Innovation might well be defined as moving boundaries. If that definition applies, few industries are poised for more innovation than healthcare. Healthcare's boundaries are rapidly shifting in the way care is delivered and in the means by which treatments are discovered. Not so long ago, care was largely delivered in a physician's office. Today, care increasingly is administered outside of those four walls--in pharmacies, in the community, online, and through mobile devices. Further upstream in healthcare's continuum, clinical research is also occurring outside the usual boundaries of an investigator site, as mobile devices capture automated and patient reported outcomes in every real-world venue conceivable.
As healthcare shifts its boundaries, healthcare leaders need to evolve our own capabilities to operate in an increasingly boundaryless arena. "Boundaryless" was coined by Jack Welch when he wrote in a 1990 annual report that GE "is a boundaryless company…where we knock down the walls that separate us from each other on the inside and from our key constituencies on the outside.” The Institute for Healthcare Improvement (IHI) took the concept of boundaryless a bit further in a 2013 white paper, citing "boundarilessness" as a leadership behavior that is needed to achieve the Triple Aim of improving patient experience, improving the health of populations, and reducing per capita costs of care.
There are four essential attributes that boundaryless leaders embody:
- They define value by having a deep understanding of their market's ecosystem. Transforming healthcare from fee-for-service to fee-for-value is becoming such a well-worn phrase that we need to be deliberate in identifying what value is. Value is often in the eye of the beholder. Many leaders use the vantage point of their own business to identify the healthcare market they serve. Boundaryless leaders in healthcare think not only of the market they serve but also of the entire ecosystem that influences it. That approach to leadership helped lift Lars Rabien Sørenson, CEO of Novo Nordisk, to the top of list of 2015 best-performing CEOs, according to a recent ranking by Harvard Business Review. Sørenson uses a triple-bottom line that measures more than the company's economic health, "because in the long term, social and environmental issues become financial issues."
- They knock down walls that impede collaboration. As healthcare increases in complexity and involves more stakeholders in and out of medical facilities, collaboration is imperative. Yet building a collaborative organization requires more than attracting collaborative employees. Boundaryless leaders create organizations that facilitate collaboration by knocking down the walls that separate people and ideas. In places like MedImmune, removing the barriers on collaboration was literal as the company redesigned office space to "get scientists out of their silos, to mix and mingle, and to brainstorm new ideas," according to a Washington Post story. And the walls need not be physical to be knocked down. Hackathons like Triangle Health Innovation Challenge (THInC) and MIT Hacking Medicine work similarly in harnessing insights from an unusual combination of people not necessarily in health sciences but united in addressing a pain point in healthcare. A 2012 MIT hackathon team comprised of a mechanical engineer, an electrical engineer, and physicians in the US and Uganda focused on infant mortality arising from poor respiration. Overnight and using spare parts from automotive sensors, they built the Augmented Infant Resuscitator (AIR) to address the breathing problems that claim 1.8 million newborns each year.
- They know that status quo can create a boundary to better outcomes. For years, Johns Hopkins ICU (and a great many other hospitals) had struggled to control infections arising from the insertion of central catheters. The consequences were often fatal. Yet the solution, developed by Peter Pronovost, MD, PhD, was a humble checklist that started simply with hand-washing. Simple as it was, Dr. Pronovost had to push the checklist against the strong boundary of status quo, describing in a New York Times interview the extraordinary resistance he faced. Yet his persistence virtually eliminated infections in ICUs at Hopkins and in other hospitals where the protocol is in place. The New Yorker claimed his work "saved more lives than that of any laboratory scientist in the past decade.
- They inspire others to move boundaries with them. Writing in Drive on the science behind motivation, Daniel Pink noted that we are compelled to action by operating with a higher purpose. Healthcare is particularly suited to leading with purpose, particularly as medicine is made personal. To remind employees of Novo Nordisk's purpose, Sørenson introduces them to patients, as "there is nothing more motivating for people than to go to work and save people's lives." Quintiles brings patients to the fore too, some of whom are colleagues who share their own life-changing experience in clinical research.
To achieve success in the evolving healthcare landscape, leaders need to be boundaryless and embrace the rapidly changing opportunity by embodying these attributes – understanding interconnected ecosystem, busting silos and driving collaboration, challenging the status quo and inspiring others.