Implementing the 4 “Ps” for Healthcare Innovation
Last Updated August 30, 2019
In many industries, “innovation” is the buzzword of the moment, driven by digital transformation and disruption. While this is true of healthcare, it is an industry like no other. Consumer-minded patients, the physicians caring for them, healthcare systems, insurance companies, and government officials all have a stake in healthcare innovation.
For healthcare leaders, “innovation” is not the latest buzzword; it’s an expectation and even a necessity for meeting the many challenges facing their organizations. When it comes to implementing innovation, what is the starting place and how can you identify areas in need of an innovative approach? Take a business leader approach and start with the four “Ps” of innovation—paradigm, process, position and product.
Introduced by Joe Tidd and John R. Bessant in their management textbook “Managing Innovation: Integrating Technological, Market and Organizational Change,” the four Ps model is a framework that can be used to organize and focus innovation efforts.
In their research published in the International Journal of Health Policy and Management, Philip Weintraub and Martin McKee examine how the four Ps can help pinpoint areas for innovation implementation within healthcare. Often interrelated but also applicable independently based on needs and desired outcomes, explore how the four Ps of paradigm, positioning, process and product are driving healthcare innovation.
Paradigm Innovation
In his book, “The Structure of Scientific Revolutions,” physicist and philosopher Thomas Kuhn introduced the concept of paradigm shift as a “fundamental change” in the core concepts, values and practices of a scientific community or discipline. Similarly, paradigm innovation both drives and is informed by a “shift” that may already be happening.
Weintraub and McKee see the role of “patients as the drivers of idea/opportunity generation within health organizations” as a paradigm innovation that healthcare leaders need to be prepared to meet. For the hospital systems, clinics and assisted-living facilities delivering patient care, this means meeting the patients where they are. Patients no longer see themselves as beholden to medical practices and establishments; instead, patient desires for convenience, comfort, accessibility and affordability are driving innovations in care.
Now, patients do not need to check-in to a hospital for surgery, go to a doctor’s office when sick or spend their final days in a nursing home. Many once-complicated surgeries can now be performed in out-patient clinics, going to “see” the doctor can mean video-conferencing with them right from the comfort of home and assisted-living and home-care are becoming the preferred options in palliative care.
When patients do require in-hospital treatment, these facilities are increasingly patient-centric. Case in point: patients and medical staff are providing direct feedback and recommendations throughout the design and construction phases of The Pavilion, a new facility that will be part of Philadelphia’s Pennsylvania Hospital. Founded in 1751, Pennsylvania Hospital is one of the most historic medical centers in the country, but The Pavilion will be a distinctly 21st-century, technology-equipped and patient-focused facility. Feeling more like a hotel than a hospital, it is already being recognized as an “explosive innovation in healthcare” by the likes of Forbes.
Process Innovation
In Tidd’s and Bessant’s definition, process innovation is a change in the way a product or service is created and/or delivered. Process innovation could mean introducing greater automation in the manufacturing process, rethinking best practices in process management or how improvements are measured. Tidd and Bessant advise that “process management is mainly about optimization.”
Applying process innovation in healthcare can mean optimizing patient care. Pennsylvania Hospital’s patient-focused initiatives are a prime example. The hospital is rethinking its departmental structure. Instead of being a hospital organized around departments (i.e., cardiology, radiology, etc.), it is organized around patients. Departments have a shared stake for a more cohesive approach to patient care.
“There’s no ownership of a department and the only ownership rests with the patient,” says Kevin Mahoney, executive vice president and chief administrative officer at the University of Pennsylvania Health System. “How do we make that patient better as fast as we can, as effective as we can. And we know we can do that by blurring the department lines and having people work side by side.”
The paradigm innovation of patients as the drivers of care has directly influenced Pennsylvania Hospital’s process innovation of how departments operate together. However, process innovation doesn’t have to be a sweeping paradigm shift. It can be simple measures, such as using volunteers to feed inpatients, freeing overtaxed nursing staff and providing extra attention to patients, according to Weintraub and McKee.
As Tidd and Bessant explain, process innovation can be “incremental processes,” leading to greater gains through continuous improvement over time than those that come from “occasional radical changes.”
Position Innovation
From a business perspective, position is the product’s or service’s positioning within the marketplace. Position innovation creates a “change in the context in which the products/services are introduced” or positioned in the marketplace, thereby changing the perception of consumers, according to Tidd and Bessant.
In healthcare, an example of position innovation is shifting the perception that a hospital is an “institution” just for the “sick.” In Pennsylvania Hospital’s design of The Pavilion facility, Mahoney explains that he “pushed really hard that the root word for hospitality is hospital…everyone says let’s go look at other hospitals. I said let’s go look at other hotels.”
Similarly, the Henry Ford Hospital in West Bloomfield, Michigan, was designed with consultants who had previously worked with Ritz Carlton. The result? A facility comprised of all private single rooms, a Main Street shopping and dining area “designed with the look of a northern Michigan town,” a chef-staffed kitchen with meals from fresh fruits, vegetables and herbs grown on the hospital grounds and community nutrition and cooking classes.
By shifting the patient perception that hospitals and clinics can be centers where they can collaboratively work with healthcare professionals to improve and maintain their health, the hospital or doctor visit is no longer a dreaded necessity where patients are given “orders” to follow so they can “get better.” Instead, the patients are consumers in charge of their own health, with engaging and welcoming facilities and healthcare professionals actively assisting them in the “product” of healthcare.
Product Innovation
Perhaps the most self-explanatory of the four Ps, product innovation is creating new or making changes to products or services an organization offers. The ultimate “product” for the patient as a consumer is their health, with the rate of positive patient experience and improved health outcomes playing a large role in measuring the quality of healthcare. For healthcare organizations, this can mean implementing product innovation into the delivery of patient care—from improving the methods of a clinical procedure to a new drug therapy to technology-aided patient experiences.
Healthcare product innovations can be both driven by and drivers of the other three Ps of innovation. For example, anxious parents of premature babies facing an extended stay in the NICU of the Ann & Robert H. Lurie Children’s Hospital of Chicago can see how the baby is doing at every moment through the PreeMe+You app. The app allows parents unable to stay at the hospital 24/7 to keep in constant contact with their baby’s care teams and track their baby’s progress in real-time, as described in Forbes’ “Examples of Powerful Innovation in Healthcare.”
In turn, product innovations facilitate the process innovations optimizing and improving patient care and outcomes. Internet-equipped smart devices, from smartwatches and fitness trackers to medical apps and even GPS-enabled inhalers for asthmatics, are enabling doctors to monitor patients remotely, amend treatment plans and reduce office follow-up appointments. Both physicians and patients save time, and patients become active participants and owners of their healthcare.
Creating Healthcare Innovation
Whether implemented as an interconnected four-step process or occurring simultaneously in an “overlap of various forms,” the four Ps of innovation can help provide an overarching direction for creating healthcare innovation that is, as researchers explain, “aimed at improving treatment, diagnosis, education, outreach, prevention and research…with the long term goals of improving quality, safety, outcomes, efficiency and costs.”
