riskgame

Last night there was an #Irishmed  tweetchat on Innovation and Healthcare . For those unfamiliar with this format, for an hour (from 10 pm Irish time) there is a co-ordinated tweet chat curated by Dr Liam Farrell and various guest. Every ten minutes or so a new theme/topic is introduced. There’s a little background here to last night’s chat. The themes were:

 

T1 – What does the term ‘Innovation in healthcare’ mean to you?

T2- What are the main challenges faced by healthcare organisations to be innovative and how do we overcome them?

T3 -What role does IT play in the innovation process?

T4 – How can innovations in health technology empower patients to own manage their own care?

T5 – How can we encourage collaboration to ensure innovation across specialties & care settings?

I’ve blogged before about some of my social media ambivalence, especially discussing complex issue. However I was favourably impressed – again – by the quality of discussion and a willingness to recognise nuance and complexity. The themes which tended to emerge were the importance of prioritising the person at the heart of healthcare, and  that innovation in healthcare should not be for its own sake but for improving outcomes and quality of care.

One aspect I ended up tweeting about myself was the issue of risk. In the innovation world, “risk-averse” is an insult. We can see this in the wider culture, with terms like “disruptive” becoming almost entirely positive, and a change in the public rhetoric around failure (whether this is actually leading to a deeper culture change is another question). In healthcare, for understandable reasons, risk is not something one simply tolerates blithely. It seems to me rather easy to decry this as an organisational failing – would you go to a hospital that wasn’t “risk-averse?” The other side of this is that pretending an organisation is innovative if it has very little risk tolerance is absurd. Innovation involves the unknown and the unknown inherently involves risk and unintended consequences . You can’t have innovation in a rigorously planned, predictable way, in healthcare or anywhere else.

I don’t have time to write about this in much detail, but it does strike me that this issue of risk and risk tolerance is key to this issue. It is easy to talk broadly about “culture” but in the end we are dealing not only with systems, but with individuals within that system with different views and experiences of risk. I have in the past found the writings of John Adams and the Douglas-Wildavsky  model of risk helpful in this regard (disclaimer: I am not endorsing all of the above authors views) and perhaps will return to this topic over the coming weeks. Find below an image of a “risk thermostat”: one of Adams’ ideas is that individuals and systems have a certain level of risk tolerance and reducing risk exposure in one area may lead to more risky behaviour in another (his example is drivers driving carefully by speed traps/black spot signs and more recklessly elsewhere)

risktherm.

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