Reprinted with permission from Harvard Business Review
Carla E. Small
Innovation and Digital Health Accelerator
Boston Children’s Hospital
Physicians, nurses, and others who work on the front lines of patient care are an important potential source for innovations that could improve patients’ health and reduce the cost of care. But turning clinicians into entrepreneurs is anything but easy. Given their day jobs — which at academic medical centers often include research, writing grant proposals, and tending to patients — they have little time. And they often lack much of the expertise needed to transform an idea into a viable product.
Boston Children’s Hospital designed an innovation accelerator to overcome these hurdles. While it’s still early days (we launched this accelerator in early 2016), we believe the accelerator has scored enough successes to prove that the model can work. In its first year, the accelerator successfully engaged more than 300 clinicians, researchers and administrators — touching more than 25 clinical departments at the hospital. It has accelerated nine projects and spun three of them out as start-up companies that have secured over $2 million in venture funding.
When we surveyed physicians across the hospital in early 2016, 98% of the 79 respondents saw themselves as innovation champions or open to participating in digital innovation activities. But only 34% were actively piloting a digital technology in clinical practice.
We took these learnings into account when we launched the Innovation & Digital Health Accelerator (IDHA). Our approach shifted to quickly vetting early-stage ideas and advancing those with promise by providing customized, “just in time” support. This rapid feedback, high-touch model provides high value to our clinical teams. Even when we don’t immediately embrace their projects, teams are inspired to reimagine them, sometimes taking them in an unexpected, more productive direction.
Why Build Your Own Accelerator?
Initially, we considered contracting with existing accelerator organizations. We looked at more than a dozen—both health care-specific programs with strong connections in the health care “ecosystem” and industry-agnostic programs. But none was a perfect match for our clinical innovators for several reasons:
• They tended to be more geared to start-up companies than to our mostly early-stage projects.
• Their model wasn’t a fit with clinicians’ busy schedules — particularly given that the vast majority of the clinician innovators applying for one of our accelerator grants have no intention of ever leaving their day job to pursue full-time entrepreneurship.
• Many of them could not handle the highly diverse projects that we wanted to support — from algorithms to apps to devices.
• They weren’t designed to offer the guidance and support for the varying stages of development — from concept to formed company — that our projects would be in.
So in the end, we decided to bring the acceleration function in-house. That offered the added advantage of allowing innovations to be developed within the clinical setting where the ideas could be tested and deployed.
Designing an In-House Accelerator
Our model provides a first-pass business analysis and in-person feedback from an in-house team experienced in business development and digital health. It offers mentoring, development support, and funding customized to each project’s needs. Core to our ability to rapidly accelerate digital innovations is our full-stack development and data science group that comprises half of our 50-person team and is responsible for building, testing, and implementing the digital innovations.
To augment our internal capabilities, we formed a network of outside experts and industry collaborators. This has allowed us to provide a wide range of services and more rapidly scale our innovations. In some cases, we’ve helped form new start-ups; in others, we’ve built technologies that are changing the way we care for patients at Boston Children’s Hospital.
We attribute our success thus far to these elements:
Build a business mindset. From the start of a project, we cultivate entrepreneurial thinking. It begins with our grant application: While many of our innovators are accustomed to writing research grants, our application is more akin to a business-plan competition. In the next stage, we actively engage clinical innovators in the vetting of their own ideas, exposing them to the business perspective. Ultimately, even if we decide that their initial idea doesn’t hold commercial promise, innovators walk away with a new perspective and the ability to evaluate their future ideas from a business angle.
Render an early verdict. When we first opened our doors to internal innovations, we were concerned that we’d be overwhelmed with low-quality ideas we’d have to turn away. To help triage the ideas and be respectful of clinicians’ time, we introduced the Opportunity SPRINT — a 90-minute rapid-fire session that brings the clinical team together with business strategists, subject matter experts, technologists, clinicians and, sometimes, parents and patients.
Foundational to the Opportunity SPRINT, is the SPRINT Deck, an IDHA-adapted lean canvas that captures the problem, solution, unique value proposition, competitors and analogs, market trends, economics, and other parameters. This naturally generates a discussion during which clinicians can hear multiple perspectives and get advice to help them advance, focus, or redirect their idea, as needed.
In one example, two leading urologists, Drs. Alan B. Retik and Michael Kurtz, submitted a prototype design for a device that could improve interventions for fetal lower-urinary-tract obstruction, a lethal condition with imperfect solutions. Learning during the Opportunity SPRINT that the small pediatric market wouldn’t support the creation of a new device, we ultimately paired this team with Boston Scientific to adapt the company’s existing technologies. The product is in pre-clinical trial today.
Give constructive rejections. In Opportunity SPRINTs, rejections are an educational opportunity, a chance to engage innovators and encourage them to recast or pivot their ideas. We found that even people whose ideas were rejected felt it was time well spent. With so many unsolved problems in medicine, we want our innovators to come back with more viable ideas.
Build a diverse team. Clinicians are unmatched in their ability to ideate, but they need collaborators with other talents. Researchers at Stanford analyzed231 medical-device startups and found that the most productive companies employed at least one physician-inventor. But when physicians comprised more than 40% of the invention team, productivity (measured by FDA approvals) declined rapidly.
Once we decide to accelerate an innovation, we invest heavily in convening customized, multi-disciplinary teams that offer the right combination of technical, business, and project-management support and adapt themselves to the clinician’s work schedule and setting. This maximizes clinician engagement, ensures diverse perspectives, and brings a sense of entrepreneurial urgency to each project.
For example, one of our projects, Prediction of Patient Placement (POPP), aims to improve triage in the emergency room by predicting the likelihood a patient will ultimately be admitted, based on clinical data. To ensure rapid iteration, we paired the ER staff with two software architects, a user-experience designer, a visual designer, a business analyst, and a project manager. Today, POPP is live in Boston Children’s emergency department, helping the hospital predict inpatient capacity needs; potentially, it could help the hospital reduce costs as well.
Tap an entrepreneurial leader. There is no clear strategy for building new ventures inside the highly regulated, health care environment, and launching new technologies in health care takes a long time. While everyone’s skills are essential, an entrepreneur or CEO-founder is the one who will take an innovation across the finish line.
Neuromotion Labs is a perfect example. It grew out of an idea by Dr. Jason Kahn and his colleagues in Boston Children Hospital’s Department of Psychiatry: to use games and wearable devices to help children build emotional strength. After research and subsequent clinical trials at the hospital, an early innovation grant funded Dr. Kahn in 2011 and provided software-development resources in 2016.
Shortly thereafter, we identified an experienced entrepreneur CEO candidate (Craig Lund) who has been a key ingredient in launching the venture-backed start-up and closing on the $1 million-plus in seed funding. The company became a MassChallenge Finalist and has begun marketing its product: a tablet-based app and wearable biofeedback device that’s coupled with coaching and support from trained staff.
Industry input. To prevent our accelerator from becoming myopic and internally focused, we have a large advisory board of industry-leading entrepreneurs, investors, strategic partners, and leading clinicians. The board brings a market perspective to the evaluation process and provides ongoing mentorship to our accelerated portfolio.
Digital technologies promise to transform health care. Frontline clinicians can and should play a central role in inventing those new applications. But they can’t do it alone. To succeed, they require an array of specialized support and an innovation system that understands their special needs.
Carla E. Small is Senior Director of Boston Children Hospital’s Innovation and Digital Health Accelerator, which combines the data, clinical expertise, and technology-development capabilities of the hospital and the resources of industry partners to build and scale innovative digital-health technologies.
This article was written in conjunction with Matthew Murphy, Innovation Lead at Boston Children’s Hospital, Kevin Churchwell,,M.D., Executive Vice President of Health Affairs and Chief Operating Officer at Boston Children’s Hospital and John Brownstein, the Chief Innovation Officer at Boston Children’s Hospital, and a professor of pediatrics and biomedical informatics at Harvard Medical School.