Senior vice president of strategy and innovation, Memorial Sloan Kettering Cancer Center
The 130-year-old Memorial Sloan Kettering Cancer Center is the oldest freestanding cancer center in the world, with 14 care sites and 150,000 patients a year. In nearly four decades with the organization, Senior Vice President of Strategy and Innovation Wendy Perchick has held numerous roles, but lately she’s charged with guiding MSKCC to the future. She’s deploying design, technology and data analytics to help create a more customized patient experience and to reshape the role of a hospital in treatment delivery. The lessons she shares extend well beyond healthcare and into any company or industry grappling with organizational issues that come from increased personalization and a decrease in the importance of physical infrastructure.
Of all the changes you must have seen in 37 years at MSKCC, what stands out as the most seismic shift?
Up until the 1980s, the treatments of cancer was a largely inpatient activity due to the toxicities of the drugs and the types of surgical and diagnostic procedures. Technology, particularly in imaging and surgery, has changed that by increasing our ability to visualize disease without dramatic invasive procedures. Also, chemotherapy was once extremely difficult for patients to tolerate. Nausea and vomiting were immediate and you wanted an inpatient environment to handle that. The development of anti-nausea drugs changed that. Up to the early 1990s, almost every chemotherapy treatment was inpatient. Now we only have a small handful of treatments that are given inpatient and those are being transitioned out.
What are the ramifications of the physical infrastructure becoming less important?
Well, it still is very important, but it isn’t the only way that we can reach and treat patients. Historically, we needed to admit patients to treat them. The change in how we diagnose patients—particularly with the extraordinary progress in imaging technology—meant we ceased to need to admit patients to treat them. As soon as we eliminated beds as a requirement, we released the primary constraint and opened up to dramatic growth in the number of patients we could treat. We moved from inpatient beds to outpatient chairs and over a 10-year period there was close to a 500 percent increase in chemotherapy treatments at MSKCC. But now the trajectory really is to the home. We’re envisioning providing patient care in multiple environments with continuous connectivity. So, yesterday we were dependent upon bricks and mortar. Now it’s bricks, mortar, remote monitoring, technology, mobile apps, and the deployment of care further and further away from the hub. Tomorrow, and I really do mean, really, tomorrow, we start to care for the patient regardless of where they are.
How do you reimagine an institution the size of MSKCC where the hospital has been core to its value for so long?
The hospital will always remain important, but not the sole site of care. I’m looking to test and prototype in various areas so that we can start to see what the ecosystem needs to look like. For example, we developed a storefront in Brooklyn where we put all of the elements that we thought we’d need to deploy chemotherapy closer to where patients live in a way that took out the costs of production, kept the patient connected and required zero waiting. We engineered production so a patient’s drugs are prepared in advance and delivered on the day of treatment. We taught nurses how to do Reiki massage and guided meditation because if they weren’t doing production, they could spend time with patients. And we used telemedicine to put patients in contact with clinicians. At chair side, we placed Skype to connect the patient’s family. This area, four years later, still has less than one minute waiting time for patients. The average is around 90 minutes in our other sites. And there has been extraordinary satisfaction.
Impressive. What have you learned from this experiment—and can it scale?
It taught us about how you use remote monitoring because we no longer needed to be tethered to a large clinical environment. And yes, it’s teaching us about how to deploy this model in other areas. Do you remember the movie in the ‘70s, The Boy in the Plastic Bubble?
Sure. John Travolta.
Okay, so that boy was getting a bone marrow transplant. At the time, the procedure was so invasive that you had to isolate the patients in a sterile environment. With remote monitoring and many other innovations in care delivery, we’re now starting our first bone marrow transplant pilot in patient’s homes. So you put those developments together and you start to realize that the edges of care are really no longer so firm or impenetrable.
You mentioned training nurses in new skillsets. More broadly, are you seeing patterns among the type of people likely to succeed in a decentralized environment?
Overall, I’m seeing a real shift in the types of people who can interact and innovate in these environments. In the world of bricks and mortar, you really had a control and deploy environment. This new ecosystem is built more around the patient. In a way, it sends the clear message, “Your cancer’s unique and so are you.”
So it would seem less important to learn the rules of an established system than to react to the situation. What underlying characteristics tell you whether someone will be successful?
It’s tough to characterize them exactly, but I guess you might say we’ve begun to hire people who are intellectually courageous. Even if they don’t know the answer, they know they can search and find real-time solutions for real-time problems. I guess we’re talking about people for whom technology is sort of a joy and not a burden to be borne or something imposed upon them. They need to be energized by technology.
You’re also implying a certain comfort level with data.
We’ve always needed people who can collect data, who can ensure its accuracy. But this next generation sees data as a series of potential connections and begins to use visualization tools to pull out insights and think, how can I use this insight to predict? Thirty years ago, all I saw in data were problems. What I see now, and almost to a dizzying degree, are solutions. I have a quantitative analytics team of economists and mathematicians and statisticians who reveals insights and actions to take. Those insights bring communities together by breaking silos between departments. You start to see people who think about systems, like designers, working with operations people in new ways and the nature of collaboration changes. We are seeing the ability to uncap the power of the data through new tools, analytic capabilities and visualization. When you see this kind of thing happening, you realize the opportunities within data are breathtaking.
Why did you do the chemo trial in Brooklyn?
The short answer is we did Brooklyn in Brooklyn because it was not in Manhattan. The truth is, in an organization like this, which is very big, we can’t shake the main ship. We need to keep the body of the organization steady and pick critical nodes to innovate around. So we put a circle of safety around the people in Brooklyn and let them go.
So, the fragile process of innovation must be protected. How else do you provide safety?
One is to provide high-level support. If they’re trying to deploy real-time location systems and the existing staff says, “That’s crazy. Why are you bothering to do that?”, they have the ability to say ‘This is a concept that we want to test.” We also try to carve out the scope to give them much more control. Another thing, and I know this is a cliché, but we really try to embrace failure and rapid prototyping so that there isn’t any such thing as failure; there’s only learning. Learning what didn’t work isn’t failure. It’s new knowledge.
What’s the role of uncertainty in innovation?
The way I look at it, you can either decide exactly how to move forward and prescribe every step, in which case you’re really not innovating. You’re probably deploying something that’s a variation on what already exists. Or you’re allowing iterative innovations to define opportunities. I don’t know what homecare will ultimately look like for cancer. I really don’t. I don’t know every system that needs to be changed. What I do know is that traditional hospitals are part of the past and in the future they become part of a portfolio of ways to treat patients. So we ask, what if there were not intermediaries between patients and care? And then, how do we get there? I don’t really know. But I do know that we can start to change things and teach ourselves as we go.