Where Does Innovation Come From

We have too many caretakers in healthcare technology and not enough innovators.

What is a caretaker? A caretaker is someone who handles the day-to-day with an eye on, well... keeping the status quo or making it a little better. In fairness this is what most health systems are looking for in a CIO, and understandably so. There's a lot at risk and we don't want to screw things up.

Keeping the status quo is great until it isn't. It's not like the world is standing still. If everyone is doing 75 on the highway and you are doing 55 you are slowly getting left behind. That's not the biggest risk though. The bigger risk is that caretakers have a dangerous lens on things in times of change. They can make decisions that lock you into a path that eventually leads to a dead end that you will have to spend millions to remediate or change in the future. I've seen this over and over. They lack thought and reasoning, they choose the path that others are on because others are on it.

I'm reminded of two healthcare CIOs who chose to go to Epic. The obvious right choice, Right? Well, that depends on a lot of things, doesn't it? In this case, neither system could afford to run Epic. They had enough savings to buy and implement Epic, but they are buckling under the cost of running it daily. Was that the right decision for that health system? I would argue that those decisions lacked basic common sense. If you can't afford to own it, you probably shouldn't buy it. This is a failure of thought, planning, and reasoning. This is the caretaker's dilemma.

I'd like to explore a different path for healthcare leaders. Innovation. To be fair, it isn't all on the CIO, in the earlier case the entire system chose to buy something they couldn't afford. There was a failure of leadership from top to bottom.

So where does innovation come from?

1. Thinking / Ideas
2. Courage
3. Initiative / Leadership
4. Culture / Support
5. Resources

That's it. How many does your health system have? If you're not with a health system, how many does your company have?

Thinking/Ideas: Innovation begins with intellectual curiosity and the ability to think differently about problems. Healthcare leaders need to cultivate an environment where questioning the status quo is encouraged and where diverse perspectives are valued. This means looking beyond traditional healthcare solutions and being willing to learn from other industries. It's about fostering creativity and encouraging teams to explore new approaches, even if they seem unconventional at first.

Courage: Healthcare innovation requires the fortitude to take calculated risks and stand behind decisions that might initially face resistance. Leaders must be willing to challenge established norms and defend new approaches, even when it would be easier to follow the crowd. This isn't about being reckless – it's about having the confidence to pursue well-reasoned alternatives to conventional wisdom, like choosing a right-sized EHR solution over a prestigious but unsustainable one.

Initiative/Leadership: True innovation demands proactive leadership that goes beyond maintaining existing systems. Leaders must actively seek out opportunities for improvement and take ownership of driving change. This means being willing to champion new ideas, rally resources, and persist through the inevitable challenges that come with implementing innovative solutions. It's about creating momentum and inspiring others to embrace change rather than resist it.

Culture/Support: A supportive organizational culture is essential for sustained innovation. This means creating an environment where experimentation is encouraged and failure is seen as a learning opportunity rather than a career risk. Organizations need to deliberately build structures that reward innovative thinking and provide clear pathways for new ideas to be heard, evaluated, and implemented. Without this cultural foundation, even the best ideas will struggle to gain traction.

Resources: While innovation doesn't always require massive budgets, it does need appropriate resource allocation – both in terms of money and people's time. Organizations must be willing to invest in exploring and implementing new solutions, but equally important is ensuring these investments are sustainable long-term. This means making smart choices about resource allocation and being realistic about what the organization can support over time, avoiding the trap of taking on initiatives that look good initially but create unsustainable burden.

So what happens when you have a few of these characteristics but not all?

Having Ideas without Courage leads to a graveyard of unused potential. You'll often find organizations where teams generate excellent solutions but leadership is unwilling to take the necessary risks to implement them. These places become frustrating for creative employees who eventually leave, taking their innovative thinking elsewhere.

Having Courage without Resources is like having a sports car with no fuel. Leaders may be willing to take bold steps, but without proper funding, technology, or staffing, initiatives sputter and die. This scenario often leads to half-implemented solutions or burned-out teams trying to innovate on top of their regular workload.

Having Resources without Culture creates expensive mediocrity. I've seen organizations pour millions into "innovation initiatives" while maintaining rigid, risk-averse cultures. The result? Safe, incremental improvements marketed as innovation, or expensive systems that no one fully adopts because the underlying culture resists change.

Having Initiative without Support becomes a lonely, uphill battle. Individual leaders might push for change, but without broader organizational backing, they face constant resistance and eventually burn out. These "innovation champions" often end up isolated, fighting the same battles repeatedly until they either give up or move on.

The most dangerous combination might be having Resources and Initiative without Thinking - this leads to expensive mistakes made quickly and confidently. It's like having a powerful car and an eager driver, but no map or destination in mind. You can cover a lot of ground fast, but there's no guarantee you're heading in the right direction.

I see that last one a lot in healthcare. The amazing thing is that most times when I see it, the people who are relaying their decisions don't see it the same way that I do. They often confuse motion with progress, mistaking the act of doing something - anything - for meaningful innovation. There's a kind of institutional confirmation bias at play, where leaders surround themselves with people who reinforce their decisions rather than challenge their thinking. They point to the size of their investment or the complexity of their implementation as proof of innovation, rather than measuring actual outcomes or value created. It's particularly dangerous because these leaders often have impressive track records of executing projects - they're highly competent at getting things done. But without deep strategic thinking, they're just efficiently implementing potentially flawed solutions. The result is a portfolio of expensive initiatives that look good on PowerPoint but don't fundamentally improve healthcare delivery or patient outcomes. What's worse, these initiatives often create technical debt and operational complexity that future leaders will have to untangle.

Well, I'm on a boat right now with my wife. I'm writing this last article as we fly down. The computer is going off soon. I just had one more thought and wanted to get it written down. If you are new to my writing, the picture is from a painting my daughter did for me and we like to take him everywhere. Added the yellow hat on this one.