S10 EP6: Ed Marx, Innovation and Technology

Ed Marx, who is a global healthcare innovator and leader with over two decades of experience in digital transformation, strategy, and execution. 

If you would like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:00:22] I'm your host, David Cummins and today we speak to Ed Marks, who is a global healthcare innovator and leader.

[00:00:28] With over two decades experience in digital transformation, strategy and execution. As a CEO of Marx Advisory, Ed helps innovation executives and organisations achieve objectives and key results. 

[00:00:41] Ed is a global speaker on all things healthcare, innovation, leadership, transformation and life. He's also a veteran, an author and a founder and an athlete.

[00:00:50] We welcome Ed today to talk about our Healthcare Innovation and Technology series. Welcome Ed, thank you for your time to be here. 

[00:00:56] Edward Marx: Dave, thank you so much for having me. I'm really looking forward to the conversation. 

[00:01:00] David Cummins: Yeah, me too. 

[00:01:00] I know we're only limited to 20 minutes, but you're an author of at least two books.

[00:01:04] You literally do go around the world speaking about innovation. You're a amazing, is it duathlete or is it triathlete?

[00:01:12] I just don't know where you get all the time. 

[00:01:14] Edward Marx: Yeah, I get up really early. 

[00:01:16] David Cummins: And don't sleep much, I imagine. 

[00:01:18] So for those people who are in the world of healthcare and hearing the word innovation, if you've actually done research or read your books or understand a little bit about innovation, you understand the power of innovation, yet I would argue Australian healthcare certainly in the infrastructure space is probably not as innovative as it could be. What is innovation for those people that don't understand exactly what it is? 

[00:01:41] Edward Marx: Yeah, so innovation at its core, it's about taking new or existing ideas and applying them in a unique way.

[00:01:50] So sometimes we get stuck on innovation because we think, it's got to be something brand new. But actually some of the most clever innovations are just taking things that we're used to already, but applying them in a different way and you get transformation. 

[00:02:03] I'll give you a really silly example, but really fast, but I think it'll make sense to everyone So, you know, they're the best innovation I've ever seen is a little sticker that's put in men's urinal. 

[00:02:15] And the reason the little sticker, it's a sticker of a fly, was put in the men's urinals because men wouldn't pay attention when they use the urinal and made quite a mess.

[00:02:22] And so there was a lot of janitorial work that had to happen to clean the men's bathroom, whereas the women's bathroom didn't need as much attention. So they put these little fly stickers in the urinal and suddenly the men's bathroom became much cleaner on its own. 

[00:02:35] So that is innovation, but it's an existing technology, it's a sticker and urinal, but put together had a transformational effect in the bathroom. 

[00:02:44] Now I know it's a silly example, but it's an easy example for people to understand. So it doesn't have to be something gee whiz, brand new 3D printing, but it can be something that we're used to every day. But again, applied in a unique way that leads to transformation.

[00:02:57] David Cummins: Yeah. And it's definitely relatable. Innovation, definitely that sticker is in Australia. It's in, I think predominantly the airports, to be honest, but I mean, I didn't actually know what it was for, but I was definitely focusing on it.

[00:03:08] So it definitely worked, it makes sense.

[00:03:10] So, with innovation, what are some of the barriers towards innovation? Then if it's that simple, then how come people are resistant to it? 

[00:03:17] Edward Marx: Well, I think in healthcare in particular, when I answer this question from that angle, one is that it comes down to leadership. And if you have leaders that are not innovative, you're not going to get innovation.

[00:03:30] So another simple example, I was leading innovation, I was running into a lot of barriers in my organisation. I looked around the C-suite, I traveled with the C-suite. 

[00:03:38] They didn't use automation, they don't use the digital key on their phone, when they go to the hotel, they don't use the digital pass to get on the airplane, they don't have the digital passport. 

[00:03:50] They're still in the manual days. Like it's been done 30 years ago. And so often times you have leadership that hasn't changed, hasn't embraced innovation and they're stuck in the same old ways. 

[00:04:00] So that's probably the biggest one. The second one is we are very risk adverse, which is understandable when it comes to patient care, right?

[00:04:06] You don't want to like experiment on someone. But if you look at what's called the bench to bedside gap in time, it used to be 17 years. 

Thankfully, we got it down to under 10 years. But we're overly careful, I think, especially in areas that don't have any negative implication to patient outcome.

[00:04:23] So, It's our processies, it's our legacy, it's our risk aversion and our leadership that really formed the biggest barriers. 

[00:04:33] David Cummins: Yeah, I totally agree with the leadership. And I know you'd certainly have a chapter or pretty much interviews in your books about leadership and even interviewing innovators in that sector, but if you do have in whatever business it is, an older CEO, like an older executive leader, how can they come back to the times? 

[00:04:53] What is something that they can do to be innovative? 

[00:04:56] Is it literally just finding someone under 30 years old who understands social media? How can we get that balance between an older generation person who may be the executive, chief executive who doesn't understand innovation.

[00:05:10] Edward Marx: Yeah, there's a couple of practical things. 

[00:05:12] Again, I try to answer all the questions here with practics. So there's two things you can do. One is have a mentor that's younger than you. 

[00:05:23] So I've done that. I have a mentor every even year and usually, right, it's that older person. That's been, you know, 20 years ahead of you, maybe a generation ahead of you, kind of showing you the ropes a little bit, but I call it reverse mentoring. 

[00:05:34] Have a mentor that's in a generation one or two levels below you. I did it to learn my social media chops several years ago and it was a godsend. The other thing that you need to do, and I did this every single year where I was in the C-suite of health systems.

[00:05:48] I would do two trips a year with my C-suite. So the first trip, we would head to all of our partners. 

[00:05:54] So we would typically have partners that we had a big spend with, and usually they're located somewhere relatively close to one another in the country, and I would take them away for four days and we would visit five or six different companies.

[00:06:06] And when we met with them, we set the agendas ahead of time. I said, please speak to us about what you're doing in other industries. What's going on that we can bring into healthcare and what are your best healthcare customers doing? 

[00:06:20] And so instead of them hearing it from me, right, they roll their eyes, you know, cause ahh Ed's always talking about innovation and always wanted to do these crazy things and it's good, and I need to do that, but it's also great when they hear it from some executive of Apple as an example or a Microsoft. 

[00:06:36] So I've brokered these meetings with, with executives of all these different types of companies. The other trip that I would take is getting with the equivalent peer group of a very forward thinking company outside of healthcare. 

[00:06:52] So it might be Starbucks. So whoever and it doesn't have to be this massive company could be your local, in one region of your particular country, but get together with other industries to open your minds and what we would do. 

[00:07:04] We had a set agenda, again this was very formal. We'd spend an entire day together and what we would do is the first half of the day we would share about us. 

[00:07:11] Hey, here's our strategic plan, here's what we're doing, here's where we think we should be going. 

[00:07:15] And then part of that, they would poke holes in it. Like, what did you think about X, did you think about Y, did you think about Z? And then we would reverse. 

[00:07:23] So we would try to offer back, give them some insights as well, and they would do the same. And we'd have this great exchange. So those are two things that everyone should be doing in order to keep that innovation cycle going.

[00:07:36] Otherwise, you get too busy, buried in the day to day and nothing changes. 

[00:07:40] David Cummins: Yeah. 

[00:07:40] And what about the barriers of we don't have time, it costs too much, I don't understand it... which are some of the ones that I hear.... and I'm like, wait a sec I'll educate you. This will give you time and you'll actually save money.

[00:07:52] But again, it's very, very hard for such a beast in healthcare or construction or whatever industry in architecture where people are, "we don't have time, we don't have money, I don't understand it so we're not going to do it. We'll just put our head in the sand and ignore this AI thing that's coming around.

[00:08:08] You know, I just find that there is a lot of barriers for those people that we need to overcome. 

[00:08:14] Edward Marx: Or worse, is our solution is to create a chief innovation officer who then creates an innovation centre. And then we believe we secede all innovation to that one person or that one office and it lets us off the hook and then we just send things over there to go to die.

[00:08:36] Now there's nothing wrong with having a chief innovation officer. There's nothing wrong with having an innovation centre, but if that's your sole strategy, you're in big trouble. 

[00:08:44] But there's different things that you can do and this is what I did with my team.

[00:08:48] So part of their annual review, right? We had KPIs, Key Performance Indicators, or OKRs, objectives and key results, whatever you want to call them, but we're all measured on something. 

[00:08:57] And I thought innovation was important enough that that was one of the four measurable criterias that I put on all my direct reports, whether they were technology officer, cybersecurity, clinical applications, whoever they were. 

[00:09:11] So they knew that they were to come up with two or three new bonafide ideas and to have executed on one of them. Now, all of these things, just like with the silly example that I opened with, with the fly in the urinal do not need to cost a lot of money, right?

[00:09:29] That's a misnomer that innovation costs a lot of money. 

[00:09:31] No, actually it doesn't have to and if innovation is done correctly, oftentimes it'll make you money or save you money. Improved quality of care helps save people's lives. So this is the sort of thing. 

[00:09:43] So you get this mindset that, hey, we need to innovate, I need to be thinking about innovation.

[00:09:48] It's not just my running the trains on time, but I gotta be thinking outside of the box and I gotta be doing some of these things that Ed's always doing, like taking these trips and visiting other people, visiting peers and other industries. 

[00:09:59] Serving on boards or advisory boards of companies where it's not just healthcare individuals that are there at the table, but it's retail and banking and finance.

[00:10:07] These are the practical things that you can do in order to ensure that you have an innovative culture and everyone's focused on it. 

[00:10:16] David Cummins: Yeah. I actually love those tips. 

[00:10:17] I worked for a global company where we did have a chief innovation officer that had a chief innovation team and yet they didn't speak to any other department. It just didn't work.

[00:10:26] And every time we tried to talk to them, they had very much their blinkers on, but it was not a two way street. That's for sure. 

[00:10:33] Edward Marx: Yeah. David, that's, again, you know, you asked earlier what are the obstacles and why don't we innovate and stuff like that? 

[00:10:39] Well, because our answer in part has been "let's add chief innovation officer. Okay. Well, that didn't work all that well. Let's add chief transformation officer. Oh, that didn't work very well. Let's add chief patient experience. Let's add chief data chief AI". 

[00:10:53] And you look at the C-suite now and it's gotten so big that nothing gets done for sure because you've got too many chiefs and they're all competing for limited resources and they all feel like you're in their swim lane. 

[00:11:06] And so what we thought was actually helpful is actually a detriment to innovation. It's kind of like volleyball. Like I think everyone can visualise volleyball. If you ever wondered, why don't I put 10 players on the court instead of six?

[00:11:20] Well, it would be a disaster if you put 10 people on the court. Six is the perfect number for volleyball. So it's the same thing in the C-suite. Why we keep adding and we don't get the results. So in fact, the outcomes are worse. So that's another reason why we sort of suffer with this poor innovation cycle.

[00:11:36] David Cummins: Yeah I mean, they have fantastic tips. 

[00:11:38] The other thing that your books talk about which I have actually.... I've recorded quite a few of these podcasts about innovation and technology, but no one has actually really picked up on this... and I'm very interested about patient consultation and user group consultation in the world of innovation and technology.

[00:11:53] And I found this fascinating for architects and builders that literally build based on user group consultation or nurses feedback or doctors import or patient requirements. But to talk about a patient requirement and consultation in the world of innovation, I actually haven't heard that before.

[00:12:08] Do you mind just talking a bit more about that? 

[00:12:10] Edward Marx: Yeah, I can't believe that it isn't just standard way of doing things. 

[00:12:14] And if you want to get really strong with innovation, you've got to be with the people who actually use the product or service and they live or die by it. And you'll get a lot better inputs than you do just from sitting around with people like yourself. 

[00:12:29] So there's many many different ways, you know that I employ in order to create this innovation culture That really gets to the heart of this. 

[00:12:36] So certainly you can have your formal focus groups and we do that and sometimes we work with marketing who has the focus group sometimes patient experience or just ourselves So it just depends on your organisation how it's organised, but you need to have these focus groups.

[00:12:50] And again, sometimes the formal ones are good to do. I also like the informal. So an example, again, these are all practical things and a lot of these are free. 

[00:12:59] One is include a patient or two on your governance. So a lot of people talk about governance. That's sort of the policy makers of, let's just say for IT.

[00:13:07] So you have a governance council that helps approve it projects or helps modify or sharpen projects. You know, what gets funded, what doesn't, what should we work on?

[00:13:16] And I love to have patients in those because we can never forget the patient perspective. Cause we often do, and all of a sudden it becomes a tech thing or a digital thing or a hospital centric thing and we, oops, wow, we're doing it for the patient, they're never going to be able to use it or. I have zero interest in this. 

[00:13:32] So it's really important to get that formal feedback through a focus group, but also this more informal. And another way of doing it is to have patients as your speakers at your organisation.

[00:13:44] I mean, it's just saying it out loud, David, it's like so obvious, but very few people do it. And so what I would do every time we had the opportunity for a town hall or some sort of event where all of IT, all my team was together. It would start off with a patient telling their story and that would reinforce sort of what we were doing.

[00:14:07] And some case it might showcase a gap in what we were doing. So that's, again, just a practical thing. Another free one is like when you are developing a product or service. So let's say you say, yes, we need to have this super duper app that, you know, takes care of everything for our patients... well, include them in the design and they love to be included.

[00:14:25] I've never had anyone say no. They're like, wow, I would love to give input and help because this will make a difference in my life. And so those are some things that you can do, but I can't imagine operating without it. But the sad case is that many people operate without that direct customer input.

[00:14:43] David Cummins: Do you have any examples of where a consumer/patient-led innovation or idea has resulted in better clinical outcomes because again, in the world of health and infrastructure we do sometimes speak to patients about what may or may not work. 

[00:14:59] So a good example is where we were build in a paeds or design of the paeds waiting room and the mums were saying, well, I'm sorry, like my kids are running around. I can't just sit here waiting for my name to be called. 

[00:15:10] And so what we actually did is we actually gave them a beeper so they could be in the playground, they could be down the shops, they could be in the cafe. And then when it was their turn, they just got the beeper, just like at a fast food restaurant, got the beeper.

[00:15:21] Then they came in because they knew couldn't stay there for like 25 minutes with a kid running around who was sick. So that was a really good innovation that we implemented one of our hospitals here. But is there any other examples you can think of in that world? 

[00:15:32] Edward Marx: Yeah, I'll give you a couple.

[00:15:34] One is the frustration when we... a lot of times, unless we're a very simple patient, but most people that are going to a hospital probably are, more complex patients. 

[00:15:43] If they're simple, they're probably just going to an ambulatory centre of some sort, but if they're a complex patient, meaning they have to have labs, they have to have radiology, they might have surgery, there might be in-patient stay and outpatient therapy or physical therapy, occupational therapy, you know, multiple touches.

[00:15:59] Well, in traditional healthcare, you're dealing with each of those departments independently, and so you might need to get your lab. I've actually had this happen to myself. I needed a specific lab 24 hours before my surgery but you know, the lab, they just knew, hey, we need to get Ed in for a test.

[00:16:19] Surgeons and the OR knew that Ed's coming in for surgery on this day. There was no one that was saying, okay, this needs to happen 24 hours in advance. 

[00:16:30] This is a true story, but this other part, I'll just add to it for the example but I mean, this literally is what happened. 

[00:16:37] We might have some outpatient therapy that needs to happen two days after that surgery and maybe some home care. 

[00:16:43] Well, while we're really good at each of these individual areas, home care is great, surgery is great. 

[00:16:49] There's no cross continuum that's taking care of everything and making sure that I'm scheduled on time for all these things. So there's no gap, there's no delay. And so we took that feedback from our patients.

[00:17:02] And so we created this cross continuum capability and they no longer would receive 30 different text messages or emails, whatever they preferred, coming at them from all these different departments, but it was one coordinated effort. 

[00:17:16] The other example again I'll give you a personal example that made a difference is we had patients, we were very strict and most of health care united states is still like this, very strict about releasing clinical results. 

[00:17:30] So their patients want the results right away, but hospitals... we say no, because they'll misinterpret their data. They don't want to get bad news through the portal, you know, things like that. 

[00:17:44] But when you ask the patients, they want their data. They want to know. And so, I had cancer, I was waiting and waiting and waiting for that lab result to come through to say all clear. 

[00:17:57] And by God, it did. The physician hadn't called me and I don't blame him. He was busy, you know, probably doing surgeries and things like that. Other things he has to do. I would have to wait maybe another day, but instead I got it right away. 

[00:18:09] So those are two examples. And that's why it's so important, so powerful to have patient input in your innovation because it makes transformative difference.

[00:18:18] David Cummins: That's fairly interesting one. So was that a change in the policy from the organisation, because that is so far away from anything I can fathom in Australia because of confidentiality.

[00:18:29] And you're right, like even a simple blood test, they just won't give you the results unless a doctor is speaking to you sometimes. 

[00:18:36] Edward Marx: Yeah. It required policy change and there's a few hospitals now that have done it. 

[00:18:40] And I think it's a wave that's going to continue, but yeah, it required a policy change. There's no privacy violations or anything like that. I think the only thing that's sometimes carved away, maybe mental health, because they didn't want the patient to receive some sort of mental health diagnosis without the psychiatrist or psychologist talking to them first.

[00:18:59] But everything else, fair game.

[00:19:01] So my results for my labs after my surgery for cancer came to me before the physician called. I loved it. It's so good from experience. It's the way it should be. 

[00:19:10] David Cummins: Yeah, exactly. 

[00:19:11] I know we're running out of time, but what are some of the risks that healthcare, if not, businesses may face if they don't jump on board the innovation bandwagon, if they don't actually push these, if they don't actually make it everyone's responsibility, what are some of the risks that a company may result from if they don't prioritise innovation. 

[00:19:30] Edward Marx: Yeah, I think we're seeing it and that's the disintermediation of healthcare. We're seeing other entrants come in. Not all the entrants are successful. You know, in the United States, we just saw Walmart, which is a big retail... they sort of backed out. 

[00:19:41] They came in and backed out. It's not the last foray, trust me. They're going to come back in a different way. They're just all learning new things and coming back. They're coming in with all sorts of innovation. 

[00:19:53] Whereas healthcare, because we're not, generally speaking, we will be disintermediated.

[00:19:58] So now we're seeing like most of the physicians now, again, in the U. S. work for insurance companies. That wasn't the case 20 years ago. 

[00:20:06] The insurance companies are proving to be more innovative in their model of delivering care, perhaps improving the lifestyle of their clinicians and so they've left the hospital.

[00:20:14] So I think we're going to see more and more of that. If we don't innovate and change the way that we do business to reduce our costs, to improve quality, to increase revenue, other people will come in and take the space. That's the risk. 

[00:20:28] David Cummins: Yeah, I think that's amazing. 

[00:20:30] Ed, I just want to say thank you so much for your excitement and innovation in this industry.

[00:20:36] Literally you are a global leader in this space and it is very obvious like some of those examples. 

[00:20:42] I would definitely be taking back to my team and I think a lot of people will learn a lot from this podcast. 

[00:20:46] So good luck for your duathlon in a few months time but thanks so much for your time because I know you are very busy and this has been so interesting to be able to have practical tips about how everyone can provide some form of innovation at really no cost.

[00:20:59] So thank you so much for your dedication to this industry. 

[00:21:01] Edward Marx: David, thank you for having me on your show and thank you for all you're doing in the world in terms of getting the message out. 

[00:21:07] Thank you. 

[00:21:08] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:21:13] If you'd like to learn more about the AHDC, please connect with us on LinkedIn or our website.

[00:21:17] Thank you for listening.