Joshua Liu

When we started SeamlessMD to deliver digital care journeys for patients, we did many hospital pilots.

Before involving hospital executives, clinical teams told us we needed to do a pilot to prove the ROI. No one wanted to engage hospital leadership at all until we had data in hand. We were regularly told “if we show we can reduce readmissions, the hospital will definitely buy this.”

It makes sense, right? Let’s start quickly, prove it out and then blow everyone away with incredible results.

So we’d do the pilot. Together, we’d invest a lot of time and energy implementing the platform. We’d run a 6 to 12 month pilot. Then we’d stop the initiative and wait while the hospital did an outcomes analysis.

Often the clinical teams would return with incredible results, such as 50% reductions in ED visits or readmissions. Often statistically significant.

And then we’d finally get that big meeting to present to hospital leadership. Sometimes even the hospital CEO would show up. We’d show those amazing improvement in outcomes. And then…

Nothing. No hospital purchase. No continued benefit to patients.

I remember one hospital CEO (who himself is a physician) telling me:

“Josh, these results are fantastic! And I can see how SeamlessMD is great for patients too. But actually, reducing readmissions isn’t a priority for us…“

At first you think it’s an anomaly. But after a while, it’s a pattern.

Pilotitis

The Advisory Board defines “pilotitis” as:

Pilotitis (noun) – “the act of continuously pursuing small health care projects but never scaling them, leading to duplication and short-lived benefits.”

I first heard the term from health tech entrepreneur Geoffrey Clapp in 2014 when he was delivering a health tech keynote. We all laughed, but every Digital Health advocate eventually realizes over time that pilotitis is no laughing matter.

Do a Google Search on “pilotitis” and, lo and behold, you find mainly healthcare webpages. So perhaps pilotitis is only a disease in our industry. Or perhaps it’s a healthcare term, poking fun at medical lingo. That said, I rarely hear colleagues in other industries getting frustrated with pilots, so it’s more likely to be a healthcare disease.

Within health systems, I suspect folks have a Love-Hate relationship with pilots. On the one hand, pilots in theory seem like a nimble way to deliver a proof of concept before investing further. On the other, so many fizzle out even if the results are good.

Unfortunately, pilotitis causes many problems:

• Wasted time and money: Both hospital staff and companies invest significant resources and time (sometimes over a year!) on an initiative that was never set up for success.
• Decline in morale: It’s one thing if a pilot fails because the results aren’t good. It’s worse if you delivered on your promise, but the initiative dies anyways. Which leads to…
• Slower innovation in the future: The next time something innovative is worth exploring, why would frontline providers or companies care to try? I’ve seen folks on both sides of the table become cynical and move on from trying to innovate in healthcare. This is sad because improving healthcare is so important and meaningful! We can’t keep losing people.
• Failed pilots due to poor implementation support: Sometimes pilots fail, not because the innovation wasn’t good, but because the execution was poor. A “pilot” is sometimes not taken seriously, sometimes treated like a “research study” where the results only matter to one researcher, etc. Operational initiatives with strong executive support are taken more seriously by staff and the full potential of the innovation is unleashed.

What causes Pilotitis?

In order to cure a disease, you need to treat the cause.

The #1 cause of pilotitis is that you’re trying to solve a problem that’s not a top 3 priority for your organization. (Note that the number 3 is a bit arbitrary – the key thing is that your innovation solves a problem that a key executive really, really cares about)

If you understand that concept, everything else falls into place. Every other aspect of pilotitis is a result of this.

If you’re not solving a problem that’s a top 3 priority for an organization, then you:

• Won’t have an executive sponsor: It’s not that the Chief Quality Officer doesn’t care about your amazing pilot results reducing readmissions. She’s genuinely impressed! BUT, the CEO has tasked her with cutting length of stay by 1 day this year, so that’s what she cares most about. And that leads to… 👇
• Won’t have access to funding: Because if your Chief Quality Officer isn’t going to pound the table at the leadership team meeting, saying your pilot results MUST be scaled across the hospital, then why would the CEO ask the CFO take out his cheque book? And that leads to… 👇
• A pat on the back – but no support to transition from Pilot to Operational initiative: Which leads to confusion and disappointment for the well-intentioned frontline hospital staff and mission-driven digital health company.

So how do you treat Pilotitis?

Fortunately, there is a straightforward treatment for pilotitis. Unfortunately, it’s not an easy treatment to administer:

Achieve Innovation-Priority Fit:

Get executive alignment and buy-in BEFORE implementing the innovation

That’s right – take your vision to your VPs and CXOs, and see if it solves a top 3 problem they care about.

What if you DON’T have Innovation-Priority Fit?

Alright, I see you rolling your eyes at me! Like I said, it’s not an easy treatment to administer. And you’re right, it could go horribly wrong. Sure, let me count the ways:

• You lose your champion: Some folks just won’t feel comfortable knocking on the door of a VP or CXO without results in hand. For some of them, this is their first time engaging an executive – are they ready to spend their social capital on your innovation?
• The approval process is delayed: Getting a meeting with certain VPs and CXOs could take a few months – especially if your champion doesn’t have existing relationships. And your champion could get demotivated from the work it takes to network across the organization, so they ask themselves: How important is this pilot really?
• The executives say “No, this is NOT a priority – at least, right now”: And in fact, they might squash your initiative entirely, and your pilot that otherwise would have gone unnoticed can’t even happen at all.

Sounds awful, but here’s why it’s a good thing: If you don’t have Innovation-Priority Fit, then the organization was never going to support your innovation after the pilot, no matter how good your results were. It sucks to hear, but wouldn’t you want to know the truth before you put in those months of blood, sweat and tears?

Just remember that priorities DO change. What’s not a priority this year can be a priority next year. I’ve see it in my own organization. We’re currently implementing a solution that was brought up three years ago, but it simply wasn’t a priority at the time. It’s not that it wasn’t a good idea – of course it was, it was being used by other organizations. But it wasn’t a priority for US just yet!

I’ve even seen health system priorities change just because a key executive changes. A new executive comes into the organization who is motivated to make your priority her priority – and BOOM, your innovation suddenly matters!

So to health system innovators: don’t give up just yet. But maybe put it on hold for the rest of this year. Just please don’t take it personally. Innovation is hard and timing matters.

And to digital health companies: don’t take it personally. What’s not a priority at one organization, may be the #1 priority at another organization. Just keep asking.

What happens if you DO have Innovation-Priority Fit?

However, let’s say your innovation DOES solve a top 3 priority for hospital leadership. This is when the magic happens. Then you often:

• Get clarity on what results you need to prove: Let’s say reducing readmissions is a priority – well, what amount of improvement matters? If the CEO says a 10% reduction is meaningful, then you know what to aim for.
• Get feedback on broader success criteria: Turns out that there are all kinds of other priorities you never knew about. Your innovation might also improve patient satisfaction scores? Now you’ve got the Chief Experience Officer engaged.
• Get funding immediately: Even for relatively new innovations, if you’re solving a problem the health system is desperate to solve, the health system will just buy the solution. There’s always funding for true priorities.
• Get to go bigger sooner: An executive who is highly motivated to solve this problem would rather just roll your innovation out more broadly, instead of starting with a tiny pilot.
• Get operational, day-to-day support: Because your solution helps address a priority, the executive team WANTS you to succeed. So they’ll often give you more resources – e.g. a project manager to support the day to day of your initiative. Gosh, wouldn’t that have de-risked the pilot you were planning to manage as a side project?
• Get the whole organization behind you: Because your initiative is addressing a priority, your initiative de-facto becomes important to the organization. Everyone around you is going to be asked to make it successful. People will be aligned to drive results.
• Get on-going engagement from executives: Your leadership team will WANT to stay engaged throughout. They’ll want to sit in on the quarterly update. They’ll want to know what they can do to help overcome obstacles that show up. Now you’re all in this together.
• Have a clear path to long-term sustainability: Since your innovation aligns with an established priority, and your leadership team is both financially and emotionally invested in your innovation – if you achieve your goals, then it’s a no-brainer for the innovation to continue and scale across the organization.

When there is true Innovation-Priority Fit, the probability of long-term success is dramatically higher.

So before you embark on months (or years) of Pilots, go pound on the door of your VPs and CXOs. Find out if your innovation solves a top 3 priority. Be even way more successful if it is. Save those blood, sweat and tears if it isn’t.