bryntenson are all excellent.

Q. What are you most excited about?

A. Fulfilling the mission of the Mayo Clinic Center for Innovation- to transform the experience and delivery of health and healthcare. To really impact lives when it comes to health and health care gets me excited.