Standardization Is Innovation

Editor’s note: The Final Cut is a recurring editorial series written by a member of the AAOS Now Editorial Board.

In recent years, we in orthopaedic surgery have been increasingly drawn to innovation. Because of brilliant ideation propelled by collaborations between industrious and inventive orthopaedic surgeons and teams of engineers from our industry partners, we are seeing an increase in new technologies that further fuels this interest. All the while, there is an echo of Steve Jobs; his work standardizing the USB port is remembered as one of his most enduring innovations. It is my hope that you will come to see standardization as an amazing innovation as well.

But what is innovation? Merriam-Webster defines innovation as “a new idea, method, or device” or “the introduction of something new.” Innovation in business is the process of introducing new ideas, products, services, or processes to improve an organization or drive growth. In medicine, it is the process of creating or adopting new ideas, products, services, or processes to improve patient experiences or clinical outcomes. Successful innovations are both desirable and usable. They can take many forms, including advancements in health-system models, management practices, information technologies, workflows, and therapies. An enterprise goal of innovation is to improve a healthcare system’s ability to meet the needs of patients and the public.

Along with driving innovation, orthopaedic surgeons have simultaneously been in search of increasing value in recent years, given the fiscal realities of the rising expense of healthcare. Skyrocketing costs of healthcare provision (potentially due, in part, to the cost of innovation) make the goal of meeting the needs of patients more difficult to achieve. However, there is an intersection of innovation and value, where change is created that adds value. A strategy called “value innovation” balances these two factors equally and is more likely to lead to successful products and services than technological innovation alone.

Value innovation is the cornerstone of the “Blue Ocean Strategy,” from a framework developed by W. Chan Kim and Renée Mauborgne in their 2015 book with the same title. They describe creating new demand by developing uncontested market space (i.e., “blue ocean”) instead of competing in the crowded “red ocean” colored by the blood of everyone who swims in it. Finding new opportunities to create better outcomes, greater access, and more convenience for patients and clinicians is key to value innovation in healthcare. A recent example is the use of special glasses that overlay templated designs onto the operative field, so that surgeons can improve their placement of implants. The glasses that project imagery are a new, uncontested market, rather than the older market of templating onto physical radiographs. However, value innovation also involves considering the cost of these innovations during development. In this case, the cost of the glasses is rapidly decreasing, especially as many industry partners are subsidizing the costs of the technology to create the images.

Another example of value innovation in orthopaedic surgery is value-based care, which involves providing high-quality care or improved outcomes with cost affordability in mind. For instance, joint arthroplasty implants with sensors that can track a patient’s progress and communicate the data to a care team offer a two-for-one exchange of renewed function and valued data. Virtual care teams can provide asynchronous care for patients, offering convenience and reducing costs. Many systems have increased use of this tool since the COVID-19 pandemic.

Standardization is the process of implementing and developing technical standards based on the consensus of different parties, such as firms, users, and interest groups. In my healthcare organization, I often say that “standardization is innovation.” How can this be, if medical innovation includes “new” processes? I propose that building agreement around standardized processes, such as using aspirin for most venous thromboembolism prophylaxis, is idealistically new. Getting 200 orthopaedic surgeons to agree on a treatment regimen that might go against individual prior trusted practices is certainly novel.

We have exercised standardization for multiple care-pathway initiatives in my healthcare system. Rather than implementing screening protocols, we implemented universal decolonization prior to elective total joint arthroplasty, which reduced surgical-site infections and promoted cost savings as we removed a costly screening component and treated all patients prophylactically. We have opted for Velcro braces for torus or buckle pediatric wrist fractures, with only essential follow-up thereafter to realize cost savings. We standardized the number of return visits for several routine orthopaedic diagnostic care pathways, opening clinic time to accommodate diagnoses with more acuity.

The process of agreement to standardize care in a way that creates additional value should be seen as novel in and of itself. If readers scoff and consider this argument to be simply evidence-based medicine with a pinch of economics—they would be interpreting it insightfully as well!

Artificial intelligence, robotics, and virtual/augmented reality are all short horizons away from our everyday existence. There will be other innovations that we cannot know are coming, but standardization can innovate our practice immediately.

We can all find some standardization in our systems and, thus, cross into the innovation frontier, without opting for an expensive tool complete with holograms that is woefully bereft of outcomes data. We must remember that in standardizing processes, we might very well be swimming in the blue ocean of value innovation and delivering on the preferred grail of value-based care.

Ronald A. Navarro, MD, FAAOS, FAOA, is the regional chief of orthopaedic surgery for the Southern California Permanente Medical Group and professor of orthopaedic surgery for the Kaiser Permanente School of Medicine. He is also a member of the AAOS Now Editorial Board.

References

Blue Ocean: Value Innovation. Available at: https://www.blueoceanstrategy.com/tools/value-innovation/#:~:text=Value%20innovation%20places%20equal%20emphasis,the%20industry%20has%20never%20offered? Accessed Oct. 21,2024.
Sambare TD, Vega AB, Rana SSS, et al: Value-based care and the Kaiser Permanente model. J Shoulder Elbow Surg 2024:S1058-2746(24)00674-8.