Healthcare Innovation: How University Hospitals Stays Ahead with David Sylvan

medDesign Podcast with David Sylvan

Ty Hagler: All right. David, thank you so much for joining me on the MedDesign podcast today.

David Sylvan: I appreciate you having me. Thank you.

Ty Hagler: Oh, very good.

So let's start with your title, chief strategy, innovation and marketing officer. you just take a minute to say, how did you manage to take all the fun jobs at university hospitals?

David Sylvan: But I do acknowledge Ty that I'm honored and privileged to, to have the roles and the responsibilities. And I think for me, the beauty is to be able to meld teams and groups that Invariably tended to live in their own silos and blur the lines between all three using this notion of, The focus on the human data and insights is that common thread and that common, that common language.

But, I think the genesis of the combination of the roles is really about how do we create a greater whole by using the influence of discipline and process that's worked in one area, perhaps using that to, to inculcate the next.

Ty Hagler: mean, each of those are like the primary drivers for growth in any organization.

David Sylvan: There are organizations that don't see strategy is the lead indicator. They see it as more of a function, more of a planning only type function or transactional only type function. And I think your observation is spot on. It needs to be the gathering of those insights to inform those tactical activities.

That is truly a strategy. But again, with that look forward to where should we go? Where do we deserve to win? And how are we how we're going to get there?

Ty Hagler: yeah, absolutely.

My favorite oxymoron is strategic planning.

David Sylvan: Yeah, yes. Exactly. It makes the hair on the back of my neck crawl. And I will tell you for that reason, Ty, I took the word planning out of the title. The planning is an activity. It's informed by strategy. The two are, are not synonymous.

Ty Hagler: Exactly. So a strategy, the, like the customer gets a vote, your competitors get a vote

David Sylvan: That's right.

Ty Hagler: way to plan for what they're going to do.

David Sylvan: That's right. That's right.

Ty Hagler: So, we, connected and you've been recognized by Becker's hospital review as one of the most trailblazing chief innovation officers. it seems like some of the output your organization has been putting out there in the innovation. You seem to be playing at a systems level in terms of like individual patents, just to the sheer volume you're pushing out there. Could you speak to some of that? Because it's just impressive what you're managing.

David Sylvan: I can't take; I can't take credit. I'll be honest that this is 160 or so year old institution. It has been spawned by has survived and will grow through self-directed innovation. So, the feedstock was already there. The DNA was already there when it came to being this top 10 research institution but being relentlessly focused on it.

Kennedy is trying to punch above our weight class. there's always There's a, very Cleveland specific, perhaps even a Midwest and sort of chip on the shoulder. Golly Gee, shucks, chips-on-the-shoulder. And so, we're always trying to run a little bit harder because we don't have the discretion of what some of our counterparts, peers and competitors have said on the coasts.

And for that reason, we do have to keep the pedal, depressed a little bit further. And so, it's for that reason that we've created this enablement mechanism to source these opportunities, but then not just be the repository, not just be the CRM for these great opportunities, but to put some wraparound services, some resourcing people and or money or both, to try to induce a de risking to see if we can move things downfield.

Ty Hagler: Very cool.

There was one mention I wanted to ask you about Vivid Visions.

David Sylvan: Yeah,

Ty Hagler: Could you speak to that? Cause that sounds compelling to me.

David Sylvan: so our observation was that strategy setting at a system level tended to be at an administrative level. Of course, we never lose sight of our patients. Sometimes we lose sight of our providers. And in as much as we can set strategy at a system level in terms of markets we want to enter or business model constructs or strategic partnerships, whether they be the other systems or other technology players.

What about the providers? What about the areas of clinical care delivery that are actually the product that we're selling, if you will? And so we embarked, this is more than a year ago, probably January of last year, upon this so called Vivid Vision exercise. We went to our clinical chairs and our chiefs and our prolific inventors within each clinical domain and said, Crystal Ball, where is your vision?

area of expertise. Where is it going to be in five years’ time? What's the thing that's going to differentiate? Think of, where TABA was five years before TABA was common, if you will. And it was this blue sky permission. And it wasn't just meant to be an academic exercise.

The idea, Ty, was okay, cancer oncology or okay, orthopedics. You've told us here's the thing that we really suspect is starting to show signal, but it's not ready yet. It gave us the opportunity to say, okay, how do we tool for that? Now? How do we reverse engineer the steps for us to be at the table when that is a thing versus the fast follower or someone that will have to always be, trotting to catch up?

And can we begin to put those resources, people, processes and monies in play To position ourselves for what the future might hold. Now, that sounds pretty simplistic, right? We should always be doing that. I just don't think we do that with enough, rigor or fidelity.

Ty Hagler: it sounds like the best way to predict the future is to create it

David Sylvan: Used to manifest us. That's exactly right. Yeah,

Ty Hagler: so within that, I guess one is when you said attention to clinicians and providers.

of the biggest recurring themes that I've heard is I've encountered the health care landscape has been just the nursing shortfall.

David Sylvan: Mhm.

Ty Hagler: And I'm curious if that's something that you found, emerging solutions to help with that, because. have a, bit large number of nurses that had retired, as a result of the pandemic. And then also just turnover of once nurses get trained, then, just they start going into it and realizing that maybe not for them. Curious how you see that as a, emerging trend.

David Sylvan: It's a huge issue. Nurses. No one chooses nursing because of the glory and the money. You choose nursing because you have a mission focus and you do want to care for people and do want to be patient facing and bedside invariably. Of course, we have nurse leaders, nurse administrators, and that's wonderful.

But they've come through the racks. They understand how the cookie is baked, if you will. We now have because of either self inflicted inefficiencies or because of, documentation burdens or shortages that you mentioned, we have nurses spending disproportional amount of time, on administrative activities, which takes them away from what it was that we're trained to do, what it was they are trained to do. And that is,

patient facing care. So what we are trying to do is we're piloting certain technologies. To reel elevate nurses back to top of license by putting tech in place to fulfill some of that burden. Your, all of your listeners, , are very aware of all of the ambient listening opportunities that are out there. those are real, those are getting perfected. That'll change not just the nurse, but, all clinicians, day in the life of. but there are also, technologies that act as sitters. You can put a technology into a room, it can watch, in quotes, the patient, it can become this two way portal, this conduit from a communication perspective, it can use algorithms to predict potential for fall or risk, it can monitor meds adherence, and it can also be, and this is the ironic part, because this was the thesis we didn't know that we needed to test, can also become a companion to the patient, And then becomes this sort of, this, hub of connectivity for the caregiver group, for the families, as well as the, caregivers.

We, we experimented with 150 or so rooms. We have a central command at one of our locations that monitors all of these rooms, and suddenly we've alleviated a lot of burden, given a lot of time back to nurses who would have been having to sit and watch, which of course is not top of license,

Ty Hagler: Sure.

David Sylvan: we would have had to have hired sitters whose sole role is to perhaps Just watch.

Again, critically important because there is, true quality and risk avoidance implications to that, but why not use tech to do that and put the human back into human roles? The first phase of this, this pilot, if you will, Ty, was so successful. We're rolling out over the next few months, literally hundreds and hundreds of more beds across different sites and different locations carefully.

You can't go 0 to 100. but by doing so, in a very, orchestrated concentric circles model, you can continue to test the scalability. and the effectiveness at the same time. And we're pretty encouraged around that. So an example of how we're trying to positively impact, the, nursing reality that

Ty Hagler: And that is the primary metric is just giving time back to nurses. Cause it seems like that's one that's like fuzzy as a metric, but, it seems like

David Sylvan: you'll know it when you see it is not something you take to the board, right? You can't put an ROI around that, although, innately, you believe that to be true. I think it's multifactorial. There's the time element. There's the risk avoidance element. Falls and meds, for example. There is the patient experience quotient as well, which, of course, is critically important. and then there's the experience of the families and the caregivers. Do they feel like they are consistently digitally tethered back to the care team versus having to hope and wait that someone rounds or have to press the button to call someone in? there's a sort of real time, connectivity.

I think it's critical.

Ty Hagler: so maybe take me through a progression. It doesn't have to be that example, but it seems like you're prototyping and building within your ecosystem. And then I'd imagine at some point in time that exports out to other hospitals. Is that okay. So tell me a little bit more about your systems in that regard.

David Sylvan: Yeah, we, in fact, we were on a call this morning with another hospital system a few hours south of us. The sole premise of the conversation was, is, we're all solving for the same thing. Can do it your way, we'll do it our way. We all surmise that there's a huge grey area between the two. Can you imagine the power of doing it together and not as linear as dual trial sites that sort of happens all the time, but how can two institutions with different, pre intellectual positionings come together to make a greater good and, there was immediately talk about, how do we systematize this and what documentation we're like, stop, let's find the one thing.

Let's find a thing. Yeah. Let's do it successfully. And let's use that as the catalyst for the formalization of something a little bit broader. So I think there's some Informality, intra, inter system that occurs and

Ty Hagler: Mhm.

David Sylvan: we have conversations of 20, 30 healthcare systems all the time around things they're seeing, we're seeing, the sharing of diligence, the, testimonial exchange, there are some constructs that are a little bit more formal, when you can think of a transcript.

A general catalyst type construct or many others where they are bringing systems together with a very discreet and distinct set of outcomes and measurables. Some are a little bit more opportunistic and organic, like the one I was discussing this morning. So I don't think there's a single pathway to success here, Ty, but critical that we do it and don't think myopically that we can just solve for our own problems anymore.

Ty Hagler: And just keep it within your own ecosystem

David Sylvan: That's right.

Ty Hagler: Yeah, absolutely.

so we talked about a couple of different emerging trends, but what are some of the trends you're watching right now for health care innovation?

David Sylvan: no one would be credible if they came on your show and they didn't mention AI because, this is not, fad. This is not faux. but it's not yet at a point ubiquitously that it's ready for prime time. So you have to be careful when it comes to the what and where you play in a generative AI, specifically By virtue of issues like harm and risk.

So the lowest hanging fruit is always going to be on, again, the administrative burden thing that we mentioned, element that we mentioned earlier. How do you create efficiencies? Not necessarily to adjust headcount. My, our premise, our thesis is the right adoption of the right AI elevates people within their roles, doesn't eliminate roles.

Or enables you to retool people, retrain people, reposition people. Of course, the clinical implications are incredibly exciting. We, radiology and imaging have been, were very early adopters of AI for self evident reasons. But,

Ty Hagler: Mhm.

David Sylvan: it no longer needs to be a very capital intensive play either.

this, becomes a primary tool within the delivery of healthcare. That of, Postal personal cellular devices. So we've created our intake mechanism method to adjudicate risk, run the traps from a risk compliance and legal perspective, get the overlay of the p. B. clinical affirmation that the thing the tool could actually do what it purports to do, and then very gently introduce it into care delivery, never to substitute the role of physician.

This is the companion to these are at best decision support. Maybe one day that changes, but never the replacement for. And of course, you have to put guardrails in place to make sure that these tools are adopted in a. support in a, trust, but verify type mode,

Ty Hagler: Mhm. Yeah. the terminology I've heard that kind of encapsulate some of that is Human- Centered AI,

David Sylvan: right? Exactly. Which again, sounds once you're more honest, but it's

Ty Hagler: but you have a content, like there's a, false dichotomy of human control versus computer control, that's two different dimensions

David Sylvan: That's right.

Ty Hagler: can have full human control and full, artificial intelligence interaction to augment, or you could try to take humans out of the loop, which just seems dangerous at some point in time.

David Sylvan: That's right. we're not gonna allow, planes to fly pilotless and we shouldn't allow, diagnosis to happen doctorless either.

Ty Hagler: That's one of the surefire ways to get dinged by the FDA if

David Sylvan: Absolutely. That's if the FDA still exists. Hi. And which I don't think you might not have ATI the three hours remaining on this podcast discuss.

Ty Hagler: Well, kudos to AdvaMed for getting the FDA employees rehired.

David Sylvan: Yes.

Ty Hagler: this is, very, troublesome period of time we're going through right now. But it was good to see that, like at least some sanity pushback and guardrails for our, systems. Do you want to comment on that?

Are you seeing any of the, Policy level changes impacting what you're seeing in your system.

David Sylvan: Yeah. we, and we're not immune. we're probably just an exemplar. We are all beginning to get our arms around the attempt to quantify the potential implications of which of these pieces of legislation will actually land. and at the worst case, of course, it's draconian. We will candidly be out of business. This is an existential period for health care. Access is a huge, worry for us. If in fact reimbursement thresholds change dramatically and rural and community hospitals begin to close, where are these patients going to go? How are they going to access care?

Ty Hagler: Mhm.

David Sylvan: Drug discovery device, regulatory approvals, cures.

These things, entities are pencils down right now tires, so we've got to we've got to get to some rational level of response in terms of at least keeping the machine fired. But we're not sitting idly. We are, delineating and quantifying all of the things that we think we might need to have to do, depending on you.

the size of the reaction that we need to address. most systems are doing the same. Some systems have huge, in diamond pools where they have a different risk tolerance. we find ourselves in a position where doing nothing and hoping is not going to be a strategy, so we do have to position and prepare ourselves.

a worrying time, especially for organizations that have a research focus, have an affiliation with a university or two, and no one has, there's no, there's neither the silver bullet or the right answer at this point. Everything is still so, nebulous.

Ty Hagler: It seems like any university based system, just that, one change that happened about indirect costs drop. That's millions of dollars across ecosystems. And usually that's the people at the margins that are most likely going to be impacted.

David Sylvan: That's right. That's right. Yeah. ,

Ty Hagler: we wouldn't be good innovators if we couldn't respond to change. And so finding a way through, I think, is maybe the superpower we bring to the table.

David Sylvan: can't let a good crisis go to waste. We saw how we could effectively and rapidly react to need during COVID, which was like another lifetime ago. We're gearing ourselves to master the same type of reaction speed energy. I think everyone was aligned and focused on the same. largely aligned and focused on the same goals during COVID.

It'll be a little bit more fractured here this time because the political subplot I think is a lot more acute than it was during COVID. COVID we certainly weren't immune from the politics of, but now it's front and center. So navigating that uncertainty along with the tactical practical uncertainty of data take, data The care delivery is what we're all beginning to lumber up around and get our minds around.

Ty Hagler: No, okay.

So then with that context, then let's say you have an aspiring, like young doctor, young nurse who comes up to you that is wanting to get into innovation. currently we're right for those kinds of opportunities to. See a big problem that's emergent and try to respond to that. Do you have any advice you could give them for how to get started?

Maybe with their idea, let's say they come to you with the solution to the current morass we're facing. What, how, would you advise them?

David Sylvan: I think you've keyed on some verbiage that would have really immediately trigger for us some guidance.

Ty Hagler: Okay.

David Sylvan: Don't come to us with solutions. Come to us with very tight, articulated problems and a potential pathway to solving. There are tons of solutions, and I know I'm speaking your language, Ty, tons of solutions looking for problems, and we just don't have that time discretion, that patience anymore.

pressure test the veracity of the problem. Is it your problem? Is it a problem for this department? Is it a problem for Just our system is a problem for our community, our populations. And of course, there's a place for all of them. But given limited time, bandwidth and resourcing, we can only focus on those that have potential for true impact.

And the time to impact is one of the dependent variables that we would assess as well. when a young inventor, he or she comes to us with an idea, we really pressure test the, problem. if it's still holding. Water at that point. And if it's not, the pushback is great. Make these changes.

Think about these things that you can do to adjust and augment. But if it does hold water, we then have mechanisms to begin to wrap some enablement around that. Do a little bit of early prototyping. Do a little bit of de risking. test the premise around what might adoption or go to market look like.

Think about an early business model. Understand funding needs or regulatory pathway hurdles. Walk it to a de risk point of understanding that it's, there is a there Then there's another opportunity to wrap a different set of resourcing around it. So we love that type of, high quality back of envelope is where we love to live.

And, it becomes a child and we like to get the child off to university one day. it's also the patient long game.

Ty Hagler: Yes, absolutely. I was giving a talk to the tech transfer office here locally yesterday, and it seems like it is a bundle of solutions many times. Intellectual property that has been patented unique, interesting things, but you're sitting at the spot of full familiarity and living on a day to day basis with the most acute problems. So how much of that matchmaking sounds like you don't have time to do that matchmaking on behalf of tech transfer offices.

David Sylvan: we have to hold the line when it comes to nearly trivial pursuit for academic gain. There is a play in place for incredibly impactful white papers and publications, of course. But if one of the mandates of our platform is sustainable alternate revenue streams, as an example, as well as the facilitation of research, certainly.

we have to find those gems that actually do have the opportunity to actually see the light of day and be liberated, commercially liberated. So the bar is actually pretty high. We see hundreds of invention disclosures a year. We used to patent 100 percent of them, and we just don't do that anymore because that's a bridge to nowhere.

As you well know, choose a subset that really think that we really think are In need of protection. and then that puts him in a threshold where we can begin the other work that I mentioned around prototyping, et cetera. But the bar is pretty high. We've created templates and a pathway and a, an assessment process so that everyone feels heard and that the feedback, regardless of what that feedback might be, is actionable.

that's how we've attempted to address what you've asked.

Ty Hagler: yeah, no, I really appreciate that. And, of course, with patents, often like to say that's not really a signal of market validation.

David Sylvan: No, it isn't.

Ty Hagler: to pay a tax on a monopoly. And it's no value judgment on the idea itself. You could get a patent on, say, like a way to make sure that toilet paper rolls are like the one way versus another.

David Sylvan: That's right.

Ty Hagler: It doesn't necessarily mean people want to actually pay for it.

David Sylvan: That's right. That's completely right.

Ty Hagler: okay.

I'm very much a bookworm.

David Sylvan: Yep.

Ty Hagler: do you have a book that you've read recently you might recommend for aspiring entrepreneur or innovator?

David Sylvan: Yeah, I have and it's a book I've read. It's a book I've recently reread because it's a book that I prescribe, if you will, to, would be inventors, to innovators, to, want to be founders. it's a book actually written by a colleague of mine. His name is Brandon Cornuke, and he wrote a book known as, that's titled The Value Proposition Matrix.

And it's really this attempt to help people. Inventors, businesses and startups systemically evaluate And, rev refine their value propositions. it's a, very digestible weekend read for anyone that's looking to go from problem to product. It forces the very difficult questions to, be asked, and then it calls out those areas where you do perhaps need to go back to, to, to the drawing board.

And I tell you it's it is being so well received by innovators inventors because it demystifies this process. Go to market and it calls out all of those elements that you really need to have some kind of coach and thought around. You don't have to bat 1000 if you don't have to have the answer for every element of the of the matrix, so to speak.

But there's, there's a threshold in which you need to have at least enough answers. And then permission yourself to solve for the gaps. So highly recommend Brandon Cronuk's value proposition matrix.

Ty Hagler: absolutely link to it in the show notes, and I'm going to pick that up a copy. I think

David Sylvan: Excellent.

Ty Hagler: Seriously. So thank you for that.

David Sylvan: Great.

Ty Hagler: so I think to close out, how can medical innovators get involved with either connect with you or ventures? What's the best way for people to follow you?

David Sylvan: We have a website. if you google University Ventures, it'll pop up and there is an innovators intake form.

Ty Hagler: Okay,

David Sylvan: And it's a pretty, pretty simple. People populate the various fields to the prompts and the questions that comes into a central repository, and we have a turnaround time to react to those.

Obviously, it's challenging to react to everything immediately, but we do attempt to be appropriately reactive. That's probably the best way to engage with us.

Ty Hagler: very good. Okay. We'll make sure we include a link to that. https://ventures.uhhospitals.org/

David Sylvan: Great. Excellent.

Ty Hagler: David, thanks so much for taking the time to talk to me today.

David Sylvan: Pleasure was mine. I enjoyed the conversation. I thank you.