Professional Documents
Culture Documents
TABLE OF CONTENTS
1
Introduction
Virtual Collaboration 9
• Virtual Fridays 9
• Virtual Infrastructure 10
Lessons Learned 15
Going Forward 17
INTRODUCTION
If ever there was an industry that was closed-minded and steeped in its own
importance and tradition, and resistant to major change…it’s health care. I’ve
never seen an industry that is so siloed and focused on itself without looking
outside of itself.
Ten nationally recognized health care organizations have been jointly pursuing the
answers to these and other questions associated with innovation. Breaking away from
Intentional, disciplined innovating – with methodologies and typical practices in health care, scores of senior managers agreed to let go of control
theories behind it – has been neglected, from local settings all so that something exciting could emerge. The results have been interesting,
the way up to the global arena. As a result, the need is so big surprising, and offer useful guidance to other health care organizations and leaders
and so pervasive it’s numbing… it’s been obvious for so long seeking to affect change earlier, more rapidly, and better than before. The network
and yet, where do we start? that emerged to answer these questions became an innovation itself.
Keith McCandless, Consultant, Social Invention Group This is the story of the Innovation Learning Network (ILN): what was done, what has
been successful, and what the future holds. The ILN hopes that this narrative will
serve as an example to other groups planning to build collaborative networks, and will
accomplish the following purposes:
Groups wishing to replicate the tools and practices used by the ILN should consult the
associated “Resources and Tools” document.
Our thanks to all the members of ILN, project staff, consultants and the VHA Health
Foundation for taking risks, trying something different, and participating in the
adventure as it unfolds.
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Innovation Learning Network 2006
We made it really clear from the onset that this was going to ORIGINS AND INITIAL GOALS
be a member-led organization.
The ILN was conceived in the summer of 2005 as a joint venture between Kaiser
Chris McCarthy, Director, Innovation Learning Network Permanente and the VHA Health Foundation (VHAHF). VHAHF hoped to bring
together a network of organizations that could create innovations, then share and
I think we’ve done very well with… helping the ILN members prototype them throughout each of their respective systems. The initial ILN charter
to create a forum for them that works… soliciting what it is called for the group of organizations to “evaluate best practices related to the
that the members would need and having it drive. selection of innovation and technology, the implementation process, and the
outcomes of these endeavors.”
Marilyn Chow, RN, DNSc, FAAN - Vice President of
Nursing/Patient Care Services, Kaiser Permanente Everybody didn’t need to be working on technology to be part of an
innovators’ network – they could be working on anything. The more important
What organization What is the role thing would be the attitude they bring. Together they could come up with what
structures are being used of project work in were the most meaningful things to work on. The principles for innovation are
for innovation? innovation? the principles of innovation, and it doesn’t matter whether you’re working on
technology or communication strategy…there are things to share and learn.
Structures Projects During the last months of 2005 and the early months of 2006, Kaiser and VHAHF
worked to recruit health care organizations and the sponsors and champions that
would serve as primary contacts for the network. The group agreed to participate in
two in-person meetings and monthly conference calls.
A fundamental premise of ILN organizers was that members should determine the
Diffusion process and content of the group. Project leaders focused on creating an environment
that was capable of identifying compelling interests and allowing participants to act on
What vehicles are being used those interests. The approach was primarily experimental, and not prescriptive.
among members for diffusion of
innovations? One need members recognized early was for all to learn about the practice of
innovation itself – the science and the methodology behind it. Three primary elements
emerged – diffusion (spread), structures, and projects – and formed the core of the
…science of innovation, the science of chaos, the science of ILN’s work and learning about innovation.
complexity. When I first heard about that in the late 80s, early
90s, and I thought, “what? That’s weird.” But in fact, quantum The fundamental purpose of the ILN has remained consistent throughout the group’s
mechanics has had some breakthroughs that Newtonian lifespan: the group would facilitate the spread of knowledge from one health care
physics just didn’t cut. It’s the same thing with our thinking. organization to another. Yet what resulted was even larger than what was originally
planned. In addition to finding great ideas within each organization’s existing
David Tew, Vice President and COO, Bergan Mercy Medical operations, the group found an effective infrastructure for innovation: the network that
Center they themselves had created.
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In April, the group met in person for the first time at CIMIT (Center for Integration of
Open
Medicine and Innovative Technology), an affiliate of Partners HealthCare in Boston.
Space
Structures Projects The meeting structure contained two essential components: the use of Open Space
Technology meeting design (Open Space), and an explicit focus on building
relationships among participants.
Open Space. Chris McCarthy, the Director of the ILN, Maggie Hentschel, Project
Diffusion
Analyst for the ILN, and Keith McCandless of Social Invention Group had chosen to
use Open Space for the group’s first session in order to facilitate the development of a
member-driven network. According to one expert, Open Space is “a self-organizing
Open Space increases responsibility and freedom for practice of individual discipline and collective activity that releases the inherent
1
participants. To be sure, what emerges is only a guess. And creativity and leadership in people.”
to even do it, you have to accept uncertainty and work with it
– trusting that people will organize themselves in a better way At the beginning of the day, all participants are invited to announce a topic of their
than you could have anticipated or controlled or planned. choice to discuss at some point during the day, and post that topic on the wall-size
agenda. Participants are free to join the discussions they find compelling, and to move
Keith McCandless in between discussions as they see fit – the only rule is to follow your passion. The
principles of Open Space are simple and direct:
These principles are supported by the “Law of Two Feet”: participants must go to
where they are learning or contributing, and are responsible for ensuring that their
own needs are met.
George Burgess
1
Anne Stadler, annestad@comcast.net
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The ILN staff had hoped that the discussions held in April would lead to further
collaboration – that participants would utilize the website as a gathering place for
further conversation and eventually, collaborative project work. A handful of the topics
resulted in additional discussions, meetings or activities.
Notes from the diffusion surveys An Example: Subcommittee on Diffusion and Spread One of the discussions
during the April meeting focused on two topics: teaching styles that can accelerate the
“[One innovation] started to spread natural[ly] and then implementation of an innovation, and the process of diffusion. A smaller group of
leadership acknowledged it as a best practice and members continued to converse and explore the topics further over the summer. The
mandated it for everyone to do.” group had several conference calls, in which they discussed methods to capture
“Implementation can drive innovation which in turn lessons from ILN members on best practices of implementation and diffusion. They
accelerates implementation….as the ‘inventors’ are the eventually settled on a survey, in which members could interview another individual
users.” within their organization about an innovation success story.
“Implementation is the responsibility of those who created
the project and asked the question. The design team The group’s activities slowed a bit over the summer, but moved back into action as
considers implementation throughout the process by the second in-person meeting in October neared. After the meeting, in which
maintaining a primary focus on the human aspect of the members mentioned the work they had done so far and encouraged other ILN
desired/intended change.” participants to contribute to the survey, the group began to gather results.
The lessons learned through the survey will certainly apply to other ILN activities
going forward. Although there may be no further activity among this particular group,
the knowledge gained through their work will become part of the dataset held by the
network that will affect future projects.
Structures Diffusion Projects
survey Some of the other discussions that began in April never resumed; some re-emerged
at the meeting in October or in subsequent conference calls. By building a network
with many interpersonal and inter-organizational relationships, the ILN created for
themselves an ability to tap into the collective knowledge, interests and experiences of
Diffusion the group, at a time when it is right for each individual member’s particular situation.
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That’s why I think to some degree it is important to have the BUILDING THE NETWORK
in-person contact. You know, you can talk over the phone but
it’s so easy to then, once you get off that hour phone call, to The group soon learned that collaborating on innovations was not something that
get sucked back into your daily organization and life. And could happen in a productive manner immediately. Group members needed time to
when you see each other and you spend some time together, get to know each other and understand each other’s strengths and interests, so they
you actually say, “OK, what are we going to do to really make could determine who to collaborate with on what projects. Relationship building turned
this happen, really make this come together?” out to be the central principle of a successful collaborative network.
Donna Deckard, Vice President of Implementation/ Relationship Building. One of the difficulties of creating a successful network is a
Optimization - KP HealthConnect, Kaiser Permanente function of time – finding the time to create
personal connections outside of each member’s Lessons learned
existing duties and official job descriptions.
Developing meaningful connections between Work hard to build
organizations and individuals required a personal personal relationships.
investment on the part of the participants. Make it fun!
Additionally, participants needed to feel trust
before they were willing to collaborate.
The in-person meetings were thus designed with a trust-building component in order
to truly cement the relationships between the participants. In addition to the formal
piece of the meeting in April, the group also gathered for dinner, where participants
were able to get to know each other personally, as well as professionally.
In the April meeting we had this great dinner. And next thing you know,
everyone’s putting on these leopard robes and having this really great
moment together where they really bonded and were laughing and sharing.
That one moment carried them through to the October meeting.
Chris McCarthy
I thought the Boston hotel was fabulous. I’d never been in a The special nature of the meeting – the platform for members to be candid, the social
hotel with robes that were leopard-skinned, leopard colored. activities, and the lack of structured expectations – led the members to develop a
That really made that first meeting, that hotel, I think was different kind of bond with each other than they would at a typical conference or other
such a great contributor to that. I know that’s strange meeting. After the two days in Boston, members reported that they felt freer to contact
sounding. It broke what would be an ordinary meeting into an each other with questions about each other’s projects and work on collaborative
innovative meeting that was not the same as every other one. efforts. Chris and Maggie worked to connect ILN members with common interests and
challenges, and made sure to include social activities in the October meeting, further
George Burgess, MD cementing the developing bonds. As those relationships developed, the network
became more distinct – a creative and adaptive organism of its own.
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Social Network Mapping. At the end of the April meeting, Keith McCandless had
asked the ILN members to put one hand on the shoulder of another ILN member with
whom they wanted to work in the coming year. The results were several different web-
like formations that allowed the ILN members to visually recognize the potential value
of the connections they had made.
After several months had passed and the network had further developed, the ILN staff
hoped to recapture this visualization in a more robust, quantifiable way. Keith brought
forward the concept of social network mapping – an emerging technology-based
method used for defining personal interactions and building relationships.
Keith introduced ILN project leadership to June Holley, an expert in building networks,
who educated the group on the concepts of social network mapping. June also
demonstrated a visual software tool that tracks the ties between members of a
network. ILN leadership agreed to pursue developing metrics about network
Before ILN composition and changes over time using the tools.
1. Prior to the start of the ILN, who did you work with or exchange information on
a project, topic or shared interest?
2. Since the ILN started, with whom have you shared ideas or worked on
projects that were catalyzed by your ILN interactions
3. Who has inspired you or given you new ideas since the ILN began?
4. Who would you like to work with over the coming year on an ILN-inspired
project or topic?
The results came in several network maps, which show the blossoming of the network
over time. The maps contain many individual stories of collaboration and connections
made. The process was repeated following the October meeting, and maps updated.
The group realized that the maps could prove a great tool to determine where
connections could be made both within and between organizations. As a service to
the member organizations, the ILN contracted with June Holley to learn about how to
Anytime you want to do something that has more impact, that create network maps for individual organizations and “weave the network” – a
usually means there’s more risk involved. technique used by community development organizations to make better connections
between organizations and individuals – using data from the maps.
June Holley, Smart Networks Weaver
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September 2006 Social Network Metrics. The network maps on pages 6 and 7 present obvious visual
differences – notice the increased size and density of each succeeding version. June
Holley also introduced some specific metrics that quantify the nature of three critical
dimensions of the network:
• Integration: Who are network leaders? How healthy is the network? Are we “in
the thick of things?”
• Awareness: How likely is it that you know what is going on far from the core?
• Connector: To what degree are the “clusters” (in this case, the institutional
groups) connected to each other
Measures of integration, awareness and connector were calculated for the pre-ILN,
September 2006 and 2007 time periods. In addition, a determination of “potential”
could be made – the likely maximum level that could be achieved with the existing
network. The results were very encouraging:
2007
Metric Pre-ILN Sept 2006 2007 Potential
Integration 184 492 761 810
Awareness 16 29 37 40
Connector 138 355 1099 1454
The level of integration – the fundamental index of network health – has nearly
quadrupled from pre- ILN levels. As importantly, the incumbents have even greater
upside -- the potential of the network is approximately 50 points higher. With
awareness, more significant growth occurred in the early months of the network, with
slower growth as members were added at the second group meeting. In contrast,
connector metrics – the measure of relationships between the member organizations
– grew dramatically after the second meeting, and shows significant potential for
continued growth.
The maps also reveal details about how well Lessons learned
the ILN has penetrated within each
participant organization. As each organization Sponsors and
is represented by a different color, it is champions need to play
immediately apparent which organizations active roles.
have been successful at inviting more
individuals to participate. In order to
successfully diffuse innovations further into organizations, individual sponsors and
champions will need to work to build connections between other ILN members and
staff within their own organizations.
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I wish you could solve for ways I could stay even better An Example: The EPIC Subcommittee. Woven into the network maps is the story of
connected. three organizations who shared experiences with implementing an electronic health
Marilyn Chow record. Evanston Northwestern Healthcare, the Cleveland Clinic and Kaiser
Permanente had all recently begun implementing the same information system. At the
first in-person meeting in April, Bobbi Schramek of Evanston, Mary Partin of the
Cleveland Clinic, and Donna Deckard of Kaiser connected about their experiences
with the implementation, and decided to stay in contact over the course of the year to
continue to share challenges and lessons learned.
Although the group initially had difficulty finding time to connect, they have since held
two conference calls to discuss areas of common interest, including some challenges
all three had encountered. They hope to help each other wade through the thorny
issues of configuring the applications, avoiding common pitfalls, and sharing best
practices. The group has also discussed possible engagement in conversation with
the vendor, utilizing their combined market share to pressure the vendor to make
necessary changes.
People are writing a list of questions that they’re sending to Bobbi, that whole
Structures Social Projects team is going to be on the phone, the implementation managers are going to
Network be on the phone. I think it’s going to be really rich, what’s going to come of it.
Mapping
Donna Deckard
Diffusion
An Example: Collaboration within Kaiser. The maps also capture increasing
integration that occurred within individual organizations. Several of the ILN member
organizations are very large entities with hundreds or thousands of employees, many
of whom may never meet or collaborate. The forums for information sharing that the
ILN promoted brought many of these individuals together for the first time. Jing Wang
of Kaiser reports that she connected with Sean Chai and Scott Heisler, two Kaiser
employees in different areas, for the first time to work on mobile sensors. Jing writes
that she found “effective knowledge sharing through [the] social network.”
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People were actually really excited to share their projects. It VIRTUAL COLLABORATION
seemed like people were proud to be able to report out on the
different types of things they were doing. Maintaining connections between ILN meetings became a high priority of the project
team. They developed two primary vehicles: Virtual Fridays and a Virtual
Maggie Hentschel, Project Analyst, Innovation Learning Infrastructure for collaboration.
Network
Virtual Fridays. In April, after the conclusion of the Open Space portion of the in-
person meeting, CIMIT staff had given ILN members a tour of the Center along with
several presentations about the group’s current initiatives. These presentations
piqued the interest of many ILN members, who requested a forum for learning about
innovations at other organizations. The ILN staff thus came up with a web-based
solution.
Virtual Projects
Structures
Fridays Chris had come up with this idea that we have people present out on Fridays
for a quick forty-five minutes the specific projects they are working on. It’s not
mandatory to attend. These would be recorded and posted, and so people in
the network could access the presentations at a later time.
Diffusion
Maggie Hentschel, Project Analyst, Innovation Learning Network
The presentations became known as “Virtual Fridays” – conference calls that included
Some of the connections resulting from Virtual Fridays: a web-based component for presenters to share PowerPoint presentations and other
interactive components. The Virtual Fridays rapidly showcase a specific topic in detail
• Guy Chicoine (Kaiser) connected Anna-Lisa Silvestre in a way that keeps the audience interested and engaged, maintaining a personal feel.
(Kaiser) to Ginger Price (Veterans Affairs) on the use of These interactions helped the members to maintain the relationships they had begun
online services to develop in April.
• Ann Hendrich (Ascension Health) and Jeff Norton (CHI)
connected with Chris McCarthy (Kaiser) about Nurse The Virtual Fridays also proved an easy way to
Knowledge Exchange introduce the group to the variety of innovations Lessons learned
• Jim Noga (Partners) and Christi Zuber (Kaiser) connected at each organization and float many ideas and
about green facility design interests to the surface. By fostering the Create an idea pipeline.
• Eric Cleveland (Mayo Clinic) connected with Andrea development of trust and professional credibility
Werner (Bellin Health, a non-ILN participant) on throughout the network, the Virtual Fridays
prioritization models resulted in many connections and
• Oyweda Moorer (Veterans Affairs) connected with collaborations between individual ILN members
Marilyn Chow (Kaiser) and Ann Hendrich (Ascension and their organizations.
Health) about nurses’ work environments
The Virtual Friday archive also allows organizations to access helpful information at
the right time. After Chris McCarthy presented the first Virtual Friday on Nurse
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Innovation Learning Network 2006
We need to allow us to sample and to look at the menu, Knowledge Exchange, an innovative process to improve nurses’ exchange of
rather than having to order the entrée to taste it. information during shift changes, Ann Hendrich from Ascension Health contacted
Chris immediately to find out more. Individuals at the Mayo Clinic and CIMIT also
David Tew expressed interest in the topic, but at a much later time; Chris was able to direct those
individuals to the archive for the complete presentation. The archive thus enables the
ILN members to access information when a particular issue has an immediate need,
and does not require every innovation to be applicable at the very moment in order to
diffuse from one organization to another.
Wiki Projects
Virtual Fridays were the most successful collaborative tool used over the course of the
Structures
Website ILN; some members have expressed interest in hosting Virtual Fridays for their own
List-serve organizations’ staff.
The wiki has certainly been used by the members Lessons learned
on a far more regular basis than the previous
website, yet still has not taken hold as a consistent Have an active virtual
tool for members. This reflects both the relative infrastructure.
inexperience of members with this form of
collaboration, and the early stage of most of the
group’s collaborative projects.
The list-serve has been utilized relatively frequently, and presents the advantage of
allowing members to push information out as well as pull information in from the other
members. ILN staff expect that traffic will increase significantly as the network grows.
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Innovation Learning Network 2006
In October, the group met in person for a second time, at the Sidney H. Garfield
Health Care Innovation Center, Kaiser Permanente’s recently opened innovation
laboratory in San Leandro, California. Three elements drove the meeting: the opening
of the session with a panel discussion; the continuation of Open Space; and a
sharpened focus on collaborative projects.
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The first day resembled the April meeting very closely in set-up: after an initial tour of
the Garfield Center, participants were asked to choose topics that they wanted to
discuss. The second day, however, had a more distinct action-oriented component.
Keith McCandless, who facilitated the meeting, asked the group to select a few topics
that had enough momentum during the discussions to move forward and become
group projects.
Lessons learned
Four groups emerged. Using a template
provided by Keith, they created concrete game The real value will come
plans for next steps, with goals, timelines and from collaborative
leaders. These included: projects.
• Personal Health Records - a group led by David Tew of Alegent Health Care
that aims to make personal, portable, electronic health records nationally
available within two years
• ILN 2007 - a group led by Chris McCarthy that began planning the work of the
ILN over the next year
Marilyn Chow
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Innovation Learning Network 2006
Follow Up. Since the meeting in October, each of the projects has progressed. With
the term of the VHAHF grant coming to a close, the ILN members have taken steps to
Virtual keep the network financial sustainable. By November, eight of the ten original
Simulations organizations had committed to supporting the ILN for the next year, a testament to
Structures Innovation Projects
both the potential that participants saw in the collaborative work and the value that
Labs they had already received from having access to each other.
Personal
Health Records The personal health record group has continued to hold regular conference calls. After
Diffusion an initial investigation revealed a wealth of existing available products, the group
decided to compile a review of the current major offerings. The group assembled a list
of available products, and created a tool to evaluate these according to the standards
Personal Health Records survey they had developed during the October meeting. In a Virtual Friday, the group
updated the ILN on their progress and enlisted members’ help to evaluate products.
The group hopes to publish these results soon, and leverage their findings to engage
in discussions with other stakeholders, such as employer groups, to make Personal
Health Records more widely available.
The virtual simulations group agreed to evaluate the Second Life website as a
potential platform for development. Since the October meeting, the group has held
two virtual meetings within the Second Life platform to begin investigating the
potential applications of this avatar-based environment. One of the committee
members has instigated discussions with an executive of Second Life; the group
hopes to learn from her how other health care organizations have used Second Life.
The innovation labs group hopes to utilize each other’s facilities to discover innovative
Second Life screenshot solutions regarding medication reconciliation. The group is still coalescing and has yet
to determine how that plan will unfold; first steps have included meetings between
CIMIT and Garfield Center staff in Boston.
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This is about diffusion, and the water will seek its own level LESSONS LEARNED
on the one hand. On the other hand, a rising tide does not lift
all boats. The boats that it lifts are the boats that are Innovation does not need to occur within a network – it can occur within a single
seaworthy. organization. Yet the ILN members found an immense diversity and richness of ideas
that they could tap into by being hooked into this network, facilitating the innovative
David Tew process.
I think that innovation is really a science of quality. It’s a Innovation is a dynamic interplay of structures, projects and diffusion – the ILN
process in which rich discovery and self-discovery and all became a successful innovation because it grew to exhibit all of these. The set
sorts of spin-off innovations are occurring as you’re trying to structures included Open Space meeting design and Virtual Fridays, from which
get to this deliverable. And most of that is an invisible thing to collaborative projects grew; these subsequently diffused into organizations via the
the senior leaders that hold the purse strings or whoever Virtual Fridays and the members’ relationships – the network itself.
originally started this thing.
Several ideas have emerged about how to build a successful network.
Keith McCandless
1. Requiring the members to decide on the direction and activities of the network
themselves will result in a more engaged, participatory group than might arise
Open Space Personal Health Records from a group that has been given a predetermined agenda. The ILN’s initially
Network Maps Virtual Simulations vague agenda fostered creativity and energy among the members, who used
Email & Web Tools Innovation Labs the open space forum to surface the issues they most wanted to address,
then expressed an extraordinary willingness to tackle these issues.
Participants cannot be given freedom without bounds, however; they must
also have responsibility for ensuring the success of their homegrown network.
3. Make it fun! Every single member of the network had a full workload before
Virtual Fridays they began participating in any of the ILN’s activities. To find time to devote to
Diffusion Survey the ILN, members must truly enjoy the work. From the very first meeting, the
ILN staff set a tone that was playful and energetic, and the members
responded in kind.
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Innovation Learning Network 2006
5. The discovery of common interests will come from surfacing many initial
ideas. Through both the open space meeting discussions and the Virtual
Fridays, members were able to learn about the projects being completed at
each other’s organizations, along with the challenges that each organization
faced. The life of the ILN can be viewed as a narrowing pipeline that
highlighted those projects that could develop momentum.
7. The true value of the network will come from collaborative projects. In order to
thrive and continue, the ILN will need to significantly and tangibly impact the
member organizations. There has been significant small-scale collaboration
(groups of two or three members) that has been hard to document; the ILN
hopes to further utilize the social networking surveys and maps to capture that
work and demonstrate value. The major projects that took root during the
October meeting demonstrate promise, and may serve as a litmus test for the
organization’s viability moving forward.
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Keith McCandless The activities of the ILN thus far establish a pattern for a continuing two-phase cycle:
face-to-face meetings with deep dives into particular topics, followed by longer periods
I’m looking forward to seeing what continues to come out of of collaborative projects and network building. In 2007, the ILN has plans to initiate
this. new activities such as group consultations and a “borrow an expert” inter-
organizational exchange program; the in-person meetings will become larger, longer,
Chris McCarthy and more frequent. While the ILN is still building capacity and momentum, it has
proven an exemplary model of a rapidly developed network with an enormous amount
I think it’s got extreme potential. of potential.
Donna Deckard As 2007 progresses, the ILN will be the group to watch.
Maggie Hentschel
David Tew
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Innovation Learning Network 2006
Virtual Fridays C
• Process Guide C-1
• Topics and Abstracts C-2
Online Collaboration D
• Site Map – ILN Website D-1
• Site Map – ILN WIKI D-2
• Screen Shots D-3
Second Meeting E
• Panel Discussion
o Participants E-1
o Summary E-3
• Meeting Agenda E-5
• Summary of Discussion Groups E-6
• Project Game Plans E-9
o Game Plan Template E-13
Going Forward F
• Summary of ILN 2007 F-1
• RFP for Social Network Mapping and Weaving F-2
Resources G
• ILN 2006 Members G-1
• Other Resources G-2
Innovation Learning Network 2006
It is a self-organizing practice of individual discipline and collective activity that releases the
inherent creativity and leadership in people. By inviting people to take responsibility for what they
care about, Open Space establishes a marketplace of inquiry, reflection and learning, bringing out
the best in both individuals and the whole. It has been used successfully all over the world in
many organizations and communities.
When to Use It
Probable Outcomes
How It Works
The Law of Two Feet means you take responsibility for what you care about -- standing up for
that and using your own two feet to move to whatever place you can best contribute and/or learn.
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The Law of Two Feet gives participants freedom to move at any time to a discussion they care
about. Caring creates common ground, and helps to remind participants of higher purpose.
1. Select a focusing statement or question for your gathering. It should frame the higher
purpose and widest context for your discussion in a positive way.
2. Invite the circle of people: all stakeholders or all the people you'd like to have in the room.
Include the theme, date, place and time of gathering in the invitation.
3. Create the circle: Set up chairs in a circle or in concentric circles, leaving space in the
center. Choose a blank wall for the Agenda Wall and label it AGENDA: AM, PM across the
top. Set up a table for computers near a wall you label NEWS. Put blank sheets of paper
(about quarter size of a flip chart page) and colored felt pens in the center of the circle. Near
the Agenda Wall and the News Wall put masking tape for people to post papers on the walls.
4. To begin the gathering: Facilitator explains: the theme, the simple process the group will
follow to organize and create a record, where to put things up and find out what is
happening, the Law of Two Feet, and the Principles of Open Space. Then, facilitator invites
people to silently reflect on what is important for each of them in responding to this
challenge.
5. Opening the marketplace: the Facilitator invites anyone who cares about an issue or
challenge to step into the middle of the circle and write the topic, their name, a time and
place for meeting, announce it and post the offering on the Agenda Wall -- one sheet per
topic—as many topics as he/she wants. They will be conveners who have responsibility for
leading their session(s) and seeing to it that a report is made and shared on the News Wall.
A recorder in each room will assist each leader.
6. When ALL offerings are concluded, the Facilitator invites people to sign up for what they are
interested in and take responsibility for their schedules, using the Law of Two Feet.
7. People participate in discussions. The Facilitator takes care of the space. Recorders enter
discussion reports in the computers and printouts are posted on the News Wall.
8. Evening News & Closing Circle: all reconvene an hour before closing to share highlights,
"ahas" and key learning in a dialogue format: simply listening to whatever people have to
offer without discussion.
9. Mail out, simulcast, or post the record that is created. Share the Gameplans and include
more people in the efforts underway.
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Day 1
Start Finish Duration Task Notes
8:00 8:30 0:30:00 Welcome/Settle In/Rapid Re-Intro
8:30 8:45 0:15:00 ILN Story
8:45 9:00 0:15:00 Open Space Technology Setup
9:00 9:30 0:30:00 Open Space Agenda Creation
9:30 15:30 6:00:00 Open Space Each topic leader should have
documented the flow of
discussion, major points, and next
steps
15:30 16:00 0:30:00 Discussion Closedown/Break
16:00 17:00 1:00:00 CIMIT Simulation
17:00 18:30 1:30:00 (back to hotel)
18:30 19:00 0:30:00 Cocktails (hotel)
19:00 21:00 2:00:00 Dinner (hotel)
Day 2
Start Finish Duration Task Notes
7:30 7:45 0:15:00 Welcome Back
7:45 8:15 0:30:00 CIMIT Presentation 1 OR of the Future
8:15 8:45 0:30:00 CIMIT Presentation 2 Medical Device Interoperability
Plug-n-Play
8:45 9:00 0:15:00 Break
9:00 9:30 0:30:00 CIMIT Presentation 3 Ambulatory Practice of the Future
9:30 10:00 0:30:00 CIMIT Presentation 4 Connected Health Initiative
10:00 10:15 0:15:00 Break
10:15 11:30 1:15:00 Closure/Connections
11:30 11:45 0:15:00 Delta/Plus
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Discussion groups
Patient Experience
Alegent Health – Ann Jones (ajones@alegent.org)
The group discussed how to learn more about the patient experience, and what tools could be
used. Tools discussed include interviewing patients, following them, and observing behaviors.
The group noted that patients’ vulnerability makes the industrial model less applicable in the
healthcare arena, as the intensity of emotions and the complexity of the processes are clear
differentiating elements. This group continued to work over the summer; the ultimate result of
their collaboration was a panel discussion that opened the second in-person meeting. For a
summary of that meeting, please see Appendix 5-1.
Open Innovation
Alegent Health – Ted Schwab (tschwab@alegent.org)
This group asked the question, “How do we continue to include outside sources of information
and keep the innovation open as we begin to implement?” The group discussed major projects
within their organizations that could use innovative thinking, lessons learned about how
innovation works, and major challenges to open innovation.
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• The importance of including multiple stakeholders in the selection, research, and design
effort not separating the design and spread activities.
• The importance of "air cover" tone that encourages risk taking -- from leaders.
• The need to create space and time for an innovation culture to bloom.
• Diminishing fear of job loss ("if my role or work process changes, I may lose my job").
• While healthcare innovates fabulously in medical devices, innovation in other key aspects
is lacking.
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- The innovation team needs a respected, inspirational leader. A physician leader can help
produce buy-in.
- Successful spread can come two-fold. First, an innovation starts to spread naturally; then
leadership acknowledges it as a best practice and mandates it for everyone.
- Let the end user customize the innovation to reduce the need for training.
o Get manufacturers to participate in the training of their devices.
- Implementation requires a robust social network that allows change agents to use
relationships to navigate through committees.
- Kaiser has an innovation team that can support operations throughout the organization.
The team has two major approaches for assisting groups:
o The team conducted a seminar for a region on rapid cycle change, then invited
others to submit ideas to implement. They started with nine teams, and cut down
to two teams. Met every other month for a year and half.
o The team held an application process for groups to receive their support. The
team helped applications to fill out the application, especially defining the
problem to solve, metrics, etc. Questions included:
How does this strategically align with organization?
How will this idea improve affordability?
What kind of support are you seeking from the innovation team?
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1) Where does innovation occur? Innovation happens all over our organization, from the top
to bottom. How do you define innovation in your organization? Innovation is trying
something new to address a problem. In your organization, where are technologies,
workflow improvements and IT upgrades either developed internally or identified
externally? Technologies and workflow improvements come out of clinical areas based
on needs and desires, and working with our regional Strategic Management Consulting,
Innovation Team or the Clinical Research Unit. I am not sure how this happen in the IT
side of our organization.
a. If a separate group exists, how large is it, how is it funded and what is their
charter? The Innovation Team is made up of twelve people (five are MDs, four
directors of departments, union representatives and two project managers) and
the group is led by Bill Marsh. The Innovation Team is part of the operating
budget for the region, and its mission is to promote a spirit of innovation and risk
taking throughout the organization in order to improve affordability. How does its
work get implemented and by whom? There are two main ways groups can tap
into the Innovation Team’s resources: first, we conduct seminars on rapid cycle
change and often invite folks to submit ideas to implement. An example is that
we had nine teams thinking about new ideas. We shaved that down to two, and
then met every other month for development. Second, there is an application
process that we can assist folks with, especially with defining the problem to
solve and metrics development. Part of the process is answering the questions:
“how does this strategically align with organization?”, “how will this idea improve
affordability?” and “what kind of support do you want from the Innovation Team?”
2) Specific Example of Success: Across your entire organization what is a good example of
a recent successful implementation of a new technology or a significant process
improvement across a large percentage of your organization (an example might be
EMR)? Be prepared to talk in some detail about how the implementation was planned
and staged as well as the results. An example of success is with our Practice
Management initiative (in Colorado) where the Primary Care MD manages their whole
panel of patients. It was well spread because there was a regional mandate to do so.
Originally it started to spread naturally. However because of the great results, and
determination that it was a best practice, leadership mandated as a standard. The
implementation started about two years ago.
3) Specific Example of Failure: Across your entire organization what is a good example of a
recent failed implementation of a new technology or a significant process improvement
that was attempted across a large percentage of your organization? Be prepared to talk
in some detail about how the implementation was planned and staged as well as the
results. Were you able to understand why it failed? Please give the details. I can’t think
of one at the moment.
4) Training (how, who and what worked and didn’t): Is the training included in the
implementation plan? Who owns the training and how much of the total effort (time and
budget) is devoted to training? What are the tools that you have used successfully and
unsuccessfully? Please detail why some worked and others did not. Training is not a
significant part of what we do with implementation, and is done ad hoc. We encourage
folks to connect with each other by phone and site visits, and also hold innovation fairs
where they can connect. Specific training we do is around the rapid cycle change
process.
5) What are your metrics for success? For the innovation team it is to improve affordability
(for example: decreased ALOS). We use a value equation and quality indicators to
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determine if we are on the right track; however we have not seen improvements in cost
just yet.
6) What are some of the key barriers to successful implementation and how did you
overcome them? One key barrier is the lack of sponsorship. We identify and bring in
sponsors early on in the project, and have them co-developing measures of success to
help remedy this. Another barrier is a lack of clarity regarding what the problem is. Our
insights have helped us to more clearly define the problem to be tackled with our
sponsors, before beginning a project.
7) Is there anything that is really unique to your organization that makes implementation
either easier or harder than elsewhere? Please provide details. In our part of the
organization its fairly easy: we have an innovation team that is sanctioned by the medical
group and health plan leaders, and is led by Bill Marsh, one of the most respected
physician leaders. Are you able to provide incentives to early and easy adoption? We try
really hard to recognize people who are trying new things: monetary rewards, email
commendations to their supervisors to name a few. And the Innovation Team helps to
make it easier for teams to adopt things early. What are some of the motivations that
have worked for you? Bill Marsh is certainly motivating; he is an inspirational leader. Also
finding and working with people around the organization that are kindred spirits—those
willing to put themselves out there to take risks.
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This is a great story to highlight as the underlying technologies are “mature,” in the market place,
and implemented across the country. The story is a long one, spanning 20 years, and it
embodies success and failure of this critical life saving integration of a dumb device with a
knowledge database of drugs and institutional guidelines within the context of a clinical diagnosis
to minimize drug errors in acute care settings. Implementation can drive innovation which in term
accelerates implementation….as the “inventors” are the users. The story highlights the fact that
in ideal projects, innovation is best done with implementation in mind.
1) Where does innovation occur? It occurs all over an organization, in all corners of the
clinical environment. Basically, health care providers see unmet needs, come close to or
make critical mistakes in caring for patients. This drives them to seek to correct the
systems that contributed to the errors. “Years ago, an anesthesia resident was caring for
a newborn baby with congenital heart disease who needed a precise intravenous infusion
of a powerful drug to dilate the blood vessels prior to surgery. After the infusion was
started, the baby remained inadequately oxygenated. Eventually the clinicians
discovered that an error in the complex dose calculations had led to a serious
underdosing of the critical drug. This sentinel experience resulted in a personal resolve
by the anesthesiologist to devote significant energy to addressing patient safety.” Out of
that vision, a multifunctional team was formed at MGH to study the problem. They
concluded that there were two deficiencies:
1)There were inadequate systems to disseminate intravenous drug knowledge to
physicians and nurses at the exact moment of need and
2)We had inadequate systems to ensure that the right drug and the right drug dosing at
the time of bedside administration.
The team concluded that both problems could be substantially resolved with a single
technological solution, along with associated care-process changes. This insight led to
the conception and implementation of “smart” infusion pumps with “onboard drug
libraries.”
Translating innovation into eventual implementation takes a “village”. At Partners, the
Corporate Sponsored Research program and CIMIT can provide such a village
environment to help technologies traverse the rocky shoals of development,
commercialization and implementation.
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5) What are the metrics of success? There are really milestones to success with this
project. First came the vision of solving the bedside drug errors. Then came the
invention of the smart pump with a drug calculator and guidance by user defined “guard
rails” to reduce or eliminate the dose errors. Next came coupling automated drug
recognition (through RFID or barcode) to prevent harm. Finally, the holy grail will be to
incorporate the vital signs of the patient with the EMR and other data systems to provide
an end to end solution. Success is in sight but not achieved yet.
7) Is there something unique to your organization that makes implementation easier than
elsewhere? Yes, at the highest levels, Partners is seeking to do the right thing first and
figure out how to get reimbursed later. As a top strategic direction, Partners has set it’s
vision on High Performance Medicine. Through the promise of improving the quality of
healthcare delivery, it will make safety a profit center at some point in the future. This
requires the lofty but comprehensive vision of integration of all of the safety initiatives
such as Smart Pumps, CPOE, eMAR, Auto ID, IT across all affiliates and information
systems into one focus. Funding will ultimately come from the revenues conserved by
reducing patient errors.
The ILN is in a unique position to advance the thinking and sharing so that many healthcare
systems can accelerate their thinking to comprehensive solutions. The Smart Pump story is an
excellent case study with considerable information available to all who request it.
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a. If a separate group exists, how large is it, how is it funded and what is their
charter?
i. Garfield Center – 2 FTE funded jointly by IT, Facilities and Patient Care
Services
ii. Innovation consultancy – 3 FTE funded by Health Plan and Operations
iii. Regional and Medical Center groups – varied
How does its work get implemented and by whom? That is very good question.
Handing off evidence-based innovation to a team that can implement is an area
that KP (and many other organizations) is struggling with. The current model
seems to be that teams that innovate also implement. Organizationally, we know
that it’s not ideal, however the plus side of this is that there is consistency in
terms of who is “running” the project. One model that KP is experimenting with is
having a “transition team”, where members of an implementation team would join
the Innovation Team during the last round of testing so that they become
embedded with the content and can easily move into implementation. We say
“experiment” because we will test this model in 2007.
2) Specific Example of Success: Across your entire organization what is a good example of
a recent successful implementation of a new technology or a significant process
improvement across a large percentage of your organization (an example might be
EMR)? Be prepared to talk in some detail about how the implementation was planned
and staged as well as the results. A good example is definitely Nurse Knowledge
Exchange (NKE). It was planned using the IHI Rapid Scale-up methodology, being
staged geographically and by time. We let each hospital region decide their approach,
and asked them to plan not more than three waves to complete the hospitals that joined
the collaborative. We will be implemented in twenty-one hospitals by 12/2006 and the
remaining ten in 2007 (See Virtual Friday presentation on KP NKE).
3) Specific Example of Failure: Across your entire organization what is a good example of a
recent failed implementation of a new technology or a significant process improvement
that was attempted across a large percentage of your organization? Be prepared to talk
in some detail about how the implementation was planned and staged as well as the
results. Were you able to understand why it failed? Please give the details. I’ll approach
this question from a different perspective. NKE is made up of four components, one
being Bedside Rounds. During the first wave of implementation we noticed that the
Bedside Rounds were not being done across the system, and the other three
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components were. We were puzzled. As we began getting data from the twenty-one
hospitals and antidotal evidence, it became clear that we had two major barriers to
overcome. The first being HIPAA. Many nurses were confused about what they could
say at bedside in front of the family or another patient. The second issue was that many
nurses had “stage fright”; being uncomfortable talking in front of the patient with another
nurse. With these two issues, we saw failure of this component across the system.
However our process metrics triggered us to look deeper, and by uncovering the
“barriers” we were able to target KP-wide interventions to push this initial failure into
success. One of the major infrastructure insights from this experience was learning how
to tap into the awesome resources at the local level. Nurse educators became our “best
friends” for simulating Bedside Rounds with the nurses. This is something that we never
considered in the innovation phase of the work, but was integral for a rapid scale-up.
4) Training (how, who and what worked and didn’t): Is the training included in the
implementation plan? Who owns the training and how much of the total effort (time and
budget) is devoted to training? What are the tools that you have used successfully and
unsuccessfully? Please detail why some worked and others did not. For NKE, we
developed a change package that included customizable training materials. Actual
training was done by and at the local medical centers. To deliver content to a broad
audience (all twenty-one hospitals) we used webcasting as our main mechanism.
5) What are your metrics for success? This varies project to project, however the dream
metric and also the most difficult is ROI. We’d love to able to standardize ROI, and I can
see that this may be a goal for 2007. Currently we rely on process metrics to at least
help us know we are going in the “right direction”. The process metrics are chosen by
doing a chain analysis from the outcomes we are trying to achieve. What are the criteria
that are used to select what technologies to implement and how to measure success?
Again, this varies by project. For example, for NKE, the prototype metrics indicated a
major improvement, and therefore we received the green light to move forward.
6) What are some of the key barriers to successful implementation and how did you
overcome them? For NKE, it was getting leadership to clearly understand its role in
implementation. Some leaders are much more hands on, and the typical result of this
approach was success. The hands-off leadership was a more difficult challenge. I’m not
sure we overcame that one, however we attempted to by creating a communication time
line that leaders could use to guide their actions across time. We’ve had some mild
success with this approach.
7) Is there anything that is really unique to your organization that makes implementation
either easier or harder than elsewhere? Please provide details. Implementation at Kaiser
Permanente is much harder. We have an extremely distributed power structure with the
local facilities being nearly as or stronger than the region and the region as strong as or
stronger than national operations. We have a tri-leadership with the health plan,
physician group and labor groups equally having a say in how to do work. Therefore it’s
imperative to have strong agreement across these entities. But there is a huge benefit in
this structure as well, mainly that when you get agreement it is very powerful. Are you
able to provide incentives to early and easy adoption? Formally, no; however, we’ve
always paid special attention to early adopters by highlighting their work. For example in
NKE, we always “storytell” that Baldwin Park, Moanalua, and South Sacramento were
early innovators and adopters. Additionally its beneficial for our early adopters as they get
more say in the design of solutions. What are some of the motivations that have worked
for you? The motivations that have worked best for me is knowing that we are on the
cutting edge of design, and being recognized for it. Having the Institute for Healthcare
Improvement and Wall Street Journal recognize your work is very, very motivating!
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Within the Institution at this time, a variety of efforts are underway to stimulate and foster
innovation. Groups working in this arena tend to be housed in local business units thus
funding comes from operational budgets. A unifying institutional infrastructure is being
developed to aid these current efforts and drive diffusion. Innovation efforts are guided
by the common notion of creating new value for patients.
2) Specific Example of Success: The project in question focused on improving the summary
visit process, which in simple terms is the concluding experience for patients as they
prepare to return to their home environment. Nine insights/recommendations were
derived primarily from ethnographic research and rapid prototyping in real time patient
care episodes and these findings were formally presented to departmental project
sponsors.
As of this writing, a guiding document that contains six elements culled from the
aforementioned design process is close to becoming a reality. The MD sponsor of the
project has been pursuing approvals for the past four months, which is a rather quick
period of time in our environment. Based on feedback and observation during the design
phase, it is believed that virtually no training for users will be required.
In this case, implementation is the responsibility of those who created the project and
asked the question. The design team considers implementation throughout the process
by maintaining a primary focus on the human aspect of the desired/intended change and
design principles and criteria at the conclusion of the project in essence provides a
blueprint for a solution(s) and the required change process to the sponsor. The sponsor
then must engage in the process of making change happen through our committee based
environment.
3) Specific Example of Failure: Due to the new and unique manner by which her team
works, the individual I interviewed chooses to see lack of implementation as a joint
inability to share and apply micro-learning to larger systems.
This individual indicates that as their program and methodology have grown and matured
it is becoming easier to engage the larger system in the necessary conversations for both
re-imagining a complex system and developing the capacity to act on both short and long
term projects that will flow from that disciplined human research oriented process.
4) Training (how, who and what worked and didn’t): With respect to the project being
focused on in this case study, no training was needed. The research and rapid
prototyping process led to the creation of a tool that worked effectively for patients and
clinicians. The tool in essence is an enabler of an existing work task so adoption and use
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5) Metrics for Success: The primary measure of success here is the ability to set a big
picture vision for how a system or experience could be re-designed/re-imagined. The
value of the meta-vision is the creation of concepts that can then become the focus of/for
further ideation, development and implementation. The vision would be composed of
design principles and criteria, which ought to strongly inform implementation.
6) What are some of the key barriers to successful implementation and how did you
overcome them? First is an inability to prioritize which systems and experiences need to
be redesigned. Secondly, implementation and the rigorous activity of navigating through
the committee structure is a secondary duty for MD’s.
7) Is there anything that is really unique to your organization that makes implementation
either easier or harder than elsewhere? The operating principles of our robust and time-
consuming decision-making process generally results in highly effective and rapid
implementation of solutions. A decision to implement means that critical mass has been
achieved in a way that guarantees resources and leadership for implementation to be
successful.
Another critical variable that cannot be overlooked is our patient centered approach to all
things. This focus allows for solutions to be implemented that usually create value for
them first which eases acceptance and adoption by staff.
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Taken from Kaiser’s Virtual Friday presentation on the Diffusion of the Nurse Knowledge
Exchange (NKE) practice.
Project Attributes
1. Trialability
• Use of rapid cycle PDSA (Plan-Do-Study-Act) is empowering and allows for
learning through trial and error
• Can test and implement in any order
• Adaptable to any unit
2. Complexity
Although the NKE change package was simple in description…
• Language was difficult
• Front line staff don’t use tools
• “NiKE: Just Do It”
Social System
• Project lead is socially networked and respected
• Nurse champions spread to other nurses
• Communication plan
• Executive sponsor works closely with project lead
Leadership
• Engaged facilitative executive sponsor
• Project lead attributes:
– Passion
– Excellent communicator
– Organized
– Able to access flex resources
– Use measurement to tell the story
Organizational System
• NKE is aligned with organizational goals
• Structure “mirrors” the National collaborative structure
• Use networks and champions to spread
• Provides formal education and freedom to “test” implementation and share
success
Collaborative Structure
• Face to face sharing and networking
• Project lead calls
• Coaching for project lead and hospital teams
• Process metrics
• Extranet to post tools
Spread model
• Know where you will spread to
• Multiplicative spread
• Use of pilot units
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Dear Participant:
We invite you to participate in creating a Smart Network Map. The map is a visual representation of the social network that is emerging from
Innovation Learning Network (ILN) interactions. Everyone that has participated or touched the ILN, however briefly, has been invited to participate.
We will be collecting data to form these maps via an online survey. Your input to this survey is critical to successful map creation.
We will use the maps to deepen our understanding of how innovations spread through social networks and to strengthen relationships among ILN
members with an eye toward spreading innovations among ILN members.
Together, we plan to use and interpret the maps on our September monthly member web-call 9-28-06 and during our Design-For-Diffusion
meeting in California.
Please follow the link below to complete the survey - It should take no more than 10 minutes to complete. Please respond no later than September
15th so we have time to prepare the network maps.
Sincerely,
Chris McCarthy & Maggie Hentschel
Questions:
1. Prior to the start of the ILN, who did you work with or exchange information on a project, topic or shared interest?
2. Since the ILN started, with whom have you shared ideas or worked on projects that were catalyzed by your ILN interactions?
3. Who has inspired you or given you new ideas since the ILN began?
4. Who would you like to work with over the coming year on an ILN-inspired project or topic?
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Summary of Results
Smart Network Map 1
Prior to the start of the ILN, who did you work with or exchange information on a project, topic or shared interest?
Before March 2006
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Since the ILN started, with whom have you shared ideas or worked on projects that were catalyzed by your ILN interactions?
As of September 2006
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Since the ILN started, with whom have you shared ideas or worked on projects that were catalyzed by your ILN interactions?
As of 2007
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Who would you like to work with over the coming year on an ILN-inspired project or topic?
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Presentation of Findings:
Notes from Social Network Maps discussions, October 19-20 Meeting (based on September 2006 Maps)
Four Smart Network maps for the ILN were reviewed and discussed in detail.
Three layers of meaning or story were explored: individual, organizational and cross-organizational. Metrics of network dynamics include:
• Awareness (how likely is it that you know what is going on around the network... 2 or 3 degrees out)
• Connectors (how connected are you to others that are connected)
• Influence (who goes to whom for expertise or inspiration)
• Integration (in the thick of things)
• Resilience (what happens when people leave the network)
The progression toward a "smart" network -- a tight or dense core with a loose or diverse periphery -- was noted by group members.
Conversation centered around actions -- informed by the mapping -- than can help spread innovation. Practices included:
• Closing triangles (introducing people that are currently not connected but should be)
• Connect or try to influence the influencers
• Engage the community in connecting to more of itself via building awareness or collective mindfulness
• Bring people from the periphery into the specific innovation efforts
• Focus mapping activities on strategic initiatives (e.g., diabetes care), using them to build generative relationships within and across
local/regional communities of practice
Group members were considering applications to many activities including ILN projects.
Note from a participant: Each graph is in response to one question so if you are doing this in your organization, getting the question(s) right is key.
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Building Smart Communities through Network Weaving
by Valdis Krebs and June Holley
Improved connectivity starts with a map – knowing the complex human system you are
embedded in. The Appalachian Center for Economic Networks [ACEnet], a regional economic
development organization in Athens, Ohio has long followed the connectivity mantra – create
effective networks for individual, group and regional growth and vitality. Recently ACEnet has
begun to map and measure the social and economic connections it helped create in the grassroots
ACEnet, founded in 1985, provides a wide range of assistance to food, wood and technology
entrepreneurs in 29 counties of Appalachian Ohio. This region has some of the highest poverty and
unemployment rates in the country, and ACEnet works with communities throughout the region who
want to improve their support for entrepreneurs as a means to provide more local ownership and higher
quality jobs.
Network maps provide a revealing snapshot of a business ecosystem at a particular point in time.
These maps can help answer many key questions in the community building process.
• Are the right connections in place? Are any key connections missing?
• Who are playing leadership roles in the community? Who is not, but should be?
• Who are the mentors that others seek out for advice?
• Who are the innovators? Are ideas shared and acted upon?
• Which businesses will provide a better return on investment – both for themselves and
These are all important questions that ACEnet wants to answer so that they can help build a more
Before you can improve your network you need to know where you are currently – the ‘as is’
picture. A network map shows the nodes and links in the network. Nodes can be people, groups
or organizations. Links can show relationships, flows, or transactions. A link can be directional.
A network map is an excellent tool for visually tracking your ties and designing strategies to
create new connections. A network map is an excellent tool for visually tracking your ties and
designing strategies to create new connections. Network maps are also excellent ‘talking
Transformation that leads to healthy communities is the result of many collaborations among
network members. Scientists describe this phenomenon – where local interactions lead to global
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-8
patterns – as emergence. We can guide emergence by understanding, and catalyzing,
connections. For example, knowing where the connections are, and are not, allows a community
networks where key nodes play an important role in what flows throughout the network.
Influencing a small number of well-connected nodes often results in better outcomes than trying
to access the top person or calling on random players in the policy network. If you know the
Recently ACEnet Food Ventures staff asked area entrepreneurs and organizations, “From whom do you
get new ideas that benefit your work?” “From whom do you access expertise that improves your
operations?” and “With whom do you collaborate?” The answers to these questions were mapped using
Valdis Krebs’ InFLOW™ social network mapping software into an Innovation Network, an Expertise
Network, and a Collaboration Network. Analyzing these networks led the team to realize that there were
several entrepreneurs who played a critical role in the food sector, but with whom they had little
relationship. The team developed a strategy for more explicitly working with these entrepreneurs, by
asking them to conduct workshops for other entrepreneurs and finding out their needs for business
assistance.
What does a vibrant, effective community network look like? Research has been done to
management consultants have all discovered similar answers about effective networks. The
amazing discovery is that people in organizations, routers on the internet, cells in a nervous
system, molecules in protein interactions, animals in an ecosystem, and pages on the WWW are
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-9
Five general patterns are observed in all effective networks:
1. Birds of a feather flock together: nodes link together because of common attributes, goals
or governance.
2. At the same time diversity is important. Though clusters form around common attributes
and goals, vibrant networks maintain connections to diverse nodes and clusters. A
diversity of connections is required to maximize innovation in the network.
3. Robust networks have several paths between any two nodes. If several nodes or links are
damaged or removed, other pathways exist for uninterrupted information flow between the
remaining nodes.
4. Some nodes are more prominent than others – they are either hubs1, brokers2, or boundary
spanners3. They are critical to network health.
5. Most nodes in the network are connected by an indirect link in the network. A-B-C-D
shows a direct link between A and B, but indirect links between A and C and A and D.
Yet, the average path length in the network tends to be short. There are very few long
paths in the network that lead to delay and distortion of information flow and knowledge
exchange.
Even though we know several keys to building effective networks, this knowledge is rarely put
to use. Networks, whether social or business, are usually left to grow without a plan. When left
This results in many small and dense clusters with little or no diversity. Everyone in the cluster
knows what everyone else knows and no one knows what is going on in other clusters. The lack
of outside information, and dense cohesion within the network, removes all possibility for new
ideas and innovations. We see this in isolated rural communities that are resistant to change, or
1
Nodes with many direct connections that quickly disperse information.
2
Nodes that connect otherwise disconnected parts of the network – they act as liaisons.
3
Nodes that connect two or more clusters – they act as bridges between groups.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-10
in a classic “old boy network”. Yet, the dense connections, and high degree of commonality
forms good work groups – clusters of people who can work together smoothly.
Instead of allowing networks to evolve without direction, successful individuals, groups and
organizations have found that it pays to actively manage your network. Using the latest research
we can now knit networks to create productive individuals and smart communities.
A vibrant community network is generally built in 4 phases, each with it’s own distinct topology.
Each phase builds a more adaptive and resilient network structure than the prior phase. Network
mapping can be used to track your progress through these four stages.
1) Scattered Fragments
2) Single Hub-and-Spoke
3) Multi-Hub Small-World Network
4) Core/Periphery
Experience shows that most communities start as small emergent clusters organized around
common interests or goals. Usually these clusters are isolated from each other. They are very
small groups of 1-5 people or organizations that have connected out of necessity, see Figure 1. If
these fragments do not organize further, the community structure remains weak and under-
producing.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-11
Figure 1 – Scattered Fragments
Without active leaders who takes responsibility for building a network, spontaneous connections
between groups emerge very slowly, or not at all. We call this active leader a network weaver.
Instead of allowing these fragments to drift in the hope of making a lucky connection, network
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-12
Network weavers4 begin with a hub and spoke network, with the weaver as the hub. The weaver
has the vision, the energy, and the social skills to connect to diverse individuals and groups and
start information flowing to and from them. The weavers usually have external links outside of
the community to bring in information and ideas. This is a critical phase for community building
because everything depends on a weaver who is the hub in the network. However, if multiple
weavers are working in the same community, we may get multiple hub and spoke networks, with
some overlap between them. Figure 2 shows a weaver connecting the previously scattered
clusters.
4
While the Athens food network focused on one network weaving organization – ACEnet, there were actually several individual
network weavers within ACEnet. Each network weaver within ACEnet had a particular focus. They all worked together from a
common vision. If several network weavers are present and willing to collaborate, increased progress is possible.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-13
Initially a network weaver forms relationships with each of the small clusters. During this phase
a weaver is learning about each individual or small cluster – discovering what they know and
what they need. However, the hub-and-spoke model is only a temporary step in community
growth. It should not be utilized for long because it concentrates both power and vulnerability in
one node – the hub. If the weaver fails or leaves then we are back to a fragmented community.
In healthy networks, the spokes of the hub do not remain separated for long. The weaver begins
connecting those individuals and clusters who can collaborate or assist one another in some way.
Concurrently the weaver begins encouraging others to begin weaving the network as well. Even
though it is a temporary structure, the hub-and-spoke model is usually the best topology to bring
An organization with a vision, and contacts to external ideas and resources, can play the role of
the hub. This is the role ACEnet took up when it saw that SE Ohio was home to many small,
uncoordinated food clusters. There was the Farmer’s Market crowd, the natural bakery, a
worker-owned Mexican restaurant and a few other entrepreneurs creating unique food products.
ACEnet brought all of these unconnected groups together around a kitchen incubator – a state of
the art facility for preparing and packaging a large variety of food items.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-14
When ACEnet decided to build a Kitchen Incubator—a licensed processing facility where
entrepreneurs could rent the use of ovens, stoves and a processing line to produce their
products—they used the need to design the incubator as an opportunity to link small clusters.
For example, for one design session they brought people from the town’s restaurants together
with small farmers who wanted to turn their produce into value-added products. Farmers were
able to learn about food production safety from the restaurateurs who explained how these
procedures could be incorporated into the incubator. Some of the farmers also used the
opportunity to sell their produce to the restaurants, who were always on the lookout for unique
raw materials. And, an unexpected bonus was that the restaurants realized that they could use
the Kitchen Incubator’s storage warehouse for large orders they made from their suppliers, and
as a result became an important part of the network.
As the weaver connects to many groups, information is soon flowing into the weaver about each
group’s skills, goals, successes and failures. An astute weaver can now start to introduce clusters
connect, their spokes to the hub can weaken, freeing up the weaver to attach to new groups.
Although the spoke links weaken, they never disappear – they remain weaker, dormant ties, able
must teach others how to weave their own network. Training in network building is important at
this juncture. Network mapping reveals the progress and identifies emerging network weavers.
This happened with ACEnet as several of the businesses and small non-profits began to
build their own local connected clusters. As the overall network grows, the role of the weaver
changes from being the central weaver, to being a facilitator of network weaving in the
There are two parts to network weaving. One is relationship building, particularly across
traditional divides, so that people have access to innovation and important information. The
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-15
second is learning how to facilitate collaborations for mutual benefit. Collaborations can vary
from simple and short term—entrepreneurs purchasing supplies together—to complex and long-
collaboration creates a state of emergence, where the outcome—a healthy community—is more
than the sum of the many collaborations. The local interactions create a global outcome that no
Network weaving is not just “networking”, nor schmoozing. Weaving brings people together for
projects, initially small, so they can learn to collaborate. Through that collaboration they
strengthen the community and increase the knowledge available in it. After working with the
ACEnet’s larger successes fall under the two top levels [6 & 7] of Ricchiuto’s Pyramid5.
Level Activity
7 Introducing A to B in person and offering a collaboration opportunity to get A
and B off to a successful partnership
6 Introducing A to B in person and following up with A and B to nurture
connection
5 Introducing A to B in person
4 Introducing A to B in a conference call
3 Introducing A to B in an email
2 Suggesting A talk to B and calling B to look for a contact
1 Suggesting to A that A should talk to B
5
http://www.jackzen.com/archives/2006/01/the_7_circles_o.html
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-16
This transition from network weaver to network facilitator is critical. The weaver is identifying
and mentoring new weavers who will eventually take over much of the network building and
maintenance. If the change is not made then the community network remains dependent on the
central weaver and his/her organization. At the transition point the weaver changes from being a
direct leader to an indirect leader, influencing new emergent leaders appearing throughout the
community. This transition is necessary for the network to increase its scale, impact and reach.
Moving from a single hub/weaver network to a multiple hub/weaver network has many
failure. ACEnet is still a dominant hub in SE Ohio, and its failure would affect the region greatly
– but not as significantly as five years ago when the network was sparser and more dependent on
ACEnet. Now ACEnet has the luxury of spending time in new pursuits such as teaching others
to knit their nets and expanding the network to other areas inside and outside of Appalachia.
As the weaver connects various individuals, organizations and clusters, these entities connect to
each other loosely. A new dynamic is revealed here – the strength of ‘weak ties’6. Weak ties are
connections that are not as frequent, intense, as strong network ties that form the backbone of a
network. Strong ties are usually found within a network cluster, while weak ties are found
between clusters. As clusters begin to connect to each other, the first bridging links are usually
weak ties. Over time weak ties may retain their structure by bridging separate clusters or they
may grow in to become strong ties binding previously separate groups into a new larger cluster.
6
Mark Granovetter
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-17
Bridging ties between clusters are also important in innovation. New ideas are often discovered
outside the local domain. To get transformative ideas you often have go outside of your group.
A successful formula for creating ties for innovation is to find other groups that are both similar
and different than your own. Similarity helps build trust, while diversity introduces new ideas
and perspectives. Connect on your similarity, and profit from your diversity.
To bring in new ideas from outside the region, ACEnet has developed several “innovation
learning clusters” that bring together leading edge organizations from around the country who
share their innovations with each other. ACEnet staff who participate then bring information
about those innovations back to the region and adapt them to the local environment. For
example, Larry Fisher, one of ACEnet Directors, participates in a rural entrepreneurship policy
cluster where he learned the basics of building a policy network from organizations with many
years’ experience. He is now leading ACEnet’s efforts to change the policy of local counties so
that it is more supportive of entrepreneurship, but he can move forward with a more sure hand
since he is building on the experience of others—and can contact them when he has questions.
Now that other hubs [network weavers] are emerging in the network, the various weavers begin
to connect to each other, creating a multi-hub community. Not only is this network topology less
fragile, it is also the best design to minimize the average path length throughout the network –
remember, the shorter the hops the better for work flow, information exchange and knowledge
sharing! Information percolates most quickly through a network where the best connected nodes
Figure 3 shows a multi-hub small-world network. Here four clusters [designated by the thick red
links] have created many weak ties [gray links] to each other. The weak ties may, or may not,
strengthen to create one tightly coupled larger cluster. The multiple hubs can be small
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-18
Initially, the ACEnet Kitchen Incubator was a major gathering place, a physical network hub,
where people ran into each other, hung around to talk, and often cooked up some kind of deal:
joint orders of jars so they could get a cheaper price, an arrangement to jointly market their
products, or an agreement to trade labor on a project.
However, after a few years, many other network hubs popped up. For example, the Athens
Farmers’ Market hosted more than 90 farmers and local food vendors who networked with each
other and their avid customers. Several years ago, 4 local organizations set up a Farmers’
Market Café that provides tables and chairs under tents so that people could hang around longer
and network with more neighbors.
Casa Nueva, a worker-owned Mexican restaurant, is not only a networking hub, but has played a
major role in organizing most of the locally owned restaurants into the Athens Independent
Restaurant Association which donates money each month to community non-profits and is
increasing the amount of area restaurants purchase from local farm families.
Six miles outside town, more than 200 people flock on Saturdays to enjoy fresh baked focaccia,
pastries and hearth bread on the outdoor terrace outside the Big Chimney Bakery. The
proprietor is a major network hub himself, who helps new entrepreneurs develop their recipes
and learn strategy from a pro.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-19
Figure 3 – Multi-Hub Small World Network
The next step is to strengthen the appropriate loose ties in the network so they become strong
ties. This happens after turf issues have been handled. A multi-hub network may be difficult to
achieve if political and ‘turf’ issues are raging through the network. If two or more community
development organizations start battling over turf and control of the community then the result
may be two or more competing, single hub networks that ignore the larger community needs and
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-20
The end-goal for vibrant, sustainable community networks is the core/periphery model.
This topology emerges after many years of network weaving by multiple hubs. It is a stable
structure that can link to other well-developed networks in other regions. The network core in
this model contains the key community members, including many who are network weavers, and
have developed strong ties between themselves. The periphery of this network contains three
groups of nodes that are usually tied to the core through looser ties:
3) Unique resources that operate outside of the community, and may span many communities
The economic landscape is full of imperfectly shared ideas and information. The periphery allows
us to reach ideas and information not currently prevalent in our network. The core allows us to act
on those ideas and information. The periphery is the open, porous boundary of the community
network. It is where new members/ideas come and go. The periphery monitors the environment,
ACEnet has helped form the Appalachian Ohio Regional Investment Coalition (AORIC) which
includes another community organization, a regional foundation, the Ohio Arts Council, and an
Ohio University based institute. AORIC is now mobilizing a large network of organizations
interested in supporting entrepreneurs as a way to create a healthier regional economy. This
network is reaching deep into communities to identify barriers entrepreneurs face, and then
collaborating on projects that will develop new supportive infrastructure to increase their
success.
7
Influenced by the research and analysis of Ronald S. Burt.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-21
Figure 4 – Core/Periphery Network
Figure 4 shows a well developed core/periphery structure. The blue nodes are the core, while the
green nodes reside in the periphery. This network core is very dense8 -- not all cores will have as
high a concentration of connections as this one. Too much density can lead to rigidity and and
8
Network density is calculated by the number of existing connections as a percentage of the total possible. Any density greater
than 50% is very high.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-22
overload of activity. Monitoring your network using social network analysis can help you see
where your network needs to shift connections to match the current environment.
At this point the network weavers’ initial task are mostly completed. Now, attention turns
toward network maintenance and building bridges to other networks. The network weavers can
begin to form inter-regional alliances to create new products, services and markets—or to shape
and influence policy that will strengthen the community or region. This happens by connecting
network cores to each other utilizing their peripheries. The network weaver maximizes the reach
of the periphery into new areas, while keeping the core strong. The weavers now focuses on
multi-core projects of large substance that will have major impact on the community.
Conclusion
As we have seen weaving a network requires two iterative and continuous steps:
1. Know the network – take regular x-rays of your network and evaluate your progress.
2. Knit the network – follow the four (4) phase network knitting process.
All throughout this process network maps guide the way – they reveal what we know about the
network and they uncover possible next steps for the weaver.
Starting with a disconnected community, network builders can start weaving together the
necessary skills and resources to build simple single hub networks. This will be followed by a
more robust multi-hub network, concluding with a resilient core/periphery structure – maximized
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-23
Valdis Krebs is a organizational consultant and the developer of InFLOW software.
www.orgnet.com
valdis@orgnet.com
June Holley is founder and President/CEO of the Appalachian Center for Economic Networks.
www.acenetworks.org
juneh@acenetworks.org
June and Valdis and Jack have created a training seminar for Network
Weavers, please contact either one of them for further information.
Building Smart Communities through Network Weaving © 2002-2006 Valdis Krebs and June Holley Page B-24
Innovation Learning Network 2006
The ILN utilizes web conferencing to enable members at a variety of locations to interact and
collaborate in real-time. Virtual Fridays are web conferences where members view and share
presentations, documents, or web pages on their computer while simultaneously dialing in to a
teleconference over the phone. There are various technologies available to conduct web-based
teleconferences, including: WebEx, Qwest, Raindance, MeetingOne, and many others. These
vary significantly in price and available features.
Suggested Roles:
Process:
Step 2: Coordinator communicates event details to participants. (i.e. date, time, dial-in number,
web conference address, login and password or meeting number…how to join will vary
depending on what web-conferencing technology is used).
Step 3: Prior to meeting date, coordinator and presenter perform a “test run” of logging into web
conferencing to ensure their computers are set up and to avoid any technical difficulties prior to
web meeting.
Step 4: Coordinator sends out a reminder to participants (a few days in advance of event date),
including an Adobe PDF version of the presentation for those that will not be able to join the web
portion of the call. Reminder should also provide tips or recommendations for joining meeting.
Tip: Coordinator should encourage presenter and participants to join web conference ten
minutes prior to start time. This ensures participants are able to fix any technical
difficulties they might encounter prior to start of presentation, and generally ensures the
web-conference can begin on time.
Step 6: Coordinator should start meeting at least 20 minutes in advance to allow ample time for
presenter and participants to join.
Step 8: Coordinator makes presentation recording available online for those members who were
unavailable during the call.
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Innovation Learning Network 2006
My HealtheVet
Department of Veterans Affairs - Ginger Price (ginger.price@va.gov)
My HealtheVet is an electronically based personal health record that the VA is currently piloting
testing. This Virtual Friday describes the creation of My HealtheVet, including the technology the
VA used, the patient base served, regulatory barriers they faced, and how they built the
technology to serve both providers and patients.
Human-Centered Design
IDEO - Ilya Prokopoff (iprokopoff@ideo.com)
IDEO is a company that provides consulting services to help organizations rethink attitudes about
innovation and prioritize the experience of end-users in order to create value. In this Virtual
Friday, IDEO presents their philosophy of innovation. This also marked the first Virtual Friday
presented by a non-ILN member organization.
st
21 Century Care
Kaiser Permanente - Hannah King (hannah.king@kp.org) and Ruth Brentari
(ruth.brentari@kp.org)
Kaiser’s 21st Century Care project was designed to re-envision the function of primary care
teams. This Virtual Friday describes the goals of the 21st Century Care project, the four major
changes envisioned, and some of the emerging results.
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Innovation Learning Network 2006
Diffusion
Kaiser Permanente – Kristene Cristobal (kristene.cristobal@kp.org) and Lisa Schilling
(Lisa.schilling@kp.org)
This Virtual Friday revisits Kaiser’s Nurse Knowledge Exchange program to examine the rapid
scale-up process in greater depth. The presenters describe their process of spread and some of
the lessons learned.
IS Innovation Program
Partners HealthCare/Massachusetts General Hospital – Jim Noga (jnoga@partners.org)
Partners HealthCare runs an Innovation Program, in which selected employees spend half of
their time working in teams to come up with an innovative solution to an organizational problem.
This Virtual Friday describes the selection criteria used, initial results, and program logistics.
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Innovation Learning Network 2006
• ILN Overview
o Participating Organizations
• Virtual Friday Archives (link to wiki)
• Resources
o Articles and Recommended Reading
o ILN member survey results
o April ILN Cambridge, MA Meeting 2006
Presentations:
Overview of CIMIT: Clinical Innovation Labs
OR of the Future Part 1 - Warren Sandberg MD, PhD
OR of the Future Part 2 - Warren Sandberg MD, PhD
Medical Device Interoperability Plug-n-Play - Julian Goldman MD
Ambulatory Practice of the Future - Susan Edgman-Levitan
Connected Health Initiative - Penny Ford Carleton RN
• Member Directory
• Event Calendar
o Event list
• Message Board
o ILN April Open Space Discussions
Accelerating Education and Implementation of Innovation - Capturing
Best Practices and Diffusion
Innovative work environments and innovation labs
Patient Experience
Open Innovation
Virtual Collaboration Processes and Tools
Liberating Structures
Making meaningful changes in organizations
Healthcare Reform based on Quality
The Link Between Accelerating Change and the Use of Incentives
o Innovation Articles and Case Studies
o Website Feedback
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Innovation Learning Network 2006
• Front Page
• Monthly ILN Archives
• Virtual Friday Archives
• Building Smart Networks
o Social Networking Tools
• Design For Diffusion Conference
o Design For Diffusion Games Plans
Collaboration and Utilization of Innovation Labs Within ILN
ILN 2007 Information
• ILN 2007 Member Organization Status
Personal Health Records Game Plan
• Personal Portable Health Records
• Personal Health Records Resources
• Personal Health Records survey
Virtual Simulations plan
• Second Life
o Design For Diffusion Report Outs
Allowing Space for Play in Innovation and Relaxing Control
Creating Internal Structures of Diffusion and Learning
Creative Communication - Of Large Scale Plans
Culture Change for Innovation
Effective Collaborative Design
Effective Engagement of Customers in the Design-Innovation Process
Enabler - How to Drive An Innovation into Action
External Diffusion
Funding Strategies for Innovation
Healthcare Beyond the Institutional Walls
ILN 2007
Patient Driven Care Design
Personal Electronic Health Records
Physician in Change Process
Report on Innovation
ROI on Innovation
Social Network Mapping #1
Social Network Mapping #2
Staff as Customer and Engaging Staff
Virtual Simulations
o Design For Diffusion Conference Pre-Reading
o Design For Diffusion Panel Bios
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Innovation Learning Network 2006
Screen Shots
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Innovation Learning Network 2006
Robin Boyar is the Senior Director of Research at Electronic Arts, the world’s largest videogame
publisher. In her role, she leads consumer research supporting EA’s PC, console, handheld,
online, and mobile games. She and her team support the development of these products from pre
concept to post launch and use a wide range of methodologies ranging from standard focus
groups and surveys to more in depth ethnographic and lifestyle approaches.
Robin has over ten years research experience. She began her career as a researcher
specializing in education and technology, working for such companies as McGraw-Hill, PBS, and
various educational software companies. Previous to her role at Electronic Arts, she was
Manager of Consumer Insights at InsWeb.com, an online insurance company.
Since 2000 Jim has led craigslist to be the most used classifieds service in any medium, with
over 10 million new ads submitted each month, and one of world's most popular websites, with
over 5 billion page views per month, while maintaining its renowned public service mission,
unorthodox business philosophy, non-corporate vibe, and staff of twenty.
Jim formerly served as craigslist's lead programmer and CTO, contributing the site's multi-city
architecture, search engine, discussion forums, flagging system, self-posting process, homepage
design, personals categories, and best-of-craigslist.
Before joining craigslist, Jim directed web development for Creditland (defunct) and Quantum. In
1994-95, Jim built what may have been the world's largest website at the time, a terabyte-scale
database-driven public website for the Interuniversity Consortium for Political and Social
Research at the University of Michigan.
Jim graduated summa cum laude from Virginia Tech with a bachelors in biochemistry, and
studied medicine and classics at the University of Michigan.
Jim has been the subject of feature stories in New York Times, Wall Street Journal, Fortune,
Business Week, Telegraph, SF Chronicle, and many other publications. He has been interviewed
for dozens of television and radio programs, and is possibly the only American CEO ever
accused in major business periodicals of being anti-establishment, a communist, a socialist, and
an anarchist.
S. Joy Mountford has been designing interfaces for over twenty-five years, ranging from
applications on aircraft to personal computers to consumer devices. She has become an
internationally recognized leader in user-centered interaction design. She has led design efforts
creating interfaces to audio and visual devices, interfaces between the electronic world and
printed materials, and toys, as well as for interactive music creation and generation systems.
Joy most notably headed the Human Interface Group at Apple Computer for eight years and then
moved to Interval Research for five years. At Interval she led a series of innovative and influential
consumer music creation and jamming software and hardware devices for various consumer
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Innovation Learning Network 2006
products. After Interval she formed her own interaction design firm, idbias, working for a range of
clients to design, redesign, prototype, and evaluate interfaces to help people be more effective
with technology. Past clients encompassed a broad range of businesses, from banks, libraries
and music publishers, to the toy companies Lego and Mattel. In 1990 Joy pioneered forming the
Interface Design Project which sponsors interdisciplinary design at universities around the world,
continued to lead this effort for various sponsor companies and now has brought this to Yahoo!
which held their first successful Design Expo in Aug 2006.
Joy joined Yahoo! Research in Sept 2005, as a Distinguished Scientist and Senior Director in
User Experience and Design for products in the Communications, Communities and Front Doors
business areas. She has recently expanded her charter to start a design innovation studio for
Yahoo!. Her project interests center around building extensible and creative spaces such as
hotels using technology, and in creating wearable technology-aware ensembles. Joy is most
intrigued about how best to bring artists and scientists together to create usable and appealing
new 'tools'. She believes that this merger of disciplines working side by side is the best way to
encourage real innovations for consumers.
Sarah Snudden has worked on a variety of innovation, advertising and market research projects
in the Consumer Packaged Goods sector. Her projects include the Clorox Bleach Pen, Clorox
ToiletWand, Glad ForceFlex and Children's Instant Oatmeal. She has worked at Ecolab,
Pillsbury, Quaker and, for the past 5 years, Clorox. She has also worked in social marketing and
health advocacy on projects such as smoking cessation and drinking and driving.
Throughout all her ventures, Sarah essentially considers herself an "anthropologist and
sociological super-sleuth." In her spare time, Sarah works on documentary film projects and
enjoys cooking, entertaining and fixing up her old craftsman home.
Ron is Customer Vice President – Supply Chain for Kraft Foods, and leads Kraft’s Global Center
of Excellence for Supply Chain Innovation. Labeled ‘The Collaborator’ in the book The Ten Faces
of Innovation by IDEO General Manager Tom Kelley, in 2005 Ron was awarded the inaugural
Global Supply Chain Excellence Award by Kraft Foods for his work around customer
collaboration and innovation. In 2004, Ron’s led a Kraft project designed to bring product design
and innovation techniques to the Supply Chain process arena. This partnership project with
Safeway was the inaugural winner of the Grocery Manufacturers of America AMC CPG Award,
which honors innovation through creativity, product innovation, and industry collaboration.
Presently, Ron is involved in expanding Kraft’s use of the IDEO process to Kraft customers in
both the EU and Asia Pacific.
Ron is a graduate of the University of Massachusetts, and resides in Danville, California with his
wife Sue and four children.
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Innovation Learning Network 2006
It’s hard to innovate in health care because everyone asks what the ROI is. How do you
balance that with the need to explore?
• Yahoo: There’s no easy answer; it’s very difficult. Experience and faith.
o Be a better storyteller about design’s value. Speak your executives’ language.
• Kraft: Customer feedback gives you working capital. Make the customer your co-
designer.
• Clorox: Figure out how to make things speak to people.
• EA: You need to present your idea as sexy. Figure out what the story is, and then brand
it.
o Remember: we are not our user base!
We’re known as an industry that is local and based of problem-solvers – how to break
free?
• EA: Understand what makes your user group different, then adapt to that – cultural
relevance.
• Clorox: Figure out what delights your audience, and keep those ideas throughout your
day.
Our basic tools for marketing are surveys, focus groups – any other means of
engagement?
• EA: Greatest innovation: surveys that are online, multimedia.
• Yahoo: Ethnography/participatory design helps people participate.
• Clorox: Look at emotional reactions – very telling.
o Look at workarounds and processes because people won’t always tell you what
they want.
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Innovation Learning Network 2006
It takes curiosity to both nourish innovation and relax control –how to allow that to
happen?
• EA: Failure. It’s a wake-up call.
People are trying to bring consumers into health care decision processes more, but we
believe that people can’t understand it. How can we reach them?
• Yahoo: Different age groups use different types of media. How do we make more out of
that?
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Innovation Learning Network 2006
Day 1
Start Finish Duration Task Notes
15:00 16:00 1:00:00 Tour of Garfield Center for
panelists
16:00 18:00 2:00:00 Non-Health Care Industry Panel
on Innovation and Human
Experience
18:00 19:00 1:00:00 Reception
Day 2
Start Finish Duration Task Notes
8:00 8:20 0:20:00 Breakfast
8:20 8:30 0:10:00 Welcome
8:30 9:30 1:00:00 Tour of Garfield Center
9:30 9:45 0:15:00 Break
9:45 10:15 0:30:00 Open Space Technology Setup Activity: share stories of
successful diffusion
10:15 10:30 0:15:00 Open Space Agenda Creation
10:30 15:45 4:15:00 Open Space
15:45 16:30 0:45:00 Discussion Closedown Activity: Mad Tea Party
16:30 18:45 2:15:00 (travel to hotel, travel to harbor)
18:45 21:00 2:15:00 Dinner Cruise
Day 3
Start Finish Duration Task Notes
8:00 8:45 0:45:00 Breakfast and Morning
Announcements
8:45 12:00 3:15:00 Open Space (continued)
12:00 13:00 1:00:00 Lunch
13:00 13:15 0:15:00 Selection of Gameplan Groups
13:15 14:45 1:30:00 Action Planning with Gameplans
14:45 15:30 0:45:00 Review of Gameplans Activity: flocking exercise
15:30 16:00 0:30:00 Closing Session
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Innovation Learning Network 2006
Discussion groups
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Innovation Learning Network 2006
External Diffusion
VHA Foundation - Linda DeWolf (ldewolf@vha.com)
This group discussed strategies for diffusing innovations to other organizations. The group
discussed the difference between creating a common enemy vs. a common vision to galvanize a
group, and suggested that using public transparency and even embarrassment were effective at
pushing organizational change. The group also talked about communication strategies.
ILN 2007
Kaiser Permanente - Chris McCarthy (chris.mccarthy@kp.org)
This group brainstormed ideas for the structure and activities of the ILN in 2007. The group
decided that the ILN would have two tiers of work: the first to explore the science of innovation
and diffusion for the advancement of healthcare, and the second to help members find practical
applications through collaborative projects. This group continued their discussion with the
development of a Gameplan. For further information, please see Appendices 5-12 and 6-1.
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Innovation Learning Network 2006
Report on Innovation
Kaiser Permanente - Christi Zuber (christi.zuber@kp.org)
In this discussion, Linda DeWolf walked the participants through the VHA's "Report on
Innovation." In summary, healthcare was viewed as an extremely "traditional" industry with very
little activity considered "innovative."
ROI on Innovation
Alegent Health - Joan Neuhaus (jneuhaus@alegent.org)
This group discussed their need to demonstrate value from innovation in order to maintain a
stream of funding for innovation-related activities. The group came up with a set of guidelines,
including sponsorship from senior leadership, the facilitation of a pipeline for projects to eliminate
failures early on, the development of a balanced scorecard to measure progress, self-promotion,
and alignment with organizational priorities. The group also talked about principles of exerting
influence within an organization.
Virtual Simulations
Kaiser Permanente - Christi Zuber (christi.zuber@kp.org)
The group had a lot of energy around the topic of "virtual simulations." This group discussed the
need to continue to expand methods of supporting collaboration and innovation between and
among clinicians and patients, and saw simulated environments in the "virtual" 3D world as a
potential tool to help support this collaboration and innovation. The two particular "products"
discussed in the most detail were Second Life and Forterra. The group continued their discussion
with the development of a Gameplan. For further information, please see Appendix 5-9.
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Innovation Learning Network 2006
Page E-9
Innovation Learning Network 2006
Page E-10
Innovation Learning Network 2006
Virtual Simulations
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Innovation Learning Network 2006
ILN 2007
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G A M E P L A N T E M P L A T E
Purpose:
TEAM/
RESOURCES
/ ACT IONS
• Leader: TASKS
Next Week Next Q Next Year
• Members:
Today
• Task
• GOALS
• Task
• Task •
•
• Action 1. …
• Action • 2. …
•
•
• •
•
•
• Member: • •
•
•
• •
• … •
•
• Resource •
MEASURES Measure 2
• …
• … Measure 1
SUCCESS • Success • • •
FACTORS Factor
ILN 2007
The purpose of the Innovation Learning Network is to foster discussion on the methods and
application of innovation/diffusion, ignite the transfer of ideas, and provide opportunities for inter-
organizational collaboration.
• Tier 1: High-level, open discussion on innovation and diffusion, often with senior
leadership and champions of innovation within each organization
o Example: Open Space
• Tier 2: Focused exploration and collaboration on a specific topic. The group could
include Tier 1 participants, plus the content experts in each organization.
o Example: a deep dive into medication administration
• Quarterly web conferences: These web conferences are for ILN sponsors and champions
to conduct the business of the ILN, to share, to learn, and to network
• In-person meetings: two-three per year with each held at a different ILN members'
campus. The purpose is for intensive, in-depth learning, sharing and networking
• Virtual Fridays: Short, topic-focused web conferences (up to two per month). Content on
a topic is presented by a member organization for thirty minutes, followed by fifteen
minutes of questions and answers. Virtual Fridays are archived into a virtual gallery which
any ILN member can visit at any time
• ILN website: ILNOnline.org is our portal into the ILN. It contains a:
o Searchable membership directory
o Discussion board
o Calendar of events
o Archives
• ILN list-serve: The ILN list-serve is one email address that allows members to email all
ILN members for quick and easy communications
• ILN wiki: The ILN wiki (accessed through the website) is a place that allows members to
collaborate and create content on the fly, including uploading files. Any ILN member can
edit and create.
• Group consultation: Any member organization that is facing a gnarly challenge can
request a group consultation either via a monthly web conference or at in-person
meetings. The group consult brings together the experience and creativity of the ILN
members to help provide breakthrough.
• Loan an executive/expert: Any member organization may borrow an expert/executive for
an on-site, focused experience. The ILN will help set up the trade/swap.
Page F-1
Network Mapping
!
& Training page 1 of 2
Proposal
I am delighted to offer you this proposal for training in Network Mapping and Network Weaving. This is just a sug-
gestion. I would be glad to modify it to better fit your needs. The proposal includes use of the Smart Network
Software by all of the participating groups at no cost, as it is still in beta testing (see attached agreement form
which must be signed by an authorized individual from each organization). The only requirement for the use of the
software is that the group provide information on any difficulties you find with the software and make other sug-
gestions, as requested, about its revision.
The goal of the training will be to provide provide a joint training with individuals from 3-4 ILN member organiza-
tions as well as ILN staff so that they are able to use the software in innovation projects in their organizations.
Outcomes:
Each participant will have the skills necessary to:
• generate survey questions,
• implement a number of data collection methods,
• enter data into the data collection sheets,
• implement all steps necessary to generate a set of maps and measures, and
• interpret the maps.
Activities:
Dec 18-31: Participants will have an initial call (1 hour) to identify projects for mapping, engage in a
short session on Smart Networks and their role in innovation. We will go over projects
for feedback, then get feedback on questions if some groups have them ready.
Dec 18-31: Individual calls as needed to clarify who will be surveyed, how, and what survey ques-
tions will include. Instruction on how to enter data into spreadsheets.
Early Jan: Training on the use of the software is provided, using the data from each organization’s
projects. This will include 2 joint phone calls and some one-on-one time as needed. I
will help them clean their data. Maps and metrics will be generated with guidance over
the phone from me.
Mid Jan: Group teleconference training will be provided in analyzing the maps; we will go over
maps with the group to deepen analytic skills.
Later: Each group will determine when follow-up survey will take place and will conduct with
assistance as needed. Group will analyze the new maps and metrics and will be trained in
how to display the changes over time.
Proposal
Outcomes:
• Individuals from participant organizations will use maps and metrics to develop Network Weaving
strategies that will enhance their networks and lead to effective self-organizing.
• Individuals from participant organizations will form a learning cluster for peer support in their NEt-
work Weaving activities.
Activities:
Dec: Phone training in Smart Networks for background; discussion on how Smart Networks relate to their
innovation/Network Mapping projects
Jan: Introduction to Network Weaving. Network Weaving Self-Assessment to identify strengths and growth
areas.
Jan: Once participants have mapped and measured networks, session to understand stories in the maps and
metrics, what they mean, “what ifs”; how the networks can be enhanced through closing triangles, increasing
periphery, etc; basic Network Weaving strategies appropriate to their project. Set targets for metrics. We iden-
tify network leaders of various types using the metrics and discuss how to support their leadership activities.
February: Face-to-face training session at gathering. 5 Dynamics that increase the effectiveness of networks.
Network Weavers analyze the network maps and discuss how they could be enhanced using “what ifs” to see
the impact of additional connections. Lead Network Weaver and I debrief session and discuss your follow-up
role and tasks.
February-June: Additional training & peer learning. Monthly or bi-monthly phone training, mentoring,
and peer exchange session to the Network Weavers each month. Part of the time will be going over spe-
cific feedback on their Network Weaving activities, and part will be training in advanced techniques.
June Holley
Network Weaver
Section G: Resources
Alegent Health
http://www.alegent.org/
Ascension Health
http://www.ascensionhealth.org/
Cleveland Clinic
http://www.clevelandclinic.org/
Kaiser Permanente
http://www.kaiserpermanente.org/
Mayo Clinic
http://www.mayoclinic.org/
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Innovation Learning Network 2006
Other Resources
Clorox
http://www.thecloroxcompany.com/
Craigslist
http://www.craigslist.org/about/
Electronic Arts
http://www.info.ea.com/
IDEO
http://www.ideo.com/
Kraft
http://www.kraft.com/default.aspx
Networkweaving
http://www.networkweaving.com/
Second Life
http://secondlife.com/
Yahoo!
http://info.yahoo.com/
Page G-2