Digital Transformation - Pushing the Envelope

In the world of high-performance flying (think space shuttles and F-16s), the phrase “pushing the envelope” is commonly used. The expression comes originally from mathematics and engineering, in which an envelope is a boundary, but was popularized by test pilots (especially those depicted in Tom Wolfe’s book “The Right Stuff”). In aircraft design and testing, the technical meaning of “envelope” is the whole set of limitations governing safe operation of the aircraft. The simplest common meaning of “pushing the envelope” is to push the boundaries of what is possible.

The purpose of a test pilot is to take a new aircraft to the limits of performance and, if possible, beyond – i.e., pushing the envelope. To be successful, and survive, test pilots must understand capabilities and limits of the airplane, their individual talents and the local environment.

 

Why would anyone do this? 

Because that is how you change the world.

It is the innovators that question boundaries – they imagine, develop and deploy new technologies that actually change the envelope and then define new boundaries and challenges to consider. On Dec. 17, 1903, Wilbur and Orville Wright made four brief flights at Kitty Hawk with their first powered aircraft – the first successful airplane. One lifetime, and many test flights later, humans landed on the moon.

What does this have to do with MUSC? Like a high-performance aircraft, our purpose is not merely to “fly the aircraft.” As an academic health system, we are expected to redefine the boundaries of health care. Literally, “changing what’s possible.” This dimension is what, in my opinion, sets us apart and likely what provides the purpose and fuel for our students, staff, faculty and health care providers.

So, what is my purpose in drawing these flight analogies? (Aside from getting a chance to show some cool pictures of jets in flight). I believe there are some relevant parallels for us to consider:

• Basic flying means that you must be moving forward (certainly not backward).
• Functioning at a high-performance level means that you must live at, near and sometimes beyond the edge of the envelope.
• Pushing the envelope comes with risk and if pushed too hard could lead to structural (or personnel) failure.
• Introducing new technologies and approaches can enable safe and sometimes breathtaking advances that change the boundaries of the envelope and therefore what is possible.
• Pushing the envelope safely and successfully is a team sport – from the conception, testing and implementation of new ideas and possibilities.

In two previous blog posts, Life Beyond COVID-19 and Tyrannosaurus MUSC Rex?, I shared some thoughts related to how MUSC must evolve to meet growing demands across our tripartite mission. Unsustainable costs and massive student debt, poor specialty care access, inequitable delivery, redundancy, hyper competition, lack of transparency – they all require more than one-off solutions. It’s why the term transformation is so apropos; we can’t do things the way we’ve always done them anymore. That world where we created those processes, standards and culture no longer exists, and if we are being honest with ourselves, it’s the difference in trying to continue to fly our Kitty Hawk Flyer when what we need is an F-22 Raptor.

The envelope is elastic, constantly changing. There is a pretty big difference between the capabilities and envelopes of a Kitty Hawk Flyer and an F-22, but both aircrafts pushed the boundaries of what was possible in response to the demands of the time and the technology available to make it happen.

One major tool within our grasp that can help us to push the envelope is digital technology.

A recent webinar led by George Westerman, DBA, principal research scientist for Workforce Learning in MIT’s Abdul Latif Jameel World Education Lab, provides an excellent snapshot of the difference between fast-tracked technology solutions and actual transformation.

“Digital transformation is less of a digital problem than it is a transformation problem,” Westerman said. “It’s a leadership problem for envisioning and driving change.

He goes on to challenge certain old-world assumptions about digital transformation as an incremental technology aid, with some very specific examples of how industries, including health care (e.g. COVID-19 and the explosion of telehealth adoption nationwide by providers and to some extent, payors), have flipped the script on those assumptions. Of note, much of what he explains is related to how best to transform culture and therefore, business. To me, this also aligns very nicely with what we seek to transform in our patients’ experiences and our daily work lives at MUSC. The move to integrate, consolidate and automate tedious, ineffective and outdated technologies with the new OurDay system for operations and human resources (coming to you in 2022-2023) is a specific, relevant example. 

Key takeaways for today? We must pursue new ways of doing our business, and that is going to take pushing the envelope across our clinical, operational, research and academic scopes of work. Now here’s the really cool part … right now, with content experts and stakeholders from across the enterprise, we’re creating a strategic roadmap that defines how we’re going to achieve this transformation. Some of the components include how it will be governed at the enterprise level, how we are going to prioritize what changes happen and when, how we allocate resources to get this important work done and how we are going to align the myriad examples of excellent work already happening in siloes around MUSC. We’re going to address pain points and innovate in ways we haven’t even thought of yet; if we can do this successfully, I predict that history will embrace our institution as a pioneer in positively transforming health care for our state and nation. The second key takeaway is that we need to pay attention to and support our teams and each other to make sure that we are in a safe zone and have the resilience to function safely at a high-performance level (more on that in my next blog).