Article Text
PDF
Abstract
Background Academic health science centres are an ideal location to translate innovative discoveries into clinical practice. However, increased cost, decreased time and encroaching technology are few of the challenges that academic clinicians face in an increasingly digitised healthcare industry. Academic health science centres have begun creating training to involve clinicians in developing and deploying innovative solutions. Few of these programmes engage clinicians in interactive and interdisciplinary activities.
Approach Hexcite is a 16-week entrepreneurship training programme at Johns Hopkins. During the programme, clinicians with innovative clinical software ideas learn how to launch start-ups. Clinicians accepted into the programme team up with a business expert, design expert and technical expert. Teams participate in 15 expert-led interactive 3-hour workshops, interview potential customers, regularly pitch their ideas to industry experts and iteratively refine their products.
Methods This report examined anonymous participant feedback, quantitative data from team productivity reports, and interview responses between 2015 and 2019. Outcomes were assessed using the Kirkpatrick Model.
Results and conclusion Many clinicians reported improved understanding of team building, design thinking and marketing communications as well as increased involvement in innovation. Many teams received funding after Hexcite. Outcomes from previous cohorts will guide more robust evaluation measures for future cohorts.
- leadership assessment
- clinical leadership
- career development
- curriculum
- health system
Statistics from Altmetric.com
Background
Clinicians spend a significant amount of time using health information technology.1 However, some describe the technology tools available as poorly designed obstacles that slow down their workflow. Those challenges lead to increased frustration among clinicians and contribute to medical errors and skyrocketing costs.2 Health Systems Innovation (HSI) is the creation of innovative solutions to improve patient experience, enhance population health and reduce per capita healthcare costs. It responds to ever-permeating technology, the growing roster of allied health professionals and the expanding needs of patients in the digital age.3
With their regular access to breakthrough research and complex clinical experiences, academic clinicians are uniquely positioned to engage in HSI.4 Additionally, clinician buy-in is essential for transformative change.5 Academic health science centres have begun deploying programmes to involve clinicians in innovation and technology implementation. Harvard, Johns Hopkins, Stanford and many other leading medical schools have also started to incorporate promotion metrics that reward academic clinicians for systems innovation.3 However, though many academic health science centres offer programmes to teach leadership and technology skills, most fail to unite clinical and non-clinical professionals or include interactive learning about technology development and deployment. Additionally, training often focuses on individual management skills gains rather than system-wide and transformative results.6
Approach
In 2015, the Johns Hopkins Technology Innovation Center (TIC) created the Hexcite programme to provide entrepreneurship and innovation leadership training to clinicians. Clinicians first pitched their novel medical software ideas to a panel of investors and technology experts. Clinicians were evaluated based on the feasibility of their ideas, their communication skills and their leadership experience. Finalists obtained authorisation from their departments for protected time to participate in all workshops and related innovation activities. Successful applicants were teamed up with a business lead, design lead and technical lead to work collaboratively on creating start-ups.
During each cohort, the teams attended 15 weekly expert-led 3-hour interactive workshops at the Johns Hopkins School of Medicine(figure 1). Each workshop began with teams pitching their ideas to guests from the entrepreneurial community and Johns Hopkins leadership team. Participants received expert feedback about potential roadblocks and who else they should be contacting. Teams then participated in 1–2 hours of instruction, activities and discussion. User-centred design (UCD) training was a prominent part of the Hexcite programme. UCD processes are considered a significant enabler of beneficial information systems. The UCD approach makes space for solution developers to consider workflow, and use cases and setting when designing new products and services.7
Lifecycle of a TIC-assisted technology start-up. TIC, Technology Innovation Center.
Instructors provided advice on teaming building, interviewing, app valuation, customer journey mapping, design thinking, intellectual property considerations and various other topics. They presented about their own experiences and provided actionable how-to guides related to the weekly deliverables. In addition to the weekly workshops, teams committed to investing an additional 7 hours per week on those team and individual deliverables. Deliverables included completing a ‘Business Model Canvas’ which consisted of invalidating and validating ‘hypotheses’ each week, and subsequently running new experiments or interviews based on new hypotheses. Teams interviewed potential customers and users inside and outside of Johns Hopkins, intending to complete at least three interviews per week. Interviews and experiments conducted were tracked in a project management portal. Teams also learnt how to plan pilots of their software products at Johns Hopkins and received feedback from industry mentors, potential partners and technology vendors. TIC hosted a final pitch event during week 16 so that clinicians could pitch their fully evolved medical software ideas to Johns Hopkins’ executives and tech investors.
Methods
TIC hosted a pilot version of Hexcite in 2015, followed by unstructured exit interviews with each clinician to capture their perception of the programme. TIC then developed a training evaluation strategy based on the Kirkpatrick Model to incorporate formative and summative evaluation methods8: (1) reaction—the degree to which participants find the training favourable, engaging and relevant to their jobs; (2) learning—the degree to which participants acquire the intended knowledge, skills, attitude, confidence and commitment based on their participation in the training; (3) behaviour—the degree to which participants apply what they learnt during training when they are back on the job; and (4) results—the degree to which targeted outcomes occur as a result of the training and the support and accountability package.
TIC developed a ‘Pre-Accelerator Reflection Survey’ to capture feedback on participant reaction to training and participant learning. The survey contained two short answer questions to evaluate participant reaction to training: ‘what did you enjoy most about participating in the programme’ and ‘what would you suggest we improve or change about the programme’. The survey also contained 23 Likert statements to measure participant learning. Likert statements prompted respondents to reflect on their abilities at the beginning of Hexcite and then again after the programme. Content areas highlighted for learning were team building, design thinking, business finance and marketing.
To measure Kirkpatrick’s second and third levels, learning and behaviour, TIC employed exit surveys, pitch recordings, project management portal surveillance and feedback from independent investors as objective measures. TIC also recorded the weekly team pitches to evaluate behaviour. Recording progression over 16 weeks provided objective evidence of participant behaviour over time. To measure the results of training, TIC reviewed the log from each team’s project management portal. The portal contained metrics indicating how weekly customer interviews were conducted and idea experiments were completed. TIC also documented which teams received funding during and after Hexcite to evaluate the results of the programme.
Results and conclusion
Since 2015, 26 clinicians and 66 non-clinicians have completed the Hexcite programme. TIC has connected clinical leads with multiple stakeholders in the software development process, helped teams refine patient-centred solutions and provided clinicians with skills that added value to their clinical roles at Johns Hopkins. All clinical leads completed the programme, despite their other priorities and responsibilities at Johns Hopkins. The high completion rate suggests participants engaged with the training and found it relevant. After Hexcite completion, TIC emailed participants the ‘Pre-Accelerator Reflection Survey’. Respondents were not required to indicate whether they were clinicians, and their participation was voluntary and anonymous. Respondents could skip questions if they wished. Of the 20 participants during the 2016 cohort, 17 responded to both short answer questions assessing their reaction to training (85% response rate). Responses included ‘I enjoyed the working sessions (user stories) and the more hands-on activities’ and ‘Move some of the hands-on exercises even earlier, as they help bond the team’. The number of participants reporting they understood how to lead a technical project grew from 36.8% to 84.2%. Participant ability to persuasively communicate a clinical solution’s value more than doubled from 42.1% to 89.3%. Their ability to effectively evaluate and communicate a clinical solution’s competitive landscape more than tripled from 26.3% to 89.4%. Additionally, project management portal surveillance results revealed that each team conducted over 20 customer interviews and tested 32 hypotheses and most teams received funding.
Using a retrospective self-assessment survey as an evaluation instrument was a limitation of this study. Additionally, clinicians volunteered for the entrepreneurship training, which introduced selection bias. To help refine programme evaluation and expand Hexcite, the US Economic Development Administration and the State of Maryland awarded TIC a $1.3 million grant to develop the regional Chesapeake Digital Health Exchange (CDHX). In 2021, CDHX will begin hosting additional Hexcite cohorts each year that will be available to non-Johns Hopkins affiliates. CDHX will also develop innovation and entrepreneurship training, which will be accessible online. Further research is needed to investigate the role of professional identity and institutional support in the degree of academic clinician innovation involvement as well as what institutional incentives and promotional pathways exist to encourage clinicians to engage in health systems innovation.
In summary, the data produced over the last 5 years demonstrate the benefits of interdisciplinary and interactive innovation and entrepreneurship training for clinicians. Through its Hexcite programme, the TIC helped create over 20 medical start-ups, which went on to investigate hundreds of medical software hypotheses. Hexcite demonstrated that innovative solutions could be designed to address real clinical problems by providing clinicians with business, design and technical partners.
Ethics statements
Patient consent for publication
Footnotes
Twitter @helloadler
Contributors AA, JM and PN contributed to concept development, contributed to manuscript writing and made edits. AA developed evaluation measures and performed the data extraction. TJ and EF performed the data analysis, contributed to manuscript writing and made edits.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.