Does an organization’s culture get more deeply entrenched the more complex the organization becomes.

Maybe, but it still can be changed, based upon the work of Dr. Jonathan Darer, chief innovation officer at TeleTracking client Geisinger Health System.

Dr. Darer’s work involves closing the “care gaps” between what patients are getting and what they need. The work speaks for itself.


“We closed 50 thousand care gaps in the first year and this year we will increase that number by 30 per cent and there will be financial improvements,” he says.

“But what’s exciting is if you do a patient’s need in terms of current disease care and prevention you can actually save their lives or improve the quality of life by reducing amputations for diabetics or reducing fractures for patients with osteoporosis.”

Accomplishing this required new ways of delivering care, something Dr. Darer is fascinated about doing.

“The process of learning how to innovate in complex organizations has been a challenging one and a rewarding one. It’s been a journey about realizing that healthcare had some real issues that I believed I could help with. Learning how to make change and do things in high performing organizations is really an art and I’ve learned a lot on that journey.”

Darer positions himself at the juncture of clinical medicine, principles of reengineering, decision support electronic health records and analytics.

From that intersection, he’s looking to change the game regarding how we as a nation deliver healthcare. Some of that has to do with implementing new data systems, automating and redesigning hospital workflow, designing rigorous new processes around all the medical things that doctors used to do.

His “journey” is more like a quest for the Holy Grail.

“The U.S. spends 30 percent more than any other industrialized country on health care and our quality is not what it could be or what it should be. So we’re really trying to attack that problem, leveraging anything and everything that we can find in terms of HIT and the principles of re-engineering, clinical decision support, etc.”

“We not only have to improve quality we have to improve efficiency, but ultimately we have to look at things in a new way that almost allows us literally to change the game in the way we deliver care to see if we can be a model organization for healthcare through continuing innovation.”

One of the biggest obstacles is “Culture.” That word is bandied about way too loosely in these times, most often with negative associations, i.e., “gun culture,” “drug culture,” etc.

Yet the first three definitions for “Culture” on Dictionary.com deal with enlightenment through the arts and humanities. Even the fourth deals with “development or improvement of the mind by education and training.” You have to dig down to the fifth and theoretically, least referenced meaning, to get to “the behaviors and beliefs characteristic of a particular social, ethnic, or age group.”

However, within those five definitions is the hope that behaviors and beliefs can be changed, no matter how entrenched they are. Dr. Darer is proving this.

“We have some real successes. Our ability now to identify patients and get them what they need is more efficient and more reliable and has grown tremendously over the past four or five years.”

“Once you prove it that’s one thing, but what’s sort of exciting about this can you change a culture of an entire organization around the message that our job to some degree is to find, identify and close gaps in care. That has spread throughout the organization. It’s a living breathing animal now that really has taken over.”

In other words, culture is starting to drive innovation.

Darer’s quest now includes showing people how to innovate in large complex organizations, which involves major culture changes

“The challenges between cost and quality are so great that incremental improvements won’t get us to where we need to be in order to meet those challenges,” he says. “Those new models of care delivery are really what we’re after.”

“It’s not simple, but it’s something the world needs to know more about. So part of my role and interest is to hopefully show and train people on how to innovate in a rational way that really drives performance.”

Click here if you’d like to hear more from Dr. Jonathan Darer, consider watching this 5:53 minute video interview posted on BluePrint Health IT.

How does your hospital innovate?


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