Challenges and Opportunities in Surgical Innovation for Today’s Health Care Leaders

The pace of health care innovation has quickened in the last decade. While it has always been a space for rapid change and transformation, the speed of technology has shortened the distance between invention and intervention. As a result, leaders have to adapt, according to Jon O. Wee, MD, FACS, section chief of esophageal surgery and director of robotics in thoracic surgery at Brigham and Women’s Hospital, assistant professor of surgery at Harvard Medical School (HMS), and capstone director in the HMS Surgical Leadership Program.  

“From both the practicing side and the technical side—how we deliver care and how we manage—innovation is leading the way. But I think that systems are generally behind innovation. There’s always this suspicion of whether the innovation is real and whether the investment needed is worth the investment required,” he says.

While the “right” decision will depend on the institution, there are some important factors to consider that will smooth the process from idea to execution. 

A Worthy Investment (or Not) in Health Care Innovation

Some innovations are worth it, some are not, and still others will cost a prohibitive amount of money. But these critical distinctions aren’t necessarily clear at the beginning. There’s “friction” in measuring the benefit and risk of a potential intervention, notes Wee, with different ways to respond. 

“You have the early adopters, the innovators who want to get involved in evaluating and pushing these products forward. At the same time, you have people with the purse strings and administrators who are afraid to commit when they’re presented with the high cost,” he says.

Wee believes that early adoption can play a key part in innovation. “The benefit is that you have a role in shaping the product, because companies can be very open to feedback and willing to make adjustments.” But it’s not for every context or institution. He stresses that leaders need to think critically about the potential value, in context. In other words: do they want to be early adopters or latecomers?

How to Make a Risk Assessment for Innovation

In the discussion about implementation, Wee notes, the first question to ask is: who is this going to benefit? The patients and professionals? The hospital system? Administrators? Electronic health records (EHRs) are a perfect example of the promise of innovation with the benefit pointed in the wrong direction. 

“It seems like EHRs should help patient care, because all this information is accessible,” he says. “But it creates a ton of work, more than it’s ever had for physicians, and the EHRs don’t communicate with each other. So it actually benefits hospital operators the most, because they bill much more and collect better. It’s not the physician or ultimately the patient who benefits.”

Artificial intelligence (AI), by contrast, has shown to be an innovation worthy of attention and potential investment. Despite a lot of hype at present, AI can assist in various operational tasks, and there’s enormous potential for it to benefit both patients and professionals. 

But it helps to have a 10,000-foot view. “I think we attribute reasoning to AI, and it doesn’t have that capacity,” Wee says. “It’s an algorithm that learns and spits out answers, but it’s not analyzing.” 

If a professional uses AI for dictation, for example, they may need to make significant edits, to say nothing of the work that they will have to do when AI performs higher-level tasks. There’s also value in assessing the directional benefit throughout, he adds. “We have to question AI as an innovation tool and understand what it’s pointing at. Is its value directed at the right thing?”

The “Right” Kind of Innovation Investing

When the time comes to spend funds, particularly to solve an institutional problem, it’s important to conduct thorough analyses. “You often have to invest your way out of problems,” says Wee. “Cost cutting only gets you so far. If you’re a hospital with a financial problem, you actually have to invest more to grow and get out of your current situation. That’s the hard part for a lot of leaders: can you count on the investment paying off, and are you willing to take that risk?” 

He cites the recent use of robotics in surgery. If that’s something a business leader is considering, Wee encourages them to reflect: “Will that bring in enough cases to compensate for our investment and contribute to growth? And if we don’t invest, will we be left behind?” 

For example, there are health care systems that have integrated as many as a dozen robots in a committed system operating 24/7—but, as early adopters, they have worked with robotics companies so as not to be burdened with as many up-front costs.

Wee also cautions against investing in a solution at the expense of employees, even though it’s a popular strategy—especially when costs are high and budgets are tight. “With an appropriate division of labor, people get very good at their jobs. So it helps the whole system by investing in people power. And you can only cut out so many staff members when you’re cost-cutting: at some point, it does affect how things flow operationally.” 

In the aforementioned case of EHRs, getting rid of support staff meant that physicians had to put in more orders and requests, creating an imbalance of the allocation of return per time. “Even though computers make it easier, every EHR advantage has made more work for the physician with fewer people around to help. It doesn’t make any sense.”

How to Deepen Knowledge and Chart a Path Forward

Health care innovation isn’t going away; on the contrary, the field will see even more growth in the coming years. Leaders will need to keep educating themselves. Equally important, they will need to learn how to bring their teams along for the implementation process. 

“Everything now has to be a collaborative effort, and those who can manage that—how to collaborate, how to bring people in and access their particular strengths—are the ones who will really excel,” Wee notes.

In his teaching, he sees the value of training clinicians and leaders on effective leadership models. The coursework takes into account the conflicting needs within an organization to find common ground and requires practice to be ingrained. 

“It’s about knowing how to work within the system. You’re not a leader if there’s nobody behind you; you have to have collaborators who understand their own roles,” Wee says. “You have to know how to lead, but you also have to know how to support. That’s when the system really gears up, and you can move forward effectively.”