In this story:

  • Dr. Byock and his team have created a shared decision-making tool for patients around one of health care's most sensitive issues—advance care planning.
  • The COVID-19 pandemic prompted further innovation—challenging the way advance health care directives are completed by developing a trusted decision maker designation.
Ira Byock

Founder and chief medical officer of the Institute for Human Caring at Providence, Dr. Ira Byock, was named one of Modern Healthcare's Top 25 Innovators of 2020. In partnership with digital health vendor Xealth and ACP Decisions©, Dr. Byock and his team created a tool that makes it easier for patients to do advance care planning.

Patients 65 years or older who don’t have an advance directive are sent emails a week before their annual wellness visit that includes links to view educational materials and download an advance directive. The process is also built into ICU stays. Within a year of the initiative’s beginning, more than 40% of ICU stays of five or more days had documented conversations around care goals.

The COVID-19 pandemic prompted further innovation. “For instance, we challenged the way advance directives have been completed and developed a trusted decision maker designation, which providers document in patients’ health records,” Dr. Byock says.

How do you identify opportunities for innovation?

I tend to identify opportunities for innovation by looking at the problems that are in front of us. My approach is straightforward: I challenge myself and our team with the question: What would success look like? This is an energizing question. It gives us permission to dream in color. Then we ask: What barriers will inhibit us from getting from where we are to where we want to be? How can we dissolve barriers or sweep them away? We want to solve for efficiency, making the right way the easy way, addressing the pain points of every stakeholder in health care.

What advice do you have for people who know how to get an idea in front of managers but may be afraid of failing?

I always start from the fundamentals. For us, those are the mission, vision and core values of Providence. Every written proposal and presentation to leadership answers the unasked question: How will this initiative advance our mission, the organization’s strategic plan? How will this move us toward Quadruple Aim goals to enhance patient experience, improve population health, reduce costs, and improve the work life of health care providers? If you invest time, energy and resources in projects that you believe answer those questions affirmatively, you have little to lose. Even if an idea is not accepted, your efforts will be seen as a good-faith effort to help the organization succeed.

How do you stay focused on innovation during a crisis?

The observation that within crises are opportunities is oft repeated because it is true. We’ve applied the same process of innovation I described—now with a sense of urgency and accelerated timelines—to solving new, pressing problems the pandemic has thrown at us. By staying focused on providing the best care possible, we’ve identified opportunities for advancing the organization’s mission and progress toward Quadruple Aim goals. It has required setting aside long-held assumptions and practice patterns and allowing form to follow function.


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