I couldn't escape a sense of déjà vu at a recent industry conference. Jonah Czerwinski, director of VA's internal innovation initiative (VAi2), delivered a glowing report. VA Secretary Eric Shinseki challenged VA's more than 300,000 employees to provide "actionable ideas" that would increase access, lower costs, improve performance, or raise the quality of the services and benefits provided to our nation's 25 million veterans. More than 50,000 VA employees responded with over 10,000 submissions.

Czerwinski praised this awesome display of care and commitment on the part of VA employees, and he described how the VAi2 program would 
manage this wealth of ideas. They would be evaluated, then selected ideas would proceed to piloting, and those proven most beneficial would be implemented.

I agree that this program, and the VA employees who contributed to it, deserve all the praise they are receiving. However, during my career in government – including significant time at the VA and more recent stints in the private sector – I've seen many attempts at innovation in large organizations. They hardly ever succeed. The ideas are excellent, the intentions the best and the pilots are often successful, but actually making them work throughout an enterprise is another matter.

Human resistance to change is notorious, but that's just part of the story. Often the very organization that encourages an innovation also presents the greatest obstacles to its implementation. The analogy that comes to mind is a railway system. Massive investments are made over many years not only in laying track to support the delivery of goods and services, but also in assembling the people and processes to keep the trains safe and running on time. If services suddenly are demanded at new locations, the underlying infrastructure – the tracks – may not go there.

A command and control approach of "turn 90 degrees to the right" has obvious difficulty for a railroad. Likewise, a sudden directional 
change inside a very large organization presents challenges of similar magnitude. But staying on the "main line" is not satisfactory either.

Several large organizations have developed reliable, repeatable processes for making the innovation-generation and evaluation pieces work. CSC, my current employer, has an office of innovation and a formal program to encourage, to nurture and to evaluate new ideas, big and small, that will improve performance, lower cost and raise quality. This program is aligned with others that fund exploration and piloting of promising innovations.  The hard part comes when the innovation collides with the reality of the train tracks. Decades of process, coordination, communication, training, audit and culture are built into the train tracks, stations and infrastructure of the main line. Rapid innovations that disrupt the main line, or obviate the need for it, challenge the system in ways that are hard to appreciate until you see them up close.


Having thought a lot about such issues, I suggest that the following key concepts are essential as large, 21st-century organizations, especially healthcare organizations, introduce rapid innovation.

Innovation must be organic. A great idea imposed from above or outside is likely to be opposed or rejected.

The case for change must be clearly communicated. Innovation and transformation are traumatic events within a large organization. The value proposition of the innovation must be clearly understood, articulated and fully communicated before the changes begin.

Stakes must be made personal. Everyone affected needs to understand their new roles and the benefits that will accrue to them once the innovation is implemented.

Infrastructure must support the innovation. Infrastructure concerns should not prohibit innovation, but the possible need for new infrastructure must be taken into account. A new train station, no matter how necessary, is little more than a place to get out of the rain if no tracks run to it.

A change management program is essential. Apply change management principles early and continuously -- detailed preparation, exhaustive communication, appropriate training, strict management, and extensive follow-up and reinforcement.

Scope and scale are important. A successful prototype or pilot project does not ensure success at the enterprise level. During piloting or prototyping scope and scalability issues must be identified, resolved, and tested.

In the 21st-century organization, "transformation" is seen as a desirable goal. Likewise, the concept of crowd-sourcing is gaining traction. If large, complex organizations wish to empower their employees and transform their operations, they must understand that conception is the easy part and the really hard work is just beginning.

-- Edward Meagher is vice president of healthcare strategy at CSC. He has held several leadership positions at the VA, including VA Acting Assistant Secretary, Acting CIO and Deputy Assistant Secretary and Deputy CIO as well as Chief Technology Officer.