Becoming the Cutting Edge: Lessons on Innovating in Emergency Medicine

By:
Richard Ngo, DMD; University of California San Francisco, School of Medicine
Jonathan Oskvarek, MD, MBA; Summa Health System, Department of Emergency Medicine
Zaid Altawil, MD; Boston University School of Medicine, Department of Emergency Medicine
Nicholas Stark, MD, MBA; University of California San Francisco, Department of Emergency Medicine

Expert Insights from the EM Innovation Collaborative panel on “Innovating in EM” in San Francisco during the ACEP 2022 Scientific Assembly, in collaboration with SAEM and ApolloMD.

The panelists who shared their unique perspectives and expertise on innovating in acute care included: 

• Dr. Monique Smith, Founder/Director at Health DesignED

• Dr. Kalie Dove-Maguire, Senior Director of Clinical Informatics at Carbon Health 

• Dr. Delphine Huang, Medical Director at IDEO

• Dr. Jesse Pines, National Innovation Director at US Acute Care Solutions

The panelists discussed a range of topics, from incorporating innovation into clinical practice to cultivating and growing an innovation-friendly culture. Here, we summarize some of the most salient points that are applicable to the full spectrum of EM trainees and physicians, from medical school through late career.

How can physicians incorporate innovation into their clinical practice?

Emergency medicine physicians must synthesize patients’ core needs into appropriate assessments and plans within short timeframes. As such, they are well positioned to extrapolate these skills to innovate in the health care setting. Dr. Huang states that incorporating innovation into clinical practice can be achieved in several ways:

• Through focusing on patient needs and problems that patients may face throughout their visit, including during critical time periods, such as the transition from the ED to home. As one example, physician innovators may consider solutions to common issues that patients face when transitioning home after discharge from the ED, such as an elderly patient’s ability to open tamper-safe prescription bottles. 

• By considering how physicians use clinical data to inform decision making. An important focus should include the translation of data into actionable next steps. This is fundamental in identifying ways to continue improving systems to better deliver care.  

• By prototyping potential innovations early, with a focus on both the process and the end-user’s values. When creating patient-facing innovations, it is important to remember what is valuable to each individual patient, as well as the reasons why they may or may not be using certain technologies. 

• Through honing in on pain points. Physicians can use their clinical experience to design and innovate around challenging aspects of care, from workflows to logistics and devices. All of our panelists encouraged physicians to take risks, seek advice, and make mistakes.

How can physicians grow a culture of innovation at their institution and workplace? 

The foundation of a successful culture of innovation lies in three areas: language, incentives, and leadership. 

Dr. Dove-Maguire asserts that it is critical to first agree on language that your institution can get behind. For many institutions, building an innovative culture around the language of quality improvement is most effective. For others, there may be opportunities to speak more directly about innovation. 

Drs. Smith and Pines emphasize the importance of ensuring that incentives are aligned. By focusing on both improving health and the bottom line, there is opportunity to align incentive structures to foster an innovative culture. Further, by focusing on innovations that improve both health and financials, early innovative products are likely to gain more traction. For example, incentive shifts during the early stages of the COVID-19 pandemic enabled many institutions to open previously closed doors in the space of virtual care and telemedicine. Institutions are most successful when innovation is prioritized and viewed as a long-term investment.

The panelists also highlighted that obtaining support from key executives and leaders is crucial. These leaders are able to help bolster common language and align incentives through powerful drivers and ultimately can help foster a culture of innovation at all levels of an institution, from environmental services and technicians to nurses and physicians. Fostering the creative potential for every member of the team to innovate results in maximal productivity.

How can innovation be used to work toward health equity? 

Health equity is achieved when every person has the opportunity to attain their full health potential. Dr. Smith posits that “innovation without an equity focus is just invention,” and that innovation can help accelerate health equity through an emphasis on patient values, outcomes, and cost containment. 

In an interesting example on how innovation negatively impacted health equity, Dr. Huang noted that when one institution recently implemented a “hospital at home” program, they noticed that many patients opted out of home-based health care. On further investigation, the team learned that this avoidance was not due to a referral or administrative issue, but rather because of psychological safety shortcomings: patients’ families were worried that their loved ones may not receive the same quality of care at home compared to the inpatient setting. This example highlights that it remains important to empathize with patients and work to build trust as health systems work toward innovating to improve health equity.

Innovation in health care is critical.
Innovation will continue to be essential to improving health care. Incorporating innovation into clinical practice requires focusing on and designing around patient needs and translating data to inform decision making. By aligning the incentives of all stakeholders and focusing on patient needs, EM physicians and trainees can foster a culture of innovation that can improve patient care.