Managing innovation is hard. Leading health care innovators is even harder.

Why?

Because of the unique nature of the business of medicine, it’s a complex legal and regulatory maze. The size of the industry, the changing health care ecosystem and the many participants, including providers, patients and payers, all play a role. To thrive, or at least to survive, physician leaders must drive innovation and overcome the many challenges confronting them and their followers.

Sick care , like other industries, puts up a lot of barriers to innovation-too much bureacracy, putting out fires, lack of leadership, micromanaging, and many more.

Here are 10 barriers you will need to overcome to move sick care to healthcare:

1. A lack of an entrepreneurial mindset. An entrepreneurial mindset is a frame of mind that identifies and pursues opportunity with uncontrolled, scarce resources. The goal is to create user/customer/patient/stakeholder defined value through the deployment of biomedical and health innovation.
2. A highly regulated ecosystem driven by a perverse set of reimbursement rules. The legal, regulatory and reimbursement environment is migrating away from fee-for-service toward a more bundled payment method that will create different incentives to practice with an eye on optimizing resources.
3. A lack of patient interest or awareness. Most patients are used to being shielded from the economic impact of their health care decisions. Some are unwilling or unable to make those decisions. In addition, the lack of value transparency and the byzantine, opaque pricing structure adds further confusion and will interfere with efforts to achieve savings.
4. Vested interests resist changing a sick care system to a health care system. Health care represents almost 20 percent of the U.S. economy and powerful, vested interests are hard set on maintaining their profits and resisting change, including some highly paid doctors and administrators. The present sick care system has been very good to a lot of people, and they don’t want to kill the cash cow.
5. Consolidation creates even more risk averse organizations and employees. Health care consolidation is creating ever-larger integrated delivery networks. Unfortunately, larger organizations have a harder time innovating than smaller ones for many reasons, including a culture that is more interested in the now than the new.
6. Moving eCare to the mass market, changing it from a fad to a trend. Use of eCare, delivering health care products, services and information using information and communications technologies, is emerging as another care delivery platform supplementing inpatient and outpatient care. While there have been many indications that doctors and hospitals are increasingly using eCare technologies to increase quality, decrease the cost of care, improve access and enhance the patient experience, the charge to date has been led by technology evangelists and innovators. Getting eCare into the mainstream will be a challenge, and new business models to realize widespread deployment and sustain it are needed.
7. Finding health care leaders with the courage to lead innovators . Intrapreneurs – physicians and workers already on board who are trying to act like entrepreneurs – have a particularly difficult road, because they not only have to find the right product-market mix for their ideas, discoveries and inventions, but they also have to confront a bureaucracy that snuffs innovation, does not reward risk and marginalizes those who threaten the status quo and labels them “disruptive.”
8. Finding early seed sage capital to support new business models. The financing environment for life science and digital health technology commercialization has changed dramatically in the last few years. The result has been new techniques including crowd funding, super-angels, corporate venture, philanthropic and community-based innovation schemes. Finding money has never been easy, but it has become harder given the number of early stage companies vying for funds. In addition, internal resources are harder to identify.
9. A risk averse mindset of new medical graduates. Limited clinical half-lives, big debt and work-life balance demands are part of the next generation of medical students and graduating trainees have different demands and expectations. A significant percentage expect to practice for a limited time before transitioning to alternative or non-clinical careers and are more risk averse, choosing employment over independent practice with the guarantee of a salary and loan forgiveness.
10. Defining, creating and measuring value. Value is the customer defined difference between the tangible and intangible benefits of a particular product offering less, or divided by, the tangible and intangible costs. Reimbursements or payments will be contingent on defining, creating and measuring that value to each stakeholder. Results will replace effort as the coin of the realm.

In addition, the challenges are different when you are trying to bring digital health ideas to patients compared to a drug or device. Sick care ain’t Uber.

Overcoming these challenges will require revised thinking and action in 4 areas:

1. Organizational structure that turns the pyramid upside down, with patients at the top, driving change through DIY techniques and the democratization of the internet and subsequent care.

2. Revised platforms and processes of care with innovative business models that result in a system of systems, including those socioeconomic systems that are resposible for the majority of health outcome disparities like education, housing, income, nutrition and equity.

3. The right people in the right jobs of the future

4. Changing rules so that they create the incentives for doctors and patients to change their behavior, and , in so doing, move from a sick care system to a health care system. We need to change the culture of sickness to the culture of health.

Physician leaders need to embrace innovation and entrepreneurship as the major tool to drive change in the health care system. Entrepreneurship is different from management, however, and requires separate and distinct structures, processes, policies and culture if it is to succeed. Overcoming the 10 health care barriers to innovation can’t be successful if you use tools and techniques you used to fight the last war. Lead innovators, don’t manage innovation.