Recruit, Reward Clinician–Innovators in Academic Medicine

This post is the first in a series arising from our new partnership with Healthcare: The Journal of Delivery Science Innovation. Learn more about the partnership here.

By Jennifer J. Salopek

???????????????????In their article in the March 2014 issue of Healthcare: The Journal of Care Delivery Innovation, coauthors Andrey Ostrovsky, MD, and Michael Barnett, MD, write that most academic medical centers “have yet to display a commitment to delivery innovation on par with their commitment to basic research,” and that conditions common to AMCs inhibit innovation. In a telephone interview, Ostrovsky invokes the metaphor of the sandbox to expand on these ideas.

“The culture of academic marries fee-for-service with dependence on grant funding, which reinforces high-volume care delivery. Academic medical centers could be sandboxes but are completely underutilized as such. It would be powerful to fuse AMCs with the innovative sandbox principles of startups,” he says.

The duo’s ideas began germinating early in their educational careers. “We were in medical school during the inflection point: the passage of the Affordable Care Act. That increased my awareness of the limitations and problems of our health care system,” Barnett says.

Ostrovsky and Barnett both have experience in startups, environments that couldn’t be more different from academic medicine. “In the entrepreneurial sector, I saw lots of incredible ideas and swift movement,” says Barnett. “That kind of acceleration is totally foreign to AMCs, where the culture of academic medicine discourages innovation.”

In their article, the coauthors propose a two-pronged approach to foster innovation in AMCs: institutional innovation incubation programs and a clinician–innovator career track. Ostrovsky says AMCs must create supportive environments to incubate ideas, ensuring that skill development, advising, technical assistance, and other resources are offered to clinical innovators. Even more important than that, however, is cultural change, “embracing the culture of failure and invalidation of hypothesis,” he says. “AMCs must be able to generate and tolerate a rapid cycle of value discovery that allows for risk taking and is sustained until an idea sticks.”

Models of efficient, innovative health care are notably not academic medical centers, notes Barnett, but clinician–innovators can help raise the level of innovativeness that Virginia Mason, Kaiser, and Geisinger are known for. The pair urges AMCs to create a career pathway that rewards early-career physicians for activities other than publishing, such as productivity care redesign, that enhance value for patients.

“AMCs are being challenged to demonstrate how they provide better value, but there is a real bottleneck for people who have good product ideas to connect with patients, to trial those ideas and refine the clinical concept. Programs falter in the face of these bottlenecks, and talented people leave academic medicine to pursue their ideas, taking away their intellectual property and the potential to generate an increasingly innovative culture in AMCs,” Barnett says.

Ostrovsky looks at this take on scholarly activity as presenting AMCs with the opportunity to solve two problems: solvency, through increased revenue streams arising from IP and tech transfer; and care for vulnerable populations.

“A sandbox environment would expose underserved patients to the most cutting-edge approaches, creating value for them. We have the opportunity to curate and cultivate innovative solutions,” he says.

Jennifer-1990-webJennifer J. Salopek is founding editor of Wing of Zock. She can be reached at