Innovation Junkies Podcast

Dr. Thomas Graham on Mission-Driven Innovation

Dr. Thomas Graham, Chief Innovation Officer of Kettering Health, joins the Jeffs to share insights about building a culture of innovation in organizations, clinical-driven innovation vs. research-driven innovation, and the future of innovation in the medical industry.

Thomas Graham:
The magic formula for success of having an innovation program is having a postulator champion and having C-Suite buy-in, so it starts with that. If you have one or the other, you’re still not there, got to have both. That’s the catalytic element that makes enterprise innovation work. The other is, don’t fall into the mistake of sequestering or making that available only to those who have an MD or PhD or an MBA. Everybody.

Jeff Standridge:
If you want to drastically improve your business, learn proven growth strategies and generate sustained results for your organization, you’ve come to the right place. Welcome to the Innovation Junkies Podcast.

Announcer:
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Jeff Standridge:
Hey guys, Jeff Standridge here. Welcome to another episode of the Innovation Junkies podcast. I’m here with my partner, Jeff Amerine. How you doing, Jeff?

Jeff Amerine:
I’m doing great. Happy to be on today. I’m looking forward to this episode.

Jeff Standridge:
Yeah, I am as well. Let’s just hop right into it. How about we do that?

Jeff Amerine:
Sounds great.

Jeff Standridge:
Today, we are honored and it is our pleasure to have Dr. Thomas Graham with us. He’s world renowned for his work in orthopedic hand surgery. He’s a healthcare executive, he’s a bestselling author, inventor and entrepreneur. Most recently, Dr. Graham joined Kettering Health in Dayton, Ohio in the spring of 2021, where he now serves as their senior vice president and their inaugural chief innovation and transformation officer. He leads the Charles F. Kettering Innovations, which is the health systems technology transfer and entrepreneurship arm. We are so honored to have you with us today, Dr. Graham, and we look forward to the conversation.

Thomas Graham:
Appreciate that greatly.

Jeff Standridge:
Absolutely. Hey, Jeff-

Jeff Amerine:
Yeah, before we launch into the really topical matters, we like to have a silly, random musing at the beginning of every episode. Today we thought it would be interesting to find out what everybody’s favorite sitcom is. So Dr. Graham, what’s your favorite sitcom? If you have one. And it’s okay to say you hate sitcoms, I guess.

Thomas Graham:
No, no, no. I love entertainment of all types. Honestly, I love Gilligan’s Island. I thought it was like, “Those people got to be able to get off of that island.” Just the way that they constructed the cast and represented so many viewpoints and perspectives and socioeconomic issues, I always got a kick out of that. Plus, I had a crush on Mary Ann.

Jeff Amerine:
That’s good, that’s good. Jeff, what about you?

Jeff Standridge:
I have to say I was going to go the Gilligan’s route too, because I’m kind of a Gilligan. I was going to go that route. But I’ll have to say, I’ll go a little more recent since Dr. Graham stole my thunder on Gilligan, but I got to say the Big Bang Theory. I just fell in love with the Big Bang Theory because you have all these scientists living together, they don’t have a social life. The writing behind it was absolutely some of the most clever writing that I’ve ever seen. In days past, Gilligan’s Island, but in the present tense, or not so distant past was Big Bang Theory.

Jeff Amerine:
I’ll take liberties of going old, not quite as old and recent. My old favorite is Beverly Hillbillies.

Jeff Standridge:
Oh, yeah.

Jeff Amerine:
I’m a big Jethro Bodine fan, I guess.

Thomas Graham:
Nicely played.

Jeff Amerine:
That was the same vintage as Gilligan’s Island, which I watched regularly. The medium range in the past 25 years would probably be Seinfeld. I thought that some of the humor in Seinfeld was pretty spectacularly good. The things like the soup Nazi and Kramer. And then more recently, and maybe more topical, I really thought that Silicon Valley, that was on HBO, was pretty hilarious. Some of those things which were intended to be situational comedy were a little true to life, based on some of the experiences I’ve had. I took some liberties, but those were mine.

Jeff Standridge:
They just don’t make them like Gilligan’s Island, Beverly Hillbillies, Andy Griffith, some of those kinds of things. I was a big Don Knotts fan too.

Jeff Amerine:
Absolutely.

Jeff Standridge:
All right. Well, how about we hop in it?
Dr. Graham, you most recently moved over to Kettering from Cleveland Clinic where you pioneered Cleveland Clinic’s technology transfer and innovation function there. I’d like to maybe start today by talking a little bit about just the concept that you refer to as mission-driven innovation. Can you tell us a little bit about what that is and how you see that and we’ll transition into how that plays into healthcare.

Thomas Graham:
Sure. It’s always difficult to define innovation, isn’t it? It’s one of the most sought after individual and corporate characteristics, but people struggle with the ability to wrap their mind around it. Right now, if you drive down the road, you’ll see innovation on every billboard or switch on the TV it’s discussed on every commercial, it seems. For us, it’s just leveraging your creative culture to improve and extend human life and create economic opportunity for individuals, institutions, and the communities we serve. We think that’s very well aligned with our mission, right? Most hospital or healthcare system missions are similar and they should be. Care for the sick, investigate their problems, train future leaders. We think that being at the vanguard of solving the unmet need is just as relevant to what we do on a daily basis and that really sums it up. I hope that translates or is translatable, scalable to every organization who wishes to get into the real practice of innovation.

Jeff Amerine:
As a follow up, I’d really be curious about your thoughts. We tend to sometimes think of healthcare as being reactionary, it’s reactive to indications. What are your thoughts about the direction that healthcare innovation is going as it relates to prevention or early intervention? Talk to us a little bit about what you see happening in that regard.

Thomas Graham:
It’s just as much in the portfolio as catching up with the latest cancer drug or device. I think, as we are able to imbibe and metabolize data better, not just in the episodic manner that we’ve done it, just like we’ve rendered care in an episodic manner. Now that we have an ability to look more holistically at the individual or larger communities, I think we now have the luxury and potentially really the responsibility of looking at the full spectrum of care. Which goes from functional wellness, maybe nutrition and everything else that goes with that wellness: imprimatur,  sleep, stress management, et cetera, all the way through acute and chronic management of injuries and disorders, through actual performance, enhancing performance.

I think that we now have opened the aperture and not looked at, what changes can I make to this hunk of metal that I stick into somebody in the operating room, and changed it dramatically. I think prevention, both on the individual and the community level is the result of that. Then you sprinkle in a little precision medicine and that’s another whole topic. But I think now we understand that the power of both the delivery and the digital components can come together and make us more effective at what I call strategic innovation.

Jeff Standridge:
I heard you say in one of your online talks, I think it was Singularity, where you said that at Cleveland Clinic, you guys had somewhere in the neighborhood of 700 royalty-producing agreements in place, or inventions in place. Whether it’s there or now at Kettering, what proportion, just guesstimate, I guess, what proportion are you seeing of more digital health types of solutions coming to the forefront versus traditional device inventions and what have you?

Thomas Graham:
Great question. Way back when innovations began with a small “i” and nobody really knew what you were talking about when we put together, I think I was the inaugural Chief Innovation Officer in all healthcare back in the early ’90s. Our portfolio has always been the four D’s, drug, device, digital and delivery. Right now the last two go together. Two thirds to three quarters of our portfolio was device. Maybe you’re an institution that has medicinal chemistry, drug development, and that can be put off in a little bit different because I think as we all know that pathway’s very long and a little different so let’s just put an asterisk by that for a second. It’s completely flipped now. Two and a half decades ahead of this now where really everything’s digital. Every darn pill probably has a digital component to it, as do devices that have capability of giving information.

I don’t think there’s any doubt that there’s still a role for shiny metal objects. That’s how I got into it, that’s how we started Cleveland Clinic Innovations. That’s how most organizations who are starting to move into innovation, find themselves. That latent innovation that happens when you start a program where you go from zero to 60 in no time, you gave an example, I have a couple also, often start with those hard assets. Yet to tell you the truth, and now I’m sounding like I’m repeating myself, the way that we manage, analyze and act on the ones and zeros is really what is driving a great deal of the innovation now.

Jeff Amerine:
As you look at some of the things that are being discussed as it relates to social determinants of health, I think that speaks to that idea of understanding some of the other factors that lead to things like metabolic syndrome and diabetes and all these chronic issues that plague many parts of the population now, where do you see that going? That speaks to the digital side of that, but what are the possibilities there?

Thomas Graham:
Remember a couple minutes ago, we were just talking about in-taking data, analyzing it. I think the quantified self is going to move from just a few of us wearing step trackers, to actually getting the information that reflects a person’s life and health, and then being able to make that personal and actionable. Where we have a relationship with that data, we might be gleaning, whether it is from something worn, something implantable, something in the home. I think that’s probably where a great deal of advancement is going to take place. Now it’s a little bit of esoterica. Wow, we scanned everything you put in your refrigerator, so we know what’s in there, so we know what you can make and we know its caloric intake and we know you’re diabetic, and going on from there to make it a little bit more concrete and actionable. That may sound overly broad, but I think taking the next step in maturation and discipline in the quantified self and turning it into actionable prevention, maintenance, treatment, type of algorithms and things we can deliver.

Jeff Standridge:
Shifting gears a little bit, I’d love to get your perspective on scientists and researchers becoming innovators, because there’s a difference there, right? And commercializable innovators. Having worked a lot with medical researchers, they are the experts and have been the experts in their entire careers and then when they develop an invention or a potential idea or a potential invention, they have innovation folks like us saying, “Well, let’s do some customer discovery. Let’s really get out there and understand from the end users and from the economic decision makers. How big is the problem we’re solving and is it big enough that it would warrant a profitable, ongoing concern if it were to be commercialized?” Have you had that experience and if so, how have you overcome that within changing the culture of a research institution to that of an innovative commercialization engine, so to speak?

Thomas Graham:
Yeah, you’ve really packed a lot into, really, the discussion of research with development, not research and development, right?

Jeff Standridge:
Right.

Thomas Graham:
First of all, let’s understand that I am so proud of our academic medical centers and research universities and how they remain on the frontier of identifying unmet needs. What we advance with the work that’s being done at the bedside and laboratory bench. Many people, let’s say in the venture community, think these things are born on third base. Those of us who’ve dedicated our careers to innovation, and what I call organic innovation, have entertained all these folks who walk in and say, “I’m an early stage investor”. And when you tell them what you really do, they can’t wait to run out the door. They don’t understand what it takes to go from a napkin idea to first-in man. Okay?

Jeff Standridge:
Exactly.

Thomas Graham:
Let’s start there. But what you’re really highlighting, I think, is the difference between the clinical driven innovation and let’s say the research driven innovation. I’ve always talked about the virtuous cycle problem identified at the bedside, “Wow, that’s the third time that I’ve seen that implant fail in exactly the same place. Let me put my mind to that. Let me go into my workshop, figure it out.” It then takes a cycle of investment, divestment, prototyping, engineering, regulatory, all the beating up you do in the long peripatetic journey that we all know is innovation, to be delivered back to the bedside.

The clinician has always known that they’ve had that relationship, let’s say, with the industry, they’ve been in a vendor-client relationship before. I think researchers sometimes subvert that because they’re used to, I don’t want to study something, let’s get a grant, let’s present and talk about it, which sometimes also threatens the actual patenting process, let’s talk about that. And then they just want to keep that going. And when you come over from the commercialization side, you’re sometimes looked at as kind of almost sullying those individuals who are dedicated to the discovery science. I’ve spent a lot of my time trying to build those bridges, trying to have individuals understand both from an aspirational standpoint and a practical standpoint, not bad to keep the lights turned on, or pay for your graduate students, or buy a couple beakers. So I think introducing the academician, the discovery scientist, to the concept of commercialization, assisting them by having the innovation nucleus, have individuals that speak their language, who are patrolling the corridors of the laboratory, not just passively rebounding ideas.

We have these situations like, “Hey, what are you working on? Jet fuel. What’s happening? Well, we figured out you can increase the efficiency of jet engines by 25%. Well, what are you doing with that?” Well, who’d want that? It’s just a research interest of mine.

Jeff Standridge:
Yeah.

Thomas Graham:
I picked something outside of healthcare as an exemplar, but the idea is innovation. Again, innovation isn’t, you can wear jeans on Friday and bring your dog to work and play Frisbee. It’s a discipline that needs to be practiced. And when you put in the right infrastructure and architecture, when you put in the right processes, when you inform people, one and first culturally, that their ideas are important, that their ideas have value. Everybody’s an expert. I don’t care whether you work on the loading dock or you are a doc, you probably have ways of improving what’s going on at your organization. Once you build that lightning rod, which is an innovation capacity, all of a sudden people say, “Wait a minute, I’m not going to shove this in the drawer, throw it away.” Or, “Nobody cares what I think.” That’s the worst outcome imaginable. Dr. Brown has a great idea, but she doesn’t have access to an innovation infrastructure. She goes, “Ah, forget about it. I’ll just put it in the drawer.” No patients are helped. The inventor doesn’t benefit, the institution doesn’t advance, jobs aren’t created. That was the whole idea.

I grew up in Appalachia. I watched the steel industry and pottery industry disintegrate. And so I’ve dedicated a significant portion of my time, but to transition our state economy from an industrial base to a knowledge base. But you gotta do it in a way that has that level of discipline and it’s a process oriented, metrics driven game. As you probably know, my clinical practice is dedicated to the care of professional athletes mostly. It ain’t a game till you keep score, and you got to keep scoring innovation.

Jeff Standridge:
So are you finding as well that the showcasing of successful ideas breeds more ideas coming to the forefront? And so are you actively involved in showcasing some of those rock stars?

Thomas Graham:
Well, listen, I’m not averse to a little theater. Right? I love thought leadership forums, ideas festivals, I love programs that can be celebrated. We all can think of Shark Tank. Let me tell you something, I think it’s the greatest thing, because it’s turned people on to entrepreneurship and again, that idea that their creative thought is important. So yeah, we like to bring individuals from the outside and speak about it. We like to celebrate our own inventors and innovators. We like to reward them.

And by the way, recruitment, retention and reward is another great benefit of having an innovation program. If an individual is trying to decide between this university and that hospital to go practice and they believe that they’re innovative, which I think probably everybody does, that’s one of the few things if you’re told you’re innovative, everybody smiles. That they’ll come to your institution even though the weather’s terrible, right? And that was kind of what we leveraged a lot here in the upper tier of the Midwest.

Thomas Graham:
So yeah, it doesn’t hurt when one person pulls in the garage and they’re driving a Yugo and one drives in a Cadillac and says, “Wait a minute, we have the same job, what’s going on? Well I invented some trinket and I have a benefit from it.”

Jeff Standridge:
Yeah, exactly.

Thomas Graham:
I just think there’s a lot of ways that innovation can insinuate itself in an organization and the wins are not just monetary, they’re not just counting the number of patents, or royalty-bearing license, or spin out companies. There’s a lot of enculturation that happens and from that comes a lot of pride in the organization, and that pride is transferred to the communities we serve.

Jeff Amerine:
And sometimes, Dr. Graham, and I’d be really interested in your thoughts on this, it’s a long process to go from having sort of an island of a few innovators and then the rest of the organization focused on operational efficiency, kind of the day to day, do no harm, take care of the immediate needs versus a culture of innovation where it’s pervasive. As you think about what advice you might give others that are early in that journey of really trying to get that cultural transformation towards building a last sustainable culture of innovation that goes across the organization, what bits of advice would you give in that regard?

Thomas Graham:
The magic formula for success of having an innovation program is having a postulator champion and having C-Suite buy in. So it starts with that. If you have one or the other, you’re still not there, got to have both. That’s the catalytic element that makes enterprise innovation work.

The other is don’t fall into the mistake of sequestering or making that available only to those who have an MD or PhD or an MBA. Everybody. The Pareto Principle operates 80/20, and if you only expose that process to what you consider your top tier of potential innovators, you’re going to reduce the output even further. Innovation, again, needs to be celebrated. The ward clerk’s going to have a great idea. You just have to be able to distribute that concept.

And then the other is: move from opportunistic innovation, the Eureka, right? That’s what everybody thinks of, I think, about innovation. To synergistic innovation, putting ideas together inside and outside your institution, even with potential competitors. Innovation is not a competitive platform, I can’t steal ideas from somebody’s head. And yes, I understand the USPTO, but collaborate even with that organization across town who you might be contributing for the next baby being born or next total need being done, you can collaborate on innovation.
But take it to that last step, which is the holy grail of innovation, which is strategic innovation. Innovate around something. Now that might be something that you poll your organization, et cetera. It usually comes down into just a couple different domains. It’s access, outcome, you might want to call that quality, patient experience and then operational efficiency. If you asked one of the consultants, they’d have 188 different parameters, it comes down to those four things because that’s what you compete over on the other side. So when you do compete, you want to be optimizing those things and your people, I guarantee it, have ideas on how to advance your organization toward improvement in one or more of those.

Jeff Standridge:
And when you talk about those four things around which to innovate, it’s not relegated only to the research institutions. The community health center or the regional health system down the street could rally around those four things with their staff and an innovation program as well.

Thomas Graham:
And might have a better laboratory. What do I mean by that? They are urban, suburban, and rural. They’re a different socioeconomic band. They have a different connectivity to their community, keep going, right? And so on the community level, innovation ignites and translates into things like job growth, et cetera, when you have med and ed. So if you already have those things, you have a little bit of a head start, as we’ve shown in Pittsburgh, Cleveland, et cetera. Down here in Dayton, we add another one, fed. We have 45,000 people working at the Ray Patterson Air Force base. So we actually have a troika of things that I believe, and this is why I’m here, will redefine… Listen, Dayton was Silicon Valley last century. Period, end report. Most patents per capita, it’s where Kettering and Patterson and Thomas Watson, all them came out of Dayton. If you drove a car today, thank Dayton. If you flew in a plane last week, thank Dayton. If you drink a cold drink today, thank Dayton. And that’s why I believe this is a perfect caldron to rediscover it.

And again, why I’m at an institution who has the name of Charles F Kettering’s right on the front, second only to… Trying to think of who has the most patents. Guys, help me out. Edison, in the number of patents. He invented the electric starter, he invented Freon. Unbelievable what these folks did. And that’s what motivates me. Can you translate it from the individual to the entire community and beyond?

The only net new job creators in our country the last 10 years are companies less than five years old.

Jeff Standridge:
That’s right.

Thomas Graham:
About half of those came out of healthcare so let’s just do the math, right? This is how important the work you’re doing and the individuals listening to this podcast are to our American economy. You might guess I’m a bit of a patriot, right?

Jeff Standridge:
Right. I love it.

Thomas Graham:
And so the idea is, my dad who was an industrialist would say, “The only thing better is making American flags out of cotton.” We’re doing things that can improve the health of your loved ones because there’s only one, I’m an upbeat, optimistic guy, there’s only one bummer I got to tell you, everybody’s going to be a patient one day. I was for two years. I was the sickest man on the face of the earth for two years, I was in the hospital. So I know it. I’m not a dilettante, I’m the poster boy for innovation, saved my life. And I’ve dedicated a significant part of my career for it. That’s why we are helping other organizations.

I have a meeting later on today with an organization from Atlanta who wants to stand up their innovation capacity. We started something called the Global Healthcare Innovation Alliance, where we helped other medical centers, research universities, government labs, and then ultimately commercial companies to innovate. People already figured out why we were helping Northwell or MedStar develop their innovation capacity. They thought it was kind of interesting that we helped Notre Dame. I said, Cleveland Clinic didn’t have a football team, that’s why I had to do that.
NASA. What’s a better example of innovation than thousands of people worried about two or three people in the harshest environment and miniaturization and performance and materials and things like that. And then they were kind of shocked that we partnered with Parker Hannifin. Some people know, some people don’t, they’re a 14, 15 billion dollar motion control giant, 400 or so parts in your car or your airplane and people ask me, “How’d you figure that out?” I said, “Well, we talked to them, number one. And second, what do you do?” “Well, probably nothing you’d be interested in, we flow fluid through tubes with valves in them.” Oh really? Just like our urologist and cardiologists think about every day? All of a sudden you have half a billion dollar medical device portfolio.

You have to be prepared to ask the questions and understand how those answers fit in a bigger matrix that we’re all building together. And that’s what makes me proud. We’re one of the founding members of HIPS, Healthcare Innovators Professional Society. We finally started a professional society with the original 33 Chief Innovation Officers. Give Toby Hamilton from Texas a lot of the credit for that, but now we can talk about it. Most of us are scabbed over, but not healed in yet. Innovation’s hard. It’s non-linear, long to success, fraught with failure. And like I said, if I hear one more time, too early, too risky? Yeah, I get that. Where do you think this stuff comes from?

So we now are sharing everything we can. I don’t think that Roy Rosin at Penn, or these folks, we’re not competing, we’re trying to help each other. Because I know I have a lock on my campus and somebody else may have the key. And if we don’t open that ability to communicate and put things together and share not only the information, but the success, then we’re going to go nowhere as an innovation ecosystem.

Jeff Standridge:
We could go on for hours and hours. We’re talking with Dr. Thomas Graham, chief innovation and transformation officer at Kettering Health System. You will want to check out his book called Innovation, The Cleveland Clinic Way. Dr. Graham, where can they find that and where can our listeners connect with you best?

Thomas Graham:
It’s available on Amazon, et cetera. My only claim to fame is I knocked the Shark Tank guy, Daymond John, off the best seller list for one week-

Jeff Amerine:
That’s pretty good.

Jeff Standridge:
Hey, that’s good.

Thomas Graham:
Best seller list. I have a lot of respect for him actually.

Thomas Graham:
I’m at Kettering Health in Dayton. We’re a dynamic regional growth oriented system, 14 hospitals, 15-16,000 employees. We’re really proud of what we do as our collection of acute care hospitals form a high performing network. We’re the official healthcare provider of the Cincinnati Bengals. We’re doing a lot of stuff right and again, when you have a head start like that, of having Charles Kettering’s name on your building, you better do that. So we’re really proud to be a faith-based, mission-driven, high innovation environment that, again, is celebrating our heritage both on an individual level, Charles Kettering, and on a regional level representing Dayton who has been so important to this country’s advancement of creative thought.

Jeff Standridge:
Well, it is a pleasure having you with us today. And it’s certainly an honor as well. We thank you so much for your time.

Thomas Graham:
Thank you, really appreciate it. Best of success to everybody. And I’m an easy guy to find and, like I said, innovation gets supercharged by partnership and we’re always open to that.

Jeff Amerine:
Fantastic.

Jeff Standridge:
Fantastic. This has been another episode of the Innovation Junkies podcast. Thank you for joining.

Thomas Graham:
Thank you gentlemen.

Jeff Amerine (Outro):
Feedback from listeners like you helps us create outstanding content. So if you like this episode, be sure to rate us or leave a review. Also, don’t forget to subscribe to get the latest growth in innovation strategies. Thanks for tuning in to the Innovation Junkies podcast.

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