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Invisible Building Blocks of Digital Innovation: the Internet of Things in a Hospital

Invisible Building Blocks of Digital Innovation: the Internet of Things in a Hospital

Innovating —the act of doing anything new in a creative way — is inherently disruptive. This is doubly true inside complex systems and regulated industries. And organizations are built to avoid disruption. Often, what we see as an example of a simple innovation is actually the result of small, invisible — but nonetheless crucial — enablers. I love these enablers and how they allow us to innovate with much less discomfort. They are the unsung heros of change and rapid cycle development. Lately, we've been on the bleeding edge of inexpensive Internet of Things technology in the hospital. And none of it would be possible without these enablers having laid some invisible bricks of digital innovation.

A few years ago, our team got very interested in voice-first interfaces; or, for the less nerdy, Amazon Echos. We were working on a project to give patients more control over their hospital rooms. It felt like voice control was a prototype worth pursuing. We were early enough to express interest to Amazon and cleared their waiting list quickly. We unboxed our magic cylinder, plugged it in, and then realized the next big hurdle: wi-fi!


our digital pal

this Echo sits in our team's space and spits out jams all day long!

Hospitals, even among regulated industries, take data privacy and security even more seriously than most. We also have lawyers with keen eyes on protecting patient data and mitigating the organization's risk. So, like any sophisticated large organization, our Wi-Fi networks are rather locked down. Unlike the set-up most of us have at home, joining wi-fi at the hospital requires a corporate username and password. While that authentication mechanism is easy enough on a laptop or smartphone, it's outright impossible for most consumer-oriented devices. Simply put, there's no way to put a corporate username and password into an Amazon echo.

Around the same time, we met someone (who would quickly join our team) who knew how to move quickly in the digital world. Matt strolled into our innovation studio one day and immediately belted out: "I know what this place is!" We often say we know our kind of weirdo when we meet them and Matt was clearly our kind of weirdo. In joining our team, he helped us create our Digital Services model. We cribbed notes from our friends a few miles across town in the federal government — the U.S. Digital Service. That team was formed to bring modern, Silicon Valley-style tech skills to existing U.S. government teams.

For us, and our friends in the U.S. Digital Service, digital services is different from IT. Where IT is responsible for designing and maintaining our networks, electronic medical records, and business systems, digital services is all about building and testing new things quickly to address the needs of end-users and innovators.

Matt's presence on the team expanded our horizons about what could be possible. We realized we needed a safe sandbox —a place to safely test our ideas before going public. We implemented our own entirely separate, airgapped network. We installed a commercial-grade business line for Internet from a different Internet service provider than the one used by the hospital. We set up our own wi-fi network to be completely separate from any of the hospital's corporate infrastructure. We also set up a second network dedicated to Internet of Things devices like the Amazon echo.

Having our own separate infrastructure provided a platform on which to rapidly experiment with emerging technology without putting the organization or patients' data at risk. And having a platform in our team's control means we can get devices up and running without burdening another team in the hospital.

Today, we have expanded our network to cover large portions of the hospital. It enables us to test new devices and concepts in patient rooms, waiting areas, and clinic spaces. Our innovation network has also given us the ability to help others in the organization in ways never before possible.

A few months ago, The head of our case management department approached our innovation team's lean engineers with a challenge: she needed a new way to capture data on the types of services and programs that patients needed. She wanted something like the famous Staples easy button. Matt had been waiting for a use case like this, and knew exactly what he wanted to deploy.


a stack of Amazon Dash buttons awaiting deployment



Around the time Amazon introduced its echo device, it also came out with something called IoT buttons. Originally offered as a convenient way to reorder frequently consumed products, the unbranded versions are amazingly flexible. Imagine something the size of your thumb with adhesive on the back and a button on the front. You attach them to your wi-fi network and can easily program them to do internet-y things. Well, someone like Matt can easily program them.

Matt set up five of the $20 IoT buttons for case management. Each one corresponded to a type of patient need. When pressed, they automatically create a row in a Google Sheet spreadsheet; instant data capture. When our radiology department needed to capture data on patient flow, the IoT buttons let them log things like arrival time, navigational issues and reasons for being late to an appointment. Matt and the lean engineers deployed them in hours at nearly zero cost.

We've also been using the IoT buttons in a patient-facing prototype. For another project, we want to capture real-time feedback from people about their experiences. Matt and team mounted some of the buttons in a cardboard box, covered it with a slickly-designed label, and we had an instant, wireless feedback device. We were able to iterate on how we asked questions about patient experiences quickly and deploy the experience boxes into patient areas without any obstacles. And, since they are easily programmed, we can get the data in really convenient ways. When a button is pressed, not only is it logged into a Google Sheet, but a robot pops a notice into our team's Slack board telling us what the feedback is and from where in the hospital it originated.

There is so much neat tech in the world and we're in a time when the release cycle is speeding up exponentially. Taking advantage of these things for testing, inspiration and innovation is a game-changer. But, it requires some building blocks like a sandboxed network and digital services leads like Matt. Investments in those enablers pay dividends in efficiency and expediency and they do it in ways we haven't traditionally embraced in healthcare.

version 1, 2 and 3

IoT button-powered patient feedback boxes 

Cutting through traditional organizational silos or finding outside contracted partners takes time, burns momentum and all too often stifles innovation entirely. Teams that want to move quickly need the resources and people who make speed and agility possible and inexpensive. It also reduces the cost of failure. Find a Matt for your team, get a mobile hotspot or your own network and you start changing healthcare with $20 buttons.

IoT enabled in-room signage (version 1.0)

IoT enabled in-room signage (version 1.0)

Rules for radical innovators

Rules for radical innovators

There's an inherent tension in introducing a highly creative process into a highly complex system. When it works, that tension resolves into a harmony with a sum greater than its parts. When it's discordant the results feel like chaos.

For the last year, we've undertaken a huge challenge: create the largest rollout of human-centered innovation in any hospital, ever. Our organization charged every leader -from nurse managers to C-suite executives -with identifying, running and sharing two human-centered design based innovation projects. In addition to training and coaching those leaders, we still had several large-scale, patient-facing projects on our plate. The volume of work alone forced our innovation team to go headfirst into rethinking how to systematize a process which is normally characterized by non-linear paths, creative doubling back and a general whimsy. We've come to know these axioms as Hub Rules.

We wanted a way to give people, including our own team, guard rails; operating guidelines for the work. But we didn't want the rules to be so constraining they'd stifle the work itself. We wanted sign posts that a traveler would fine encouraging, not daunting. The rules themselves needed to feel optimistic, intuitive, and even slightly disruptive.


Rule 1:
Empower Everyone

democratize design!

Rule 1: empower everyone: let's face it, even the word innovation is loaded. To some it means iPhones and to others it's just a rebranding of strategy. If you're an incumbent player in a space, like a radiology tech who's worked their whole career in known model, innovation may sound like code for being obsoleted. We couldn't have that, not if we need people to want to come to this work. Empowering everyone is all about making the process open, easy, clear and accessible. We heeded Empower Everyone when we created our simplified process and tools: Listen, Imagine, Do.

We changed our language to make innovation feel normal, like things anyone would do every day; we just put those things in a purposeful order. It also means going to the gemba, or going to where the work is. It's more empowering for a coach and supplies to go to a nursing station than ask nurses to leave their post and come to our studio.


Rule 2



always be designing!

Rule 2: always be designing: It goes like this: "so we're ready to hire the coder/videographer/doctor/whomever, right?" Well, maybe not so fast. Do we know the script for the video? Have we tested it? Can we make a prototype film with a smart phone? Can we mock up the app in PowerPoint first and get people to test it? If we haven't exhausted our opportunities to get input and feedback from users, then let's keep designing. This might sound counter intuitive to those of us who believe in the always be shipping mantra of the startup world. If we keep designing, are we chasing perfect instead of accepting good? The key here is to recognize that the process of iterating ideas and prototypes still produces impact! If a team of mid-level managers creates a pretty good iPhone video as a prototype, they can get it deployed as a test so much faster than hiring a video company. And when they want to make a change, it's a 15 minute effort, not months of work and dollars spent. ABD also means we inculcate the notion that a good design is never finished, it's only getting better.

Rule 3:
Solve Within Arm's Reach

(or how we learned to always go smaller)

Rule 3: solve within arms reach: If there were one rule to rule them all, this would be it! We've all tried to boil the ocean -those projects where in the first meeting we've already identified 20 contingencies and resource needs. If a nurse comes and says I want to redesign discharge for our hospital, which executive wouldn't embrace that energy with open arms? So the nurse tries. Before he gets started, someone else takes them aside and suggests who else they need to include in the project. After 3 months of trying to align the schedules of 15 people, the meeting happens. Some know immediately what must be done. Others don't know why they are there. And somewhere, someone is running it up the flagpole that they weren't included. We should probably meet again, right? Maybe monthly? And so the discharge committee gets formed. People debate best practices, egos get bruised, and the courageous nurse who stared the project feels more defeated than if he'd never bothered at all.

Solve Within Arms Reach is all about short-circuiting that. To that nurse we say: "awesome! Let's get started. What part of the discharge process can you work on first? Which part can you and maybe a small team affect on your own?" Often, it turns out, that scope is pretty small. It might be constrained to reimagining the last sentences you say to someone going home. But we can work on that! We can get started today! We can make an impact on that and tell the story and get others doing it too. That's how innovation spreads. That's how we go to scale!

SWAR has another benefit. People do and make quickly. And that's something we don't get to do enough in this modern life. It feeds the soul and makes us feel productive. Who wouldn't rather go home and say: "today, I started doing discharges differently"? That's so much more rewarding than: "we had our monthly discharge project meeting today..."


Rule 4
Run Towards

The Challenge

because it CAN be solved!

Rule 4: Run Towards the Challenge: One of my dad's favorite lines is action conquers fear. What happens we we see a challenge and run headlong towards it, believing it can be solved? Too often, in corporate settings, we start by failing to start. We have meetings, we study the problem, we debate who has the right to work on it, who can work on it and what the solution must be. Some of the best innovators I know flip that it's head. The early pioneers in the United States Digital Service and early Presidential Innovation Fellows speak about this often. These were some of the brightest folks culled from Silicone Valley. They came with the mindset it's easier to start tackling a problem when you run towards it head on. We've borrow that energy and encourage our colleagues to do the same.

Running towards is all about optimism. Think about every action movie where the heroine is outrunning imminent danger. She gets to a chasom, the metal airlock door slowly sealing itself on the other side. What to they do? They taking a running start, leap across and know the rebells will have cracked the code, opening the door on the other side by the time they've gotten there. Whew!

Rule 5
Design With,

Not For

together is always better

Rule 5: Design With, Not For: perhaps no other industry is as plagued by paternalism as healthcare. We have a culture of doing for, not with. But for innovations to take hold, they have to be things we all feel good about and see value in. There's nothjng more empowering than involving people. When we have a team of patients, innovators, doctors and administrators, all on equal footing, all participating in creating the solution, it's unlike anything else. It completely obliterates the need to sell ideas and concepts back to someone. No groups feel left out. No one feels like they have to paint the barn shed.

These, like all rules, should be questioned. They should be bent, and broken and reformed. And if they are as helpful to you as they have been to us, then pass them along.

The journey is the Innovation

The journey is the Innovation

Sometimes it's not the impact of the project, it's the experience that makes all difference to patients, staff and innovators.