Intrapreneurship Experiences at Geneva University Hospitals

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PERFORMANCE

The art of surfing on side effects Faced with the need to “do more with less”, Geneva University Hospitals launched several initiatives, two of which are presented here. The first relies on the MicroMBA, an innovative training programme which, because it brings in more than it costs, has become a profit centre rather than an expense. By encouraging entrepreneurial behaviour, this programme also “along the way” gives managers, and doctors in particular, management skills to improve services and reduce costs. The second initiative makes use of the “opportunity file”, a project presentation tool that improves resource allocation (equipment, beds, staff, etc.) by requiring applicants to produce a much more comprehensive analysis aligned with the institution’s concerns.

Taking on challenges is part of everyday life in a hospital. This is obviously the case when it comes to saving lives or reducing suffering. But the challenges do not stop there. Given the level of healthcare costs, operational costs must also be reduced without affecting quality of care. The leader’s challenge can be summed up simply as “doing more with less”, in the face of patients/customers who are increasingly well informed and whose expectations continue to rise.

The difficulty does not stop there, because there is another challenge that is far from negligible: maintaining motivation and morale among the troops despite this unfavourable environment, in a hospital which, like Geneva University Hospitals (HUG), employs more than 10,000 staff. The difficulty is compounded by the emergence of “Generation Y”, which not only no longer accepts hierarchical authority as self-evident, but also has higher expectations in terms of leadership. Traditional management methods, in which the authority of the boss was unquestioned, are of course outdated and no longer make it possible to attract the talent we need in order to remain at the cutting edge.

This development calls for unavoidable paradigm shifts. Without going into the many initiatives implemented within HUG to meet this managerial challenge, we present here two innovations that break with convention and have produced very interesting results. Their originality lies in the fact that they aim to develop intrapreneurial behaviours within HUG. We are convinced that entrepreneurial behaviours and culture are one of the ways that will enable challenges to be turned into opportunities.

Bernard GRUSON Director General, Geneva University Hospitals

The management challenge

The first innovation was aimed at developing the management skills of doctors with supervisory responsibilities, even though management training is far from being a priority for them. Until now, although this is changing, doctors have shown little interest and little willingness to devote time to improving their management skills, since their promotion within the hierarchy has been based almost exclusively on technical competence.

Convinced that cultural change depends on training, we came to the conclusion that training had to be made as attractive as possible. After trying to broaden the catalogue of courses offered to managers, we called on Professor Raphael Cohen, director of the Entrepreneurship and Business Development diploma at the University of Geneva, to design an original approach, hoping in this way to attract middle managers. Indeed, they are the ones who, occupying a pivotal position, will be tomorrow’s managers while already being those who are, or will be, on the front line in managing the famous Generation Y.

The reason we thought of Professor Cohen was that he had designed and delivered, with great success, the first entrepreneurship course at the Swiss Federal Institute of Technology in Lausanne (EPFL) and at the University of Geneva. The challenge he had faced at the time was to give engineers and scientists a taste for management and business, fields whose very names sounded like a dirty word to them. As healthcare professionals’ perceptions are fairly close to those of engineers, the training centre team felt that what had worked for the latter might also work for our managers.

Drawing on this experience, in 2003 Professor Cohen designed the MicroMBA, a bespoke annual programme which, instead of focusing on management training, is centred on innovation and entrepreneurial behaviour. The range of topics covered includes tools for identifying and seizing opportunities, as well as marketing, communication, project management, process management, negotiation, leadership, human resources and conflict management. The aim is to introduce participants to all the subjects covered in an MBA, along with additional topics, but in an extremely concentrated format so that they acquire the essential tools, the vocabulary and a frame of reference identifying the key questions to keep in mind for each subject.

These rather theoretical, highly compact courses leave very little room for practice. To avoid the pitfall of a strictly theoretical approach, Professor Cohen requires participants, divided into small multidisciplinary groups, to identify an innovation within the institution and to implement it after the course. This requirement forces participants to put almost all the tools taught into practice. Once completed, the projects in question are presented to the other participants, while an executive summary ends up on our desk.

Training that pays off

Quite apart from the fact that this programme is an excellent talent revealer, it has become a profit centre rather than simply an expense burdening the training budget. The projects carried out do indeed produce a measurable return on investment. Being on the ground, MicroMBA participants are in the best position to identify opportunities and seize them. We have thus had projects that generated measurable savings, others that improved service quality, and still others that generated additional revenue. Overall, we can say that MicroMBA projects have brought in more than we have spent on training.

This emphasis on innovation did not sideline the management messages that originally motivated the programme. While learning how innovation and intrapreneurship work, participants also became familiar with a series of soft skills and management tools. Instead of making them the main message, management skills were introduced gently, showing how they facilitate the implementation of an innovative project. In other words, the side effect corresponded to the primary objective. Participants have quite clearly become better leaders.

There have been other side effects. The fact that this programme brings together doctors, nurses, managers and people working in logistics has had the effect of substantially breaking down silos within HUG and developing participants’ personal networks. The links forged during the MicroMBA last beyond the programme between people who would probably never otherwise have collaborated or got to know one another. The MicroMBA has also helped to develop an intrapreneurial culture in which initiative-taking that supports the institution’s strategy is encouraged.

MicroMBA participants have not only become agents of change; they have, moreover, developed a taste for it. The existence of this energetic driving force could be measured in 2010, when we introduced the HUG management innovation prize, in which four of the ten finalist groups included people who had taken the MicroMBA. The pleasure and enthusiasm expressed by participants in taking this training also had the merit of “infecting” their colleagues by making them want to follow the programme. It is indeed one of the rare cases where contamination is encouraged by a hospital director...

This entrepreneurial momentum has been supported by other initiatives such as the creation of days and prizes dedicated to medical innovation and quality, as well as the creation of an innovation office that guides and supports all staff wishing to take initiatives that support HUG’s strategy. The combination of these measures with a series of others is helping to change the mindset of the hospital’s staff.

The resource challenge

If there is another mindset in relation to which we would like to create imitators, it is the one relating to resource allocation. The hospital management is in fact very frequently asked to support requests for resources. These range from staff recruitment to the purchase of ever more high-performing equipment, including increases in floor space or in the number of beds in a unit. Over the years, we have realised that these requests are generally developed more in line with the applicants’ own perspective than with institutional concerns.

To avoid the waste of time and frustration resulting from refusals caused by incompletely presented projects, we came to the conclusion that management’s expectations needed to be clarified when resources were being requested. Knowing that MicroMBA projects require participants to obtain the agreement of the decision-makers concerned for their ideas, we also asked Professor Cohen whether the tools taught in the MicroMBA could improve matters in terms of resource allocation.

He suggested using the “opportunity file”, which he developed as a complement to the IpOp model. The opportunity file is designed precisely to answer the questions that decision-makers asked to support an innovative project must ask themselves, which amounts to allocating resources (money, people, space, etc.). The IpOp model developed by Raphael Cohen is the tool that makes it possible to analyse the project systematically and in a structured way before drafting a robust opportunity file.

Raphael Cohen, in collaboration with Brigitte Rorive from the Medical-Economic Analysis Department, therefore adapted the opportunity file to the specific situation of HUG so that every new request for resources would be formulated after a rigorous and structured examination. All the hospital’s administrators were therefore invited to attend training designed to teach them the IpOp model and how to draft the HUG opportunity file.

Making use of side effects

As the IpOp model and the opportunity file are the basic tools for analysing and launching innovative projects, the simple fact of teaching them has the effect of indirectly training people in an intrapreneurial way of approaching things. Experience has shown that between 32 and 55% of those taught these tools develop the desire to use them by proposing intrapreneurial projects.

Even though the main purpose of introducing the opportunity file is to improve the resource allocation process, its side effect is to develop an intrapreneurial outlook. As our staff internalise the discipline required to obtain resources, they will do so using the tools of innovation. This should encourage a certain number of them to apply these same tools in taking initiatives that will continue to improve services and optimise costs.

It is indeed through innovation, and not only medical innovation or innovation aimed at improving quality, that we will be able to meet the challenges mentioned above. Since innovation is the cornerstone of intrapreneurship, it is my duty, as director, to promote innovation and entrepreneurial behaviour within HUG. The challenge is to do so in a way that is acceptable and relevant to staff.

The examples mentioned here show that it is sometimes better not to tackle certain problems head-on, and that the indirect method, which makes use of the side effects of treatment, can sometimes successfully meet major challenges. This proves that contamination and side effects in hospitals can sometimes be beneficial. Besides, we are not the only ones in the medical field to benefit from side effects: the inventors of Viagra made a fortune thanks to the side effects of a treatment initially intended to cure circulation problems. ●