Bobbi Pritt, M.D. (00:40):

Hello, I'm Dr. Bobbi Pritt, a clinical microbiologist and laboratory leader at Mayo Clinic, and your host for today's episode. I'm excited to be here today with Mayo Clinic Laboratories' CEO and president, Dr. Bill Morice. We'll be discussing some recent topics in the news, and then we'll move on to explore how to create an innovation strategy that drives value for your organization. Bill, welcome back.

William Morice II, M.D., Ph.D.  (01:04):

Yes. Great to be back, as always.

Bobbi Pritt, M.D. (01:06):

So, let's start with what's new and noteworthy in clinical diagnostics. You just came back from Washington. I'd love to hear a little bit more about what you learned while you were there.

William Morice II, M.D., Ph.D.  (01:17):

Well, I learned a couple things. I was there trying to get a read on the upcoming cuts with PAMA implementation, the challenges of data collection. As you know, I think we're just reaching the end of the data collection period, but just how difficult that is for hospitals to report. So it's almost certain to give a skewed dataset for use for rate setting. That was the purpose. I would say that the two takeaways are pretty similar to what we've seen. Number one is that there is genuine interest in getting this addressed. There's over 100 co-sponsors for the RESULTS Act to address this issue. It's bipartisan support as well. So, a lot of support. And then, the practicality of the cost of the bill, right? So what happens now with the RESULTS Act is the Office of Management and Budget, OMB, will take a statistical model to say how much will this cost the government?

And then for the law to be passed, if it costs money, that means that money has to be taken out of somewhere else in CMS reimbursement because they need budget neutrality. Again, probably the most important thing is to stay informed, stay engaged, engage your local representatives. Yeah, we really need to make sure this gets supported.

Bobbi Pritt, M.D. (02:24):

Well, you know, it's so important. I'm sure that's going to be a challenge. So, advocacy is more important than ever. Moving on to the next topic, we have the screwworm, what they call the New World screwworm is back in the United States. I don't know, have you been hearing about that, Bill?

William Morice II, M.D., Ph.D.  (02:38):

Only in the lay press, actually.

Bobbi Pritt, M.D. (02:40):

Yeah, it's a really big deal. So, the New World screwworm, it was eliminated from the United States through the sterile fly program. It was a really ingenious kind of low-tech, old-fashioned method. Unfortunately, though, the flies weren't eradicated off the face of this Earth, and they're still around. They're in the Americas, South America, Central America, and Mexico. And now, they're coming back up again. And we now have the New World screwworm in Texas. No human cases, but there have been now 37 confirmed domestic animal cases. And it's not just Texas as well, it's now New Mexico. So, it's a huge problem for the livestock industry.

William Morice II, M.D., Ph.D.  (03:20):

Yeah, sure. Because I understand that the fly deposits the larvae into tissue. As the larvae grows, it develops spines and spins in its location. So, it sounds pretty horrible.

Bobbi Pritt, M.D. (03:33):

It’s very destructive.

William Morice II, M.D., Ph.D.  (03:34):

Yes.

Bobbi Pritt, M.D. (03:36):

It's what we call creeping myiasis. So, myiasis is just when mammalian tissue is colonized by a fly larva. And most of the cases we see, you know, maggots, fly larvae, whatever you want to call them, they usually stay in one spot and they cause a furuncle. But these actually creep, or invade, through the tissue, and they could be really destructive. They can go through the skin, so they can ruin animal hides. They can go through the meat, so they can ruin edible products. But then, they can actually kill the animal and invade right into the brain and other organs. So, very destructive, very important for laboratories to be able to identify these maggots if they're removed and sent to a lab. So important laboratory component, but then big public health efforts to just make sure to monitor, look for any new reported cases. And then they're working on eliminating the screwworm again using the same techniques that have been successful in the past.

William Morice II, M.D., Ph.D.  (04:35):

Wow.

Bobbi Pritt, M.D. (04:37):

Big deal.

William Morice II, M.D., Ph.D.  (04:39):

Big deal.

Bobbi Pritt, M.D. (04:40):

Right. Now, I think we'll change to something completely different. Welcome to the deep dive. Today, Bill is staying on with us to go beyond the headlines and discuss how to create an innovation strategy that delivers true value for patients and your organization. So Bill, now we're going to go back in time when you were the chair of the Department of Laboratory Medicine and Pathology, time that I remember fondly. I was here for all of it, and I remember you led an initiative to change how we approached innovation as a department, which of course, innovation is a little different than say, test validation or development. It really is its own thing. So, can you give our listeners a summary about what you did with this innovation strategy?

William Morice II, M.D., Ph.D.  (05:28):

Yeah. Well, first of all, I remember it fondly as well. I'm glad you do, too. It's probably my favorite job I've ever had, being the chair of the department. As you bring it up, it's hard to believe this is actually about 10 years ago now. I began my tenure in 2015. Dr. Noseworthy was the CEO of Mayo Clinic at the time. He asked me as I came in, what did I think was the biggest risk for DLMP and Mayo Clinic Laboratories as a combined entity? I actually told him, my concern was that we were losing the ability to innovate as the business grew, right? As the volumes grew through MCL, as you've experienced in your own lab, it puts real pressure on really meeting patient needs. And yet, if we're not thinking about innovation, we're not meeting not only the current but the future needs of patients. And so, Dr. Noseworthy supported me in that, and so that really initiated it. He asked me to craft an innovation strategy.

Bobbi Pritt, M.D. (06:17):

Well, I know that it was a lot of work and you were very successful with it. What were a few elements that you think were essential to the success?

William Morice II, M.D., Ph.D.  (06:25):

It seems like a success. I think it has been. You know, it really starts with the basic premise that systems will produce what they're designed to produce. We have always had great innovation in DLMP. What we experienced in our career arc here in the department was that over time, it was really strong in the laboratories, but it became difficult then for us to respond to big land shift change, big changes in diagnostics. Like, for instance, NGS, next-generation sequencing, came into being as a clinical tool. That was bigger than any one individual lab, and I also was now, as department chair, responsible for the resource allocation within the department. And at that time, all the resource allocation was from the same bucket, if you will. And so, those two things really conspired against us in terms of keeping the thing that really draws all of us here to Mayo, which is, in part, of course, the needs of the patient, but not just the current needs, but the future need.

With those things in mind, I started to both do my own research, look at other industries, and then get an industry expert. What are some of the key principles if you're going to design a system that actually fosters and protects and grows innovation? What does it look like? The things that start to come out were, you need a separate structure, right? Because the demands of innovation are different than the demands of clinical production, as well as the questions. The questions you ask going into innovation is, "Is this worth doing? Does it have some feasibility to it, right?" Whether you actually roll it out is, does it work, and does it achieve its goal? So those were the two pieces that really went in, Bobbi, was thinking about then, how do we create a structure across the divisions that allows us to think strategically around test development across divisions?

And also, how do we then, as department chair, how do I work with my administrator to actually create the resources and the resource allocation mechanisms and the oversight to actually drive whatever we were trying to accomplish?

Bobbi Pritt, M.D. (08:15):

Yeah, it's kind of a tricky spot to be in, right? Because it sounds like you need structure. You have to ask yourself these questions. You can't just say, "Go forth and innovate." But you need that flexibility so people can try things that might possibly fail. So how did you approach that? How do you balance the more structured approach with the need to remain resilient amidst this rapid pace of healthcare as well?

William Morice II, M.D., Ph.D.  (08:37):

It's a great question. There's another book that I contributed to on leadership development, and I actually tell the story when I rolled this out to the division chairs, and it went over like a lead balloon because they were like, "Hey, we're doing test development just fine until you showed up." And it actually made me step back and realize the first thing is, you really have to invite people into what the problem is and what you're trying to accomplish. So actually, after that division chairs meeting, we set aside every Friday morning just to get all the division chairs in a room in Rochester to just talk through, "OK, what are the challenges that I'm seeing? Do you see them too?" So, you have to really get a lot of engagement. Why is that so important? Because you're actually trying to maintain a dynamic tension in this process, right?

Meaning, yes, it's important to have priorities, right? Dr. Noseworthy said, "We'll give you more resources if you show us that you're responding to institutional priorities around test development." Which he didn't feel was happening at the time. Great. Flip side is a lot of the best innovations are from the ideas of people that are solving problems in their day-to-day world. It's you in the laboratory getting called about a pathogen and this doesn't make much sense or whatever, and it makes you think about what's missing here. It's me in the heme path lab doing the same thing. So, how do you balance sort of that top-down prioritization with the roots-up spark of innovation that could lead to really big things? That takes a lot of stakeholder engagement. It takes a lot of iteration. It takes a lot of trying and failing as a leader. If you're going to ask the people that are innovating to try and fail and be willing to fail and admit when something was a great idea and it's not feasible, you have to have that same level and same approach as the person and persons leading the effort as well.

Bobbi Pritt, M.D. (10:13):

Well, I recall some of this, so I know that you did engage staff, make sure that they were incentivized. People like to innovate generally, but you're right, they may say, "Well, why are you trying to tell me how to do this? I do this just fine already." Plus, you have to have that accountability. So, you had the regular meetings. Were there other specific approaches that you used?

William Morice II, M.D., Ph.D.  (10:37):

Yeah, we did a couple of things. You know, one of the concepts that I really liked as I did my research was A, the separate budget. If you don't have a separate budget, you're going to always take out of one pot, innovation will be the first thing to go every time when you're at times of economic stress. The second was a spot where you can innovate, right? An actual dedicated space where we could have collision between the different divisions in the department. And so that was the advanced diagnostics lab, right? That was a physical structure. We put in some things in place to make sure that those things had transparency in how they were used. So, one of the things that was probably one of our greatest successes was setting up an advisory committee that would review proposals that was independent from me.

That was an independent advisory group from members from across the department that were thinking about what went into that Advanced Diagnostics Lab and got access to those resources. And then, also transparent about what we were trying to accomplish. So if you recall, Scott Beck and I both said, "If everything that comes into this innovation space works, then we have failed." Because if we're really innovating, there has to be some things that are stretched that were great ideas, like I said, but just weren't quite actionable at the time. And I think we accomplished that. We kept the division chairs engaged and involved, and we would talk about and celebrate when it made sense when something didn't work.

Bobbi Pritt, M.D. (11:52):

Well, the ADL is still going strong, and I've had projects going through there. We're using it to kind of test the waters on certain things before we want to start trying to even bring it to development. So, I think it's a great idea. And like I said, there's multiple ideas now that go through there every year. Some will make it to clinical practice, others will just die out. And that's OK though, because we'll learn from any failures. And I shouldn't say the word failure. It's maybe a failure of the test or the instrument, but not a failure of the project because the project was to test it out to see if it worked to begin with.

William Morice II, M.D., Ph.D.  (12:28):

Exactly. It sounded like graduate school. Like I tell people, the hard part about medical school is getting in. Hard part about graduate school is getting out because you could be right, but your test system might not be able to prove it. So the other thing that's really been great and an unanticipated benefit of the ADL and the innovation structure, it gives me now in my current role, the opportunity to actually invest in innovation in the department. Because now that MCL (Mayo Clinic Labs) and DLMP are separate, we have to really be very transparent to auditors about what money is going into the department. I could put more towards it, right? I can say, "OK, how much of our budget should be going into that?" And I can also do that in a way that still gives DLMP the autonomy to respond to some of what we're seeing as market priorities, but also use those resources to continue to foster that grassroots thing as well.

Bobbi Pritt, M.D. (13:17):

Well, it's definitely one of the more exciting things that I get to do maybe before, you know, right after all the exciting things I do with direct patient care, is preparing for the new tests, the new outbreaks, trying to get ready so I can care for our patients. And innovation's really neat. I've been involved in a number of projects and, you know, some have failed, some have gone forward, and we actually now use various outputs from that in the clinical lab today. You know, we've talked in the past about discovering new organisms, and we have a couple more in the pipeline now as well that looks like we're going to be working on.

William Morice II, M.D., Ph.D.  (13:52):

That's awesome. And, you know, the other thing that was difficult for the department was putting oversight on those resources, the management team and things in place. But you need that for that transparency downward as well, right? You know, if we're going to give resources, are they being used; have we reached a point that we should pivot? But hopefully also, there's still some unstructured resources to help people pursue. And also kind of looking back to your set point, not failures, but what have we learned? Because I always go back, I think about the other company I thought a lot about when I was thinking first about the innovation strategy was 3M. And that 3M gave, at that point, a 20% unstructured time to their scientists. And that's where sandpaper came from. There was a scientist, they had a water-resistant paper, a glue, and a mine grit.

And the guy thought, "What if I put these together?" And the other that came out of that was Post-it Notes. So, the story of Post-it Notes is really interesting, because they had a scientist in the '60s that was charged with making an aerospace glue that would be incredibly strong. Well, the project failed completely, because the glue he came up with was not only not strong, it didn't leave any residue. It would just kind of come on and off. Well, years later, another 3M scientist was getting frustrated that his bookmarks in his hymnal, because he was in the church choir, kept falling out. And he knew about this glue and he said, "I wonder if this would work for my bookmarks?" And that's where Post-it Notes came from. So, you have to balance. I mean, you have to create the environment for success. It has to have accountability, and you have to balance prioritization with creativity.

Bobbi Pritt, M.D. (15:18):

Yeah. Well, fascinating conversation. And now I'm starting to wonder what my next Post-it Note discovery is going to be. But you're right. Innovate, but hold yourself accountable, have some structure around it, and then see what happens and comes up with. Well, thank you for creating that foundation that we've continued to build upon.

William Morice II, M.D., Ph.D.  (15:38):

Well, thank you for making it work.

Bobbi Pritt, M.D. (15:45):

Let's wrap up with the top takeaways and how to learn even more on the topics we discussed today. During the news segment, we explored some takeaways on current legislation that will impact laboratory medicine, and we talked about the New World screwworm, a rather worrisome experience that some of our states are seeing. And then in the deep dive, Dr. Morice and I discovered what leaders can do to create an approach to innovation to deliver true value for their organizations and the patients we all serve. For more on this topic, we've included an article from Dr. Morice in the show notes on the four steps for establishing a new approach to innovation. Thank you for joining us today. If you haven't already, make sure to subscribe so you never miss an episode. Next time, we'll welcome Mary Jo Williamson, Mayo Clinic Laboratories' chief administrative officer, to discuss leading through periods of rapid change. I hope you can join us.