The Big Unlock podcast- episode 11

Episode #11: With Edward W. Marx, Chief Information Officer of Cleveland Clinic
“Innovation is everyone’s responsibility.”


In this episode, Ed Marx discusses how innovation is not just for the select few but is everyone’s responsibility. He also discusses his recently released book, Voices of Innovation, a collection of over 40 essays by practitioners of innovation in healthcare.

Innovation is not invention, and it does not necessarily have to be. However, it is important to have a framework for innovation in order to increase the chances of good outcomes. Success with innovations also depends on the willingness of people to share their experiences. At the Cleveland Clinic, it’s a “team of teams” approach that has ensured success with innovation in healthcare.

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Paddy: It’s my great privilege and honor to welcome back to this podcast our very special guests today at Mark’s CIO of a Cleveland clinic. Ed welcome to the show.

Ed Marx: Paddy thank you for having me. Always a honor to be with you.

Paddy: Thank you so much. Firstly, congratulations on your latest book Voices of innovation.

Ed Marx: Thank you. I’m so excited you have no idea. And while my name is on the cover, I definitely give all credit to those that we had 40 some authors that really wrote the book the content of the book. And so, it’s really a testament and a thanks to them I just happen to be the story weaver if you will.

Paddy: Well I’m sure it was an exciting prize. How did the idea for the book come about.

Ed Marx: So I’ll give credit to HIMSS. So, I’ve been fortunate to serve in organizations where a lot of innovation tends to happen. So, they reached out to me maybe four or five years ago asking me to write a book on innovation and how do you do it. And they have a process for innovation. So, I think that’s good it’s a helpful tool. And I thought it would be a good idea to use that framework. The part what they call the innovation pathway to sort of highlight how other organizations are doing innovation along those pathways that way it’s repeatable as opposed to someone with a great idea that happens to have good timing. So, with that I said yes, I absolutely would love to. But then you know life happens we’re all very busy. It was really hard to find the time and energy to put it together with everything else going on in life. But I finally hit that perfect spot where we had significant contributions and a few spare weekends to put things together so that’s how it came about. It took five years but I’m glad it’s out.

Paddy: Well let’s talk about innovation it’s interesting you mention that HIMSS had the innovation care pathways that we’re also trying to get some visibility for. So, innovation is a hot topic. Everyone is doing it or claims to be doing it. However, innovation is also a buzzword in the same vein as artificial intelligence and digital. What is your definition of innovation?

Ed Marx: That’s a great point Paddy because it tends to be more theoretical and it sounds really good when you say the word. But who’s actually doing that. That’s why I love the concept of this book and the pathways because there’s a methodology that you can follow. So definitely there’s thousands of definitions. I’m pretty simple person. I just think about it as applying something new or old which is a little bit of a twist a lot of times people think innovation is invention and then not it doesn’t necessarily have to be it can be the application of something new or old but in a different way. So, let me give you two simple examples one sort of funny but actually had a lot to do with my thinking along the lines of innovation and then I’ll give a very recent example. So, I was traveling one time internationally I went to the restroom and as a male urinal and there was a fly in the urinal, and I thought that was kind of odd. And I finished my business and when I came back to that same airport two weeks later that’s different bathroom same airport. Sure, enough there’s a fly in the urinal. And I was very perplexed and trying to figure it out. So, I actually looked it up and you can actually find this case study where what they did, they were actually stickers. And so, they had a problem with workflow and with the amount of effort it took to clean a men’s bathroom versus a woman’s bathroom. So, the men’s bathroom they had to send someone in to clean every hour because men weren’t as careful. And so, by putting this sticker in the male urinal they got to the point where I had to clean the bathroom once or twice per day. Now that is innovation, but it wasn’t necessary something new. They took a sticker which have been around for decades and a male urinal it’s been around for a long time. Put the two together and have this new outcome. So that’s a real practical kind of funny example of how innovation works. And then another one I would tell you more recently where we’re listening to the situation that happens in every hospital and certainly in a big health system, you’re going to have it because of the scale happen much more often. But how often do you have maybe an emergency within your hospital or within your health system or another practical way of looking at it is you know it’s dark out its winter time and you want to have a police escort or a security escort take you to your car take you to your garage because you’re not feeling safe. So within a week we developed an app that allows any of our caregivers at a press of a button to call for security escort or to call for an emergency if something comes up so they can just do it real quickly as opposed to trying to find a phone. They just pull out their smartphone. Press a button and so it’s an innovation but look at all the technologies. There’s nothing new. That’s the smartphone that they had its geo location which we had. So, it’s just pressing a button and that’s the development. So those are two funny examples but real. And then one more practical example of what I mean by innovation where you’re applying something new or old or both to develop something and have a new outcome.

Paddy: It’s very interesting in fact. I am very familiar with the case study of the fly on the urinals. In fact, this is the work of behavioral economist and I happened to listen to Richard Thaler the Nobel Prize winning economist from the University of Chicago. Talk about this and he talks about this in his book – Nudge, where all these little motivational that about this is classic behavioral economics are in place. The other one is also extremely interesting to me and I want to make a comment about that so innovation is not just old and nil, but it sounds like it could come from something that’s been applied in another industry or another field altogether. You know there’s this concept of making sure that people are discarded safely to their cars late at night. If you go to any college campus, they had these blue lights it is the same thing. In their campus security and safety right. So, it’s very interesting. So, Ed I know you love military analogies and you’ve talked about voices of innovation as sort of a field manual. So, you want to elaborate on that.

Ed Marx: Yeah. So, you have to look at how does the military train people and ensure they follow processes allow for the variation in innovation and they do it through a miss case as a young Army engineer officer its field manual FM – 35. They kind of called the woodchuck manual. They kind of make fun of second lieutenants and young captains who are reliant on this manual but I I was very reliant on this manual because I found myself in a place where I was given a commission as a combat engineer officer and when I showed up for my training everyone had an engineering degree except for me. I had my undergrads actually psychology. I was pretty clueless when it came to math and certainly engineering. So, I paid really close attention in my I think it was like 20 week school but when I graduated I was faced with hey you need to build an airport or runway or when I did that was horizontal construction where I did vertical construction had a vertical construction Platoon. It would be building a camp. Well how do you do that. Well you pull out your manual your FM – 35 and you follow the instructions and then when you do that you certainly innovate depending on your location on what sort of materials you use and those sorts of things. But there was a framework and that was the only way for us young secular tenants and young captains to be successful. So, innovation as we said is so theoretical. How do you make it practical so basically voices is a field manual if it was if we were in the army we’d probably call it FM – 39 and anyone can take it and just follow the pathways. Now there’s no recipe for success, there’s no recipe for innovation but it’s a framework so it’s better to have a framework where at least you can modify around the edges and sort of stick with the concepts because you know it’s going to lead to a good outcome more or increase the likelihood of a good outcome than kind of winging it. And I think that’s the problem with innovation today. Lot of people wing it. Some people get lucky and they make it but most of them don’t. Most of them end up being failures. So anyways that’s the concept and we talk about the military analogy. It’s a field manual it’s a very practical tool.

Paddy: Right. I’ll come back to this again. I think the whole notion of having some level of reliability repeatability in innovation processes some consistency in order to improve your chances of success, I will come back to this in a minute. But talking about the book itself – Voices of innovation – you mentioned it has over 40 contributors. Of course, I am really proud to say I’m one of them. What I would like to ask you is what was so. I haven’t got a copy of the book yet. I’ve ordered it. It should be it should be coming my way pretty soon. But I have seen some of the chapters while they were in the making. So, I wanted to ask you what were some of the team that stood out when you put the pieces together and were there any surprises.

Ed Marx: [00:09:46] Well what I loved when the call went out for contributors is the fact that innovation and maybe this isn’t a surprise, but I actually got to see it unfold before me. Innovation isn’t just for the select few it’s not for the big health systems like we’re blessed that the Cleveland Clinic and other large health systems that have their own innovation centers and innovation team-of-teams things like that. But that wasn’t the predominant amount of contributors that we had. It was really across the spectrum. So, we had safety net hospitals and they would call it scrappy innovation which I love. We would have other public hospitals like in Spain, a main academic medical center out in Madrid we would have small hospitals. We would have large hospitals. Then we had the vendor community participate as well. I thought to be important to get their take on it and how they view innovation and apply it to their particular work organizations and then we had a little bit of academics. So, it’s a really good mix. Showing that innovation is happening across the spectrum. And again, I can’t think Paddy of one example as I try to go through in my head the 40 different essays where it actually came out of a purposeful incubation center. So, these are all. So that’s another sort of surprise if you will. These all came just from people like you and I practitioners out there doing good trying to serve excellently in our organization to do the best for patient care and then innovation happen.

Paddy: [00:11:30] I love the way you put it. Innovation is not just within the purview of a select few. You know I could argue that innovation happens. I think we could both argue that innovation happens in a thousand different ways on a day to day basis in organizations at all levels. That’s kind of what you were alluding to earlier. Now you also alluded to the fact that it doesn’t necessarily have to come out of a specially set up incubator, but the fact of the matter is that many organizes, many healthcare organizations including the clinic, have set up special innovation groups to channel new ideas to harness innovative solutions and so on. So how do these groups stand apart from what you know what you see on a day to day basis what special purpose do they serve and why have them.

Ed Marx: [00:12:25] So I think they are very important to have at the clinic. We’ve seen at the last time I had a count eighty-two patents come out not just related to healthcare IT specifically but in general in the for medical. And I’m not sure that would have happened without that framework because some of these are more very complex and go to market strategies and those sorts of things. So, I think it can be helpful to have those sorts of facilities but so it takes everyone it it’s really a broad ecosystem. My only point. So, I totally respect. I want to be clear I totally respect those organizations that have that capability because I think it can certainly and does add value, but I don’t want to take anything away from the thousands of others that don’t have such a capability because innovation can happen any place. And as the book demonstrates and again, I have to test myself, but I think all 40 examples just came out of non-sort of incubators if you will but just people who had an idea of how to either invent something new or take something that’s been out there awhile but apply it in a different way. And again, the framework. So that’s what’s helpful again going back to the pathways and the manual concept is now anyone can take this pathway and apply it. So that’s the nice thing that these incubators and innovation centers offer right they have pathways and so they have expertise in helping people along this framework. And that’s great for that organization. Like we said. But think about the thousands of other organizations that don’t have that so now they have a simple pathway that they can follow. And in the field manual they’ll see three four or five different examples from again a broad spectrum of individuals and organizations that are doing innovation and how they work their way through that pathway. So, there’s eight components of the pathway one just for example is stress simplicity. And so, if you go to that chapter, you’ll see three to five organizations and leaders who have stressed simplicity in their innovation process and as a result had a very positive outcome. And then you just work your way around the pathway. Again, it’s a framework it’s not a recipe and everyone it falls in is not going to have success, but it provides this opportunity kind of levels the playing field if you will.

Paddy: [00:14:54] Yeah, I think you may. I think that is very well set out because you just articulated why innovation groups need to exist side by side with all of their thousands of day to day innovations that happen because this whole framework for enabling the development of a patent and then you know validating the technology or the innovation and then introducing it into the standard of care. All that requires a structured approach and a methodology and a framework. And that’s not possible within day to day operation. So, I think you make a really important distinction there. Now innovation in healthcare delivery innovation is hard enough but in healthcare is even harder because we are a highly regulated industry and patient safety is at stake. So, I was in a recent conversation with Dr. Toby Cosgrove and he said that it takes 13 years for an innovation in healthcare delivery to find itself into a standard of care. That’s a long time for innovation to become fully pervasive within an organization. So, should that be a benchmark for innovators to set their expectations accordingly?

Ed Marx: Well it is a sad comment right. That the bench to bedside gap is so long. When I first started in my career, I know it was 30 years and it’s since been cut over by 50 percent as Dr. Cosgrove pointed out. And I think it depends on the area that we’re talking about with innovation. So, if you’re looking at and I’m certainly no expert but as I understand it on the pharmaceutical side because of all the safety processes we have in the federal clearances it takes quite some time because of all the again all the quality and safety issues. So, it’s more understandable but I think we’re innovating faster on the edges of again another buzzword but digital. So, the example I gave you with the phone app that we developed I think we developed that within a week. So, we had our problem and we developed the solution pretty quickly. What does take time though so if we were to say oh what we should take that to market and try to create a business then that process I think is where things would start to slow down a bit because you know it’s a sales process and those sorts of things and you know again you have to there’s a lot of legal ramifications and those sort of things that kind of trade that layer of time that otherwise you would shrink that bench to bedside gap. So back to your question should we go into it as innovators thinking it’s a 13-year slog. I don’t think so. Not when it comes to the digital realm. In general, yes. As a data shows but in the digital realm, we can move much faster. And I think that’s part of the struggle with a lot of startups right. A lot of funding has been pumped into digital startups and we’ve seen a very high failure rate. There’re multiple reasons for that but one for sure is the length of time that it takes. So, if it’s going to take a year or two years it’s hard to produce results and your funding can run dry before you get to that point. So that’s one issue that we all grapple with right.

Paddy: Let’s talk about digital for a minute or two because digital and innovation are closely interlinked. There is of course a huge amount of venture capital going individuals of startups. Last year I believe it was somewhere in the region of eight or 10 billion dollars that went into digital health startups as we see money. Now we’ve clearly seen some breakthroughs right in the past few years. For instance, telehealth technologies are gaining ground. They may not be exactly where you wanted them to be but then have certainly gained a lot of ground and they certainly gained a lot of mind share. But then the flip side of it is that a lot of digital health startups they struggle they struggle to go beyond a pilot or two and many of them just burn through their cash and disappear. So what’s missing in this picture. What advice do you have for innovators looking to make a difference in healthcare especially digital health startups?

Ed Marx: I think there’s two or three items one is recognition of the length of the sales cycle. So that’s the point that you and I have already raised. The second is deep understanding of the marketplace. And I’m sure all industries say that they’re complex, look at nuclear industry definitely complex, banking financial services definitely complex. While health care is arguably right up there if not higher in terms of complexity and so you really have to have this deep understanding it’s not just this. It’s not just coming up with a great idea and then everyone’s going to want to have it and introduce it but it’s really this concept of the workflow. Workflow is king so you can have a great idea and we deal with this all the time right we’re approached all the time. We get 100 new ideas a month. If we were to implement even five of those, they would not necessarily be in concert with one another in terms of workflow. So, it’s hard to come in there with a very specific solution without understanding the entire ecosystem. So that’s sort of the second thing which blends into the third thing and that is no health system, or no hospital is the same as the other. So, you can have the greatest product but if it doesn’t integrate with the workflow it’s not going to get adopted. And if you don’t understand that whole continuum and I mean at a deep level not just from reading about it it’s not going to work. So, I think that’s the other part.

Paddy: In other words it really takes a village for innovation to succeed whether it is from a digital health startup or any other form of innovation as it relates to health care delivery. So, you know sort of collaborations that they need to be thinking about. You’ve already mentioned it’s not just between technologists and clinicians but it’s also a support framework right. The form of executive sponsorship, governance, change management, integration, infrastructure readiness. There’s so much in, as CIO of Cleveland Clinic, there’s gaps filled up on a day to day basis. So, what has been your experience at the clinic in integrating innovative solutions. Whether they are internally developed like the app that you just talked about or something that comes to you from the outside from let’s say the Silicon Valley ecosystem. How do you integrate these solutions and make it work? You know the last mile problem as I like to call it because ultimately unless it gets integrated into the clinical workflow it’s not going to succeed. What has been your experience?

Ed Marx: So for us we take a team-of-teams approach, so no one is doing anything in a silo. So, we get pretty clear visibility upfront. And so, we talk about it all the time so let’s just say we have a business problem for us our business problem last year was access. We had so many patients who were trying to come and see a clinician and we had capacity to see them. But how do we make that transaction as simple as possible and as easy as possible from a patient experience perspective. So, working together. So, this would be operations, clinicians, IT’s working together. We came up with a solution. You know it’s not anything brand new for many but for us it was an innovation. And so, we were able to really set up more online scheduling and then leveraging our capacity for virtual visits. And we took a multiprong approach but working together. So had someone gone out and done their own thing and tried to plug in some application and it wasn’t thought out in terms of our overall workflow and how it how it would impact clinicians or how it would impact technology what have you. It wouldn’t have worked. It would have failed. So, by taking a team-of-teams approach we take a business problem and we get together, and we say how do we solve this. And so, we bring some technology solutions. Sometimes it’s not technology. Sometimes it’s pure process. I could give you other examples where I was in the mix and it really turned out technology was not really the innovation needed. It was really a process innovation. And so, we didn’t have to add in a technology component to that. So that’s how we accomplished things here at the clinic and I think one of the things that make us somewhat unique is this whole team-of-teams concept. And so that helps with adoption. So once something is selected like we are going to you know like part of our thought is do we need to have. Will there be call centers in the future. Will it all be online through robotics and thoughts and what an artificial intelligence and those sorts of things. So really thinking about that. But we do it together. We don’t do it in isolation. So that’s the key if there is one lesson that I would offer it seems simple, but I know from previous history it doesn’t necessarily happen at all organizations is just this concept of team-of-teams work things out together collaboratively in fact that’s one of the eight components of the innovation pathway is collaborate and listen. And another one is about using people with IT and without IT. And then we have another part of the pathway that cocreate solutions and blending cultures so probably I know that I think about it four or five the components of the innovation pathway have everything to do with the team-of-teams concept.

Paddy: Right. Right. I think that is a way if anything that could be a key takeaway from this conversation that innovation is about team-of-teams. It’s definitely not some lone genius in a garage somewhere.

Ed Marx: Yeah, I had this was funny and I won’t name the organization, but I remember we were starting to do a lot of innovation and it sort of grew at a grassroots level. And I remember someone taking me pulling me aside taking me to task because it was in that person’s job description was the word innovation and they felt that all the grassroots innovation that was taking place and some of the processes that were getting layered in were taking away from what this person perceived as their area of responsibility and they had quite a bit of trouble with it. And so you could see how that would be so damaging. I believe and I share this with my team innovation is part of everyone’s responsibility. In the clinic I believe that’s our culture. Our culture is innovation. It is everyone’s responsibility.

Paddy: Awesome. Going back to the book and you know in the last couple of minutes that we have. Within the book you managed to pull together multiple voices from a very diverse group of practitioners, and I believe the contents have been enormously enriched by virtue of unique perspectives. So, what was what would you say was the one big challenge you had in putting the book together specifically. You have to leave out anything or did you feel like there was something missing that you would have like to see.

Ed Marx: No I was very happy. You know we went through all the contributions we had, and we had to make some decisions about what goes in and what doesn’t. We were looking for diversity as I mentioned earlier in the podcast and we received that. So, there was no real surprise there. So, we’re very happy about it. I think having people willing to share their experiences in a transparent way and taking the time to do it that’s probably one of the biggest barriers to innovation and adoption. In general, is people taking the time to share what they’ve learned and even if it’s negative I always talk about one way to spur innovation is actually to talk about your failed innovations because those lead Well one you learn, and they can lead to new ideas. So, it’s really, I would love to see that. You know I could see a second book coming out and full of more stories and I would love to see our entire ecosystem globally being willing to share more. Because at the end of the day the reason we all do what we do is to enrich people’s lives, to make sure that the quality of care continues to escalate, to make sure patients are as safe as possible and they have a health care issue. Or what are we doing to encourage wellbeing and living a full life. So that’s why we should be compelled to share our experiences so I would hope that the next time we ask for examples that we would increase the amount by tenfold we did we had a great response. But I would just love to see it continue to expand because the more we share the better we all get. And I always say health care is flat. There’re no boundaries. There’re no walls there’s no borders. So, we need to share what’s going on around the world with one another and learn from every type of institution whether it’s academic or a physician practice. We should all learn together.

Paddy: [00:28:33] So one last question Ed these days we often tend to talk about disruptive innovation. So, I’m very curious to hear your thoughts on whether healthcare is ripe for disruption. And how should we be looking at disruptive innovation in the context of health care.

Ed Marx: I do believe that we are ripe for disruption and that really was one of the motivations behind the book is to encourage others give them a practical tool because we have to accelerate. We cannot do incremental innovation because I don’t think we’re going to go fast enough. So, we need to figure out how to disrupt we can learn a lot from what’s happened in other industries. And I think the important thing is as we try to have disruptive innovation that we remain missional at the core that our primary purpose in disruption and innovation is to really advance patient care, patient safety, quality of care, the ease of use for both caregivers and patients to interact with one another. So, it needs to be missional. I would hate to disrupt innovation for the sake of disrupting and not be missional. So, I think as long as the different partners in the ecosystem all have that missional focus we need to disrupt as quickly as possible.

Paddy: Ed thank you so much for being on the show. Well what a fantastic conversation. All the best with the book and I hope to talk to you again very soon.

Ed Marx: [All right thank you Paddy. Always a pleasure to be with you.

Paddy: Thanks a lot.

We hope you enjoyed this podcast subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

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About our guest

edmarx

Edward Marx is Chief Information Officer at Cleveland Clinic, an $8 billion medical system that includes a main campus, 10 regional hospitals, 18 family health centers, and facilities in Florida, Nevada, Toronto, Abu Dhabi and London. He is responsible for the development and execution of strategic planning and governance, driving optimal resource utilization, and team development and organizational support. Ultimately, he will develop leaders and leverage digital healthcare technologies to enable superior business and clinical outcomes.

Prior to joining Cleveland Clinic, Edward served as Senior Vice President/CIO of Texas Health. In 2015, he spent over two years as executive vice president of the Advisory Board, providing IT leadership and strategy for New York City Health & Hospital.

Edward began his career at Poudre Valley Health System. CIO roles have included Parkview Episcopal Medical Center, University Hospitals in Cleveland and Texas Health. Concurrent with his healthcare career, he served 15 years in the Army Reserve, first as a combat medic and then as a combat engineer officer.

Edward is a Fellow of the College of Healthcare Information Management Executives (CHIME) and Healthcare Information and Management Systems Society (HIMSS). He is on the CHIME Faculty for the CIO Boot Camp, training aspiring healthcare technology professionals. He has won numerous awards, including HIMSS/CHIME 2013 CIO of the Year, and has been recognized by both CIO and Computer World as one of the “Top 100 Leaders.” Becker’s named Marx as the 2015 “Top Healthcare IT Executive” and the 2016 “17 Most Influential People in Healthcare.”

Ed received his Bachelor of Science in psychology and a Master of Science in design, merchandising, and consumer sciences from Colorado State University.

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