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Author: Don Obrien

Investing In Teaching Safety-Net Providers To Innovate Can Address Health Inequities


The American health care system requires significant innovation to respond to the evolving needs of underserved communities and prevent exacerbation of health inequities for people getting care in safety-net settings. The global pandemic has accelerated innovation in health care delivery and has shown that the most successful organizations were able to pivot and profoundly change the way they deliver health care to their communities.

Safety-net health systems that serve low-income, immigrant, and black and brown communities typically are resource constrained. These systems have limited innovation capacity and thus struggled with their response to COVID-19. There is a sustainable solution that works—embed innovation competencies in safety-net provider systems. This is the story of how a wide range of organizations did this by building upon philanthropic dollars to spark, seed, and spread health care innovation and ensure that communities with the greatest need for innovation are not left behind.

Investing In Capacity Building For Innovation

Traditionally, philanthropy has supported innovation by providing project-by-project funding or focusing on specific populations. Our experience working in different health systems across the country shows an alternate approach: investing in a more sustainable way by building an organization’s capacity and skill set for innovation. This capacity outlasts any particular project and positions the organization to tackle emergent new problems successfully.

Design thinking is a human-centered approach to innovation that creates a discipline of experimentation, of failing fast and inexpensively, and of rapidly testing and learning to prove concepts. By investing in the organization’s becoming skilled in design thinking, the tools and processes can be applied to challenges over time, not just today’s challenge. Our insights are based upon experiences with an array of safety-net health care systems that have built the infrastructure and processes to incorporate innovation capabilities into the fabric of their organization with a goal of impact and sustainability.

These organizations committed to design thinking as a methodology to: (1) authentically partner with their patients and communities to design better systems to meet patient and community needs; (2) seed a culture of innovation in their organizations; and (3) shift the organization’s focus to solving the right problems by understanding problems from “the customer’s” point of view.

Examples: Building Innovation Capabilities In Safety-Net Systems

In 2012 Blue Shield of California Foundation (BSCF) supported the Center for Care Innovations  (CCI) to design the Catalyst program to build innovation capabilities in safety-net health systems. The Catalyst program was an experiment to understand whether safety-net health systems had the interest, time, and ability to learn, apply, and sustain innovation skills to improve care.

After 10 years the Catalyst program has trained 338 catalysts across 92 organizations in five states. Leaders and staff from both safety-net health care organizations and community-based organizations have adopted design thinking skills and are building a culture of innovation in their organizations. Organizations used these skills on a range of projects from strengthening organizational culture, to building new workforce models, to reimagining how they deliver care using technology and new processes. The CCI recruited graduates from the program to serve as coaches for subsequent cohorts and built a robust network of innovators to support each other in transformation and change.

In 2015 the Nicholson Foundation (TNF) worked with the CCI to explore New Jersey safety-net systems’ interest in deeper investment in innovation and design thinking. Subsequently, TNF introduced the Catalyst program to nine New Jersey health systems that included federally qualified health centers (FQHCs) and safety-net hospitals. TNF’s support catalyzed and accelerated the health systems’ interest in design thinking. When TNF wanted to make a deeper investment and build at least one innovation center in the state that would sustain innovation over time, the CCI connected TNF to health care systems across the nation that had innovation centers committed to design thinking that could serve as models for potential adoption by health systems in New Jersey. One system was Columbus Regional Health (CRH).

CRH’s Innovation Center in Columbus, Indiana (a city of 50,000 people in the southeastern rural part of the Hoosier State) was initially funded by its foundation, Columbus Regional Health Foundation (CRHF), to establish a systematic and sustainable approach to innovation in a community health system. CRH developed an intentional innovation model built on design thinking competencies, and built those skills and mindsets into its operations and strategy, external partnerships, physical space, and new facilities planning. CRH minimized new operating expenses by training existing hospital staff and an internal quality improvement team in design thinking—essentially creating design thinking consultants that now routinely lead teams and provide design thinking expertise to projects.

Building on the CCI Catalyst program experience, CRH developed a self-sustaining internal catalyst program, trained 42 catalysts (some of whom now serve at trainers), and developed and published its own curriculum and training materials. Its Innovation Center now has a significant annual impact on decreasing costs and increasing revenues as a direct result of applying design thinking and process improvement tools to strategic projects.

Innovation Center Model Goes To St. Joseph’s Health

Synthesizing the lessons from the CCI Catalyst program and the CRH experience, as well as insights from other innovation partners, we co-created with TNF and St. Joseph’s Health (SJH) a sustainable innovation center at SJH in Paterson, New Jersey, an ethnically diverse city in North Jersey with a population of 150,000 people, many of whom are facing economic challenges. TNF provided a planning grant to design and develop an innovation center guided by the SJH senior leadership team. The plan deepened SJH’s commitment, and TNF subsequently provided additional grant funding to create the center in a phased approach. Critical success factors included hiring an experienced innovation director, developing a Design Thinking Catalyst program for leaders and staff, and aligning SJH’s Center for Innovation to support its strategic priorities from the start.

SJH’s systemic adoption of design thinking proved to be tremendously important in its response to COVID-19 challenges. The design thinking mindsets gave its staff the ability to pivot, experiment, learn from their customers, and frame emergent problems in a way that was powerful and effective. The COVID-19 crisis served as a proof of concept to SJH leadership of the value of design thinking and the potential of its center to advance its strategic priorities. The grants from TNF served as seed funding to develop innovation skills while reducing the risk to SJH of adopting design thinking and developing a Center for Innovation.

Supporting Innovation In Underresourced Settings

A variety of approaches have been successful in building design thinking competencies among safety-net providers regardless of their size or geographic location. Common across these models was the pivotal role philanthropy played, making it possible to catalyze change, remove financial risks, and see improvements early. Financial risk is, of course, a high barrier to innovation, especially for safety-net providers.

Additional lessons learned as to how to successfully leverage philanthropic investment to drive innovation include:

  • Create a phased approach to innovation

Building innovation competencies within organizations is most successful with shorter cycles of investment and learning. This is best accomplished through a series of smaller, shorter-term grants rather than a single multiyear grant, giving the funder the ability to tailor the grant to what the grantee organization has learned and how it needs to move forward. TNF’s approach was to start broadly, learn from the organizations most committed to making change, and then go deep with a single innovation center. This allowed TNF to be flexible and provide bigger grants where there was a greater likelihood of success.

  • Bring more than money to the partnership with grantees

The CRHF, TNF, and BSCF all funded “benchmarking trips” to visit and learn from innovation centers in hospitals and other businesses, vetted and engaged external consultants, connected grantees to networks of people learning how to apply design thinking, and identified educational resources from which grantees could learn how to develop innovation skills. Money isn’t the only barrier these organizations face. Flattening the learning curve, knowing which resources to bring in, and learning from others who have been successful are huge accelerators for change.

  • Expect different levels of impact

Design thinking provides an inclusive process to hear the voices of patients and communities and design solutions that meet their needs, offering tremendous impact at the individual project level. But it can also bring about significant financial gains at the organizational level. CRH saw an annualized positive revenue impact greater than $1 million when it built a repeatable approach to innovating.

  • Leverage the power of shared goals and collective impact

If you are a regional funder, consider bringing together other community-based organizations and funders working on common community issues to build these skills while tackling a common project. Community organizations are partners, not competition. You will be creating a design thinking network, which is critical to building innovation muscle. Having multiple grant funders on a project also ensures that the project receives the time and attention needed to be successful.

  • Bring new donors to the table

This type of work attracts a different kind of funder than the more traditional type of donors to health systems that fund new buildings, new equipment, and new technology. “Innovation” is such a generic term that it can lead to uncertainly about what a donor is funding, especially when compared to funding equipment. If concrete examples of the outcomes sought and the types of projects to achieve them are used, a different type of donor will embrace the idea of funding innovation skills that outlast any single project. In design thinking, the ability to co-design with patients and families can be a strong attraction for additional government and private grants, especially for underserved and underinvested communities.



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