Passion for innovation during hard times
Innovating is hard, even impossible if you believe there is literally no new thing under the sun. Innovation is rarely something entirely new and seldom originates from a single person. Instead, innovation involves continually building upon and transforming existing knowledge and concepts. Innovation is like cooking tried ideas with a well-staffed restaurant kitchen and presenting the outcome to hungry customers who want a fantastic taste of something they feel they should have had before. Innovation implementation is hard because, along the way, people must connect to ideas and each other to find that secret sauce. To put innovation to use, people usually must work together to meet needs, share visions, facilitate transitions, garner support, assuage concerns, and communicate benefits. One reason sustaining innovation and innovative groups is hard is because scarcity mindsets can develop and lead people to unproductive competition for credit and resources. When I joined DIHI in November 2019, I embraced these difficulties. I was motivated by the idea of improving care for sick patients in US health systems, working hard to face risks, overcome challenges, building confidence in new areas (to me), and having a supportive team — yet feeling slightly on an autonomous edge.
November 2023 marked four years since I started working with the Duke Institute for Health Innovation (DIHI). It has flown by because I feel like I’ve been working with the kind of team you see joyfully and exhaustively collaborating at the end of the movies “Chef” and “Burnt.” Nevertheless, the COVID-19 epidemic, the open launch of ChatGPT, increased regulation of AI (a good intention, but be wary of risks inherent in concentrated power), demand for fast digital communication, and system-wide structural change brought kettles to full boil. The difficulties of creating, implementing, and sustaining innovations may have been higher than ever in DIHI’s decade of existence. The public popularity of generative AI created a compulsive thrill and provoked urgency. Admittedly melodramatic, this existential pressure increased my fears of setbacks. Any existential threat was scary because I love this team and how seamlessly we can work together. Over Thanksgiving and Christmas 2023, I struggled to verbalize why and started outlining this blog. I then wondered, could sharing this gratitude help us find, connect, and collaborate with similar teams? Can imaging the team’s recreation bolster it?
Innovation: The process of creating, developing, and implementing new ideas, products, services, or methods to improve or alter existing processes, systems, or ways of doing things, resulting in value creation or positive impact. Innovation often involves thinking creatively, taking risks, and challenging the status quo to bring about positive change or advancement in various fields, including technology, business, and healthcare. It can manifest in many forms, from incremental improvements to groundbreaking inventions that transform industries and societies. Innovation is a crucial driver of progress and competitiveness in today's rapidly evolving world.
Servant leadership
Let’s assume the answer is yes. First, I’d look for a “leaders eat last” team founder. The founder would serve the team by ensuring it had the ability to easily connect with others, especially potential innovation users, at any time to share results and get feedback so that needs are serviced. Second, the founder would build a team of people who could work together and know each other well. I’ve personally found that exchanging ideas with teammates is made easier when they share a passion, abide by community virtues, and align with a cross-functional flat organizational hierarchy. Ideally, the team members would each have a broad understanding of the industry and a deep understanding of at least two different domains, preferably contrasting ones (e.g., fields within arts and sciences, humanities and technologies, poets and quants). I’ll expound on these with anecdotes and reasons and follow that with a discussion of ways DIHI’s built such a team and what the team’s made possible.
Suresh Balu is a “leaders eat last” director of DIHI. Suresh will always be the last to eat when we have a team meal and hold doors for others. While any leader can abide by that literal definition, Suresh embodies its spirit. When I first interviewed with DIHI, a military veteran on the team told me a story about how Suresh visited him and his family in the hospital when they were facing medical challenges and that he was among the first by his side. He also told me he would take a bullet for Suresh and about how Suresh, repeatedly, was willing to sacrifice his resources and well-being to promote the team’s good. Many others described Suresh as taking ownership of the team, including the criticisms and responsibility, without passing the buck. These aspects of the interview made me sure I was making the right career move, and Suresh has lived up to the praise. Suresh has cared about my career growth and has also been among the first to care for my family or personal wellness when asked to. He shines the spotlight on others and aspires for his team to become greater than himself (Exhibit A, B, C). Finally, he leads the team with character and skill. Suresh applies his business strategy and computer science expertise while staying emotionally calm and steadily handling problems. Suresh sets a high standard for communicating with others, having a passion for healthcare innovation, keeping one’s ego in check, supporting ethical practice, and balancing the team.
'If your actions inspire others to dream more, learn more, do more and become more, you are a leader.' - John Quincy Adams
“The greatness of a leader is measured by the achievements of the led." - General Omar Bradley
The next most crucial quality would be the ability to collaborate with each other and the people we serve at any time, at any place, and with flexibility in the method or tools. When innovation involves continually building upon and transforming existing knowledge or concepts, it is pragmatic to facilitate an interconnected network for accumulating, transferring, and testing ideas. The way DIHI met these qualities can be explained by first describing its structure and values and then how that strategy guides daily team and solution-user (i.e., customer, partner, stakeholder) communication.
Close-knit structure and value alignment
DIHI’s team environment is catalyzed by lean size (5-15 members over the years), a flat hierarchy, and upheld core values. The small size has made it relatively easy to know one another and share information. What is likely more important is most members have worked together for several years – no matter how good the culture, it usually takes time to build trust and learn to communicate well. The small size also simplifies communicating through a flat organizational hierarchy. Information can flow seamlessly and comprehensively within a small, flat organization, irrespective of titles or roles. Additionally, individuals are more likely to contribute because they are more likely to feel how the team needs them and see their own value and impact within the team. Furthermore, this structure catalyzes the creation and maintenance of core values and behaviors. DIHI has been able to hire specifically for and check itself on alignment with not only management and technical skill needs but also values. These values include “ubuntu,” bold humility, and intellectual curiosity. By “ubuntu,” we mean believing that your success is my success. When hiring, we look out for “we” versus “I” language (the latter is better). We also watch for how interviewees have helped other people grow. We value authentic altruism in action. Overlapping with the “we” language is bold humility. We want to be bold (because we should be confident in our skills and purpose) yet humble. There needs to be a willingness to disagree with people yet a willingness to learn a great deal from the people you fundamentally disagree with. In interviews, we ask people how they have adapted, changed their views, and incorporated new and positive behaviors. Last but not least, DIHI interviewers look for passion and curiosity. People interested in healthcare often are altruistic and ardent, but it isn’t a given. We look for passion in the emotion of voices, authenticity of stories, and willingness to get grit under fingernails. Curiosity builds adaptability. Questioning helps people explore new possibilities and find new perspectives. Curiosity allows people to connect existing knowledge with new elements (over time, they have likely developed understanding in at least two different domains. More on this later), which can lead to creative insights. Curious people are willing to learn and ask questions; it can indicate their altruism because they are hungry for growth and feedback.
‘I’ vs. 'We' Warnings (requested from readers)
Responding to “What have team members thought of me?" with “Everybody loves me” or responding to “Why do you want to work on healthcare data with us?” with “I have strong healthcare and data science skills, and this will ensure I’m in the right place at the right time.” Be forewarned if people act like they led every project or idea.
Intra-team supportive ambition is a daily practice
The DIHI notion of “team” is fundamental to us. When I made the interview rounds in 2019, everyone emphasized the importance of dropping one’s work at almost any time to help a teammate answer a question or create something. It is common for technical questions to be answered within an hour, to stop work to coach a medical student, or to put aside one’s work to help a teammate design a user interface. I knew about team values and that companies existed that upheld them (thanks to Team Fuqua!), but I’d worked with dozens of teams and had yet to find ones quite like DIHI.* Every Thursday, the entire team, including data engineers, software engineers, user experience experts, data scientists, project managers, product managers, program managers, strategists, clinicians, and qualitative researchers, meets. The room fills with announcements, demonstrations, arguments, and discussions. Any person could lead the point at issue. When I started at DIHI, I was caught off guard by how much I was expected to contribute and how much pushback I could get. I still am. When managers speak out for product needs, such as hearing from a clinical team and pitching our idea for how to do it, “solution architects” Mike, Jamie, and Matt will question why the clinical team wants it and challenge the approach. When we work through the issue together, we learn more about healthcare technology, clinical voices, and clinical needs while becoming better at determining how products fit the team’s strategy. Clinicians on the team have helped me probe the solutions that other clinicians recommend so that the team better understands how much those solutions could help solve the problems at hand. While data scientists will help me check the quality of a machine learning model (often part of a solution), they could give me feedback about anything — say this article.**
* External Forces and Luck - This is not to blame past ones. There are cases where I should have stayed longer. External forces can kill teams, no matter what they do. During the work of our founder, I am sure there was a measure of luck.
** Poets & Quants: The team helped with this article. The first draft was written using ChatGPT and Grammarly Premium. With one anecdote, it read as if one person on the team could handle everything single-handedly -- totally missing the point! For these reasons, I heard the draft was impersonal, impenetrable, and piecemeal. This article is a passion piece, so it was hard to accept feedback. Now that I have, I'm widely told it's better. We truly help drive each other to be better versions of ourselves.
Solution-user communication is frequent, open
Hunger for feedback is foundational for effective solution-user communication. Feedback loops are a well-known fundamental of innovation and entrepreneurship. A strength of DIHI is its closeness to its solution users (i.e., primary stakeholders, customers, and clinical partners) who may provide feedback. Through our organizational embedding in Duke Health, we believe we have an easier time getting input from clinicians or patients than independent entrepreneurs. We are rooted in the social and political environments facing the problems we are working to solve, so we collaborate closely with care providers to identify the problem, develop the solution, implement the innovation, and scale the product. (Mark Sendak described this in his “Get Out of the Valley” article in DIHI Impact Volume 23.) One process we have loved that exemplifies this relationship is our Request for Applications (RFA), which sources innovative ideas from faculty, staff, students, and trainees across Duke University and Duke Health. Once Duke Health leadership has selected projects for strategic alignment, we fund and provide our entire team’s weekly support to make their ideas a reality. Projects may close or downsize early if we discover the solution no longer solves a problem, meets a need, or needs adjustment for prompt user testing. Projects may not be fruitful or scale if there is an imbalance between the designer and user or executive administrators and caregivers intimate with the workflow. (Read more about AI on the front lines). The maxim “Do No Harm” is sustained when, amidst agile feedback and testing, ‘waterfall’ management helps assemble information for team, internal, and external reviews to be as sure as possible that the innovation is well-tested before it is trialed with actual patients. Collaboration with nurses and doctors or anyone daily facing a big healthcare problem is not only pragmatic but fun and inspiring. You can get the warm fuzzies by seeing how you help a clinical team and impact patient health. Authentic altruists are refreshed. Curious staff can learn from the best teachers of boundless medical knowledge. Grassroots sourcing and connectivity fuel a passion to persevere through the hardship of innovation.
Cause to be uneasy
So far, we’ve established that, in search of similar teams or teammates, we should look for an authentic servant-leader, helpful and respectful teammates, and proven altruists who aren’t also self-deprecating. We’d look for a group with solid relationships with their solution users. Sounds perfect and too obvious – who wouldn’t? It gets a little more challenging when your other criteria are a flat hierarchy of members who respond well to curiosity and work processes grounded passionately in the end goal of the healthcare industry: people’s health. It’s harder because it can take longer within a flat organization to make decisions, know who to turn to for tasks, and uncover corrosive power struggles. It’s hard because margins within the healthcare provider industry are typically lower than other healthcare industries, such as pharmaceuticals or medical devices – motivation to join the team and stay is likely intrinsic. It’s hard because healthcare provider centers themselves are famously hierarchical and siloed; their structure will contrast with yours. People with terrific character can still be hard to work with when they’re incompetent, and the infrastructure and processes erode without the team and extra-team supporters committed to buttressing the groundwork and connecting the silos.
Pi-shaped competence
The good stuff comes together when the team members are each competently skilled, knowledgeable bridge-builders. In 2023, Suresh revealed a criterion he looked for when shaping the team: “pi-shaped people.” To him, the ideal team members would each have a broad understanding of the industry and a deep understanding of at least two different domains, preferably contrasting ones (e.g., fields within arts and sciences, humanities and technologies, poets and quants). The Greek letter pi looks like a bridge. In our case, it stands for two disparate skills bridged by the pursued passion and experience of catalyzing healthcare improvement. When p-shaped people bridge unrelated fields, they can spark connections and conversations that ignite novel yet practical ideas. Exposure to art and other creative work can inspire technologists to think outside the box. Art and interpersonal communication can be used to convey complex scientific ideas in a more accessible way, allowing innovative ideas to meet needs and be implementable.
Pi-shaped persons’ multidisciplinary mindset equips them to appreciate the nuanced demands of various stakeholders, leading to innovative and pragmatic ideas. The mindset, extended outward, invites collaboration of people and cross-pollination of concepts, breaking
down silos and encouraging fresh perspectives. There is a potential symbiosis between a mix of these individuals and grassroots innovation — they not only catalyze novel concepts but also supply the skills to execute them effectively, yielding a cycle of inspiration and action.
Summary
Let’s review how we build or find likable and effective innovation teams:
- A “leaders eat last” team founder who can hold people with various, even diverging and distracting, skills and passions together.
- A breadth and environment of interpersonal skills enabling rapid feedback cycles, from each other and including front-line consumers. Feedback includes gateway reviews for team and solution-user safety.
- A bedrock of passion, morale resilience, equity, and equality.
- It is a melting pot of experienced and hungry team members whose technological, humane, and healthcare skills are varied enough to be quirky and spark creativity.
These traits are especially important because
- Innovation is rivalrous and hard by nature.
- Egos, indiscipline, distractions, etc. easily gain a foothold and can destroy from within.
- Healthcare systems may generate low profit margins and be fragmented.
- External political, economic/environmental, social, technological, and supplier forces can destroy.
Why, again?
We seek partners, collaborators, and investors committed to bolstering DIHI, this innovation team framework, the Health AI partnership, and connecting disparate health islands. If you support the values and believe in the ideal of the team described, please share your good words with us and others. Please share your innovative ideas and enable us to learn with you. Let’s build new bridges.
Influencers
Ideas above were influenced, especially, by:
1. Ashley Friedlein, CEO, and co-founder of Econsultancy, coined the phrase “Pi-Shaped people”
2. Sandhu S. et al. “Accelerating health system innovation: principles and practices from the Duke Institute for Health Innovation” Patterns Perspective. April 14, 2023. https://www.cell.com/patterns/pdf/S2666-3899(23)00047-8.pdf
3. Rogers, David. “Rethinking Governance for Digital Innovation.” MIT Sloan Management Review. August 16, 2023. Rethinking Governance for Digital Innovation (mit.edu)
4. Brooks, David. (2023). How to Know a Person: The Art of Seeing Others Deeply and Being Deeply Seen
5. Isaacson, Walter. (2014). The Innovators: How a Group of Hackers, Geniuses, and Geeks Created the Digital Revolution. Large print edition. Farmington Hills, Mich., Thorndike Press, a part of Gale, Cengage Learning