On April 27, The Economist (web version) published a brief piece titled Entrepreneurship in its regular "Idea" column in which it briefly defines and characterizes entrepreneurship - well done, but no biggie. More interesting was a reminder that one aspect of entrepreneurship is "intrapraneurship" - defined as "the introduction and implementation of a significant innovation for the firm by one or more employees working within an established organisation". I thought it was timely for health care and physician leaders to examine this a bit further so I surfed around, connected a few dots from my own consulting experience, and learned a few things worth sharing here.
Posted-It in 1976
The classically cited example to illustrate intrapreneurship is the doggedness that led to invention and marketing of the Post-It by 3M. But the idea originated much earlier from a concept articulated by the Norman Macrea, the economic forecaster, and published in The Economist back in 1976 stating that: "...dynamic corporations of the future should simultaneously be trying alternative ways of doing things in competition within themselves."
The term "intrapreneurship" was coined shortly thereafter by Gifford and Elizabeth Pinchot who have since written extensively about innovating within organizations and have built a well known consulting business focused on encouraging and teaching both intrapreneurship and entrepreneurship. More recently there's been renewed interest in intrapreneurship as an antidote to stagnation in this down economy (for example, see Fight Paralysis with Intrapreneurship, published online in the Financial Post on February 3, 2009).
Wired for Internal Innovation?
So this, and some recent client experiences, got me thinking about health care organizations that do and don't do well at intrapreneurship. I've recently consulted at two similar community based organizations that deliver health care to vulnerable urban populations. Both operate under relatively inflexible regulatory and reimbursement constraints, are governed by community Boards, and have limited financial resources for investment. Yet one organization visibly more creative, vibrant, current, optimistic, and professionally energetic than the other.
It's the Culture, Stupid!
As I thought about successfully intrapreneurial organizations and some successful past projects involving internal innovation, I came up with a short list of selected cultural and environmental attributes that characterize organizations most capable of successful intrapreneurship:
Candor, Trust, and Confidence: An organization (code for "leadership team") that is open to the possibility that "we can always be better" (rather than "we are the best") is most fertile for intrapreneurship. Candid, confident, and data based internal conversations about performance and improvement build incentive and trust for stakeholders. This is a requirement for employees (and internal health care leaders) to take the personal risks required to "step up and step out" of daily routines and create alternatives - that by definition may or may not work right away.
Strategic Clarity: As the Cheshire Cat observed: "If you don't know where you are going, any road will get you there." Without directional clarity it is difficult for leaders to know when and how to invest in committing internal resources to innovation. Health care leaders with clear operational, programmatic, and business strategies are able to recognize and enable potential contributions to getting there. A clear destination invites intrapreneurs to identify potential contributions they could make and risk their "day job" security in favor of innovation and potential reward.Enabled Local Leadership: If most decisions are made at the top, local opportunities that may contribute significantly to organizational success may go unrecognized. Organizations with enabled local leaders - at the clinical team, program, or site levels - can best leverage intimate knowledge of customers and operations. They are known (and can be trusted) by potential intrapreneurs can advocate for innovation opportunities to be sanctioned at higher levels.
Distributed Accountability: A companion, but not identical to, local leadership is an organizational environment where accountability to results is well defined at all levels. If performance isn't tied to metrics that contribute to the overall organizational strategy (of care, safety, service, science, etc.) it becomes hard to appreciate the connection between innovation and value. If, for instance, the organization's strategy of safety and community service depends on developing interventions that measurably avert ICU transfers due to hospital acquired morbidity on medical-surgical units, it makes sense for intrapreneurial nurses and physicians - whose performance is measured, in part, by those metrics - to develop innovative systems and collaborations that help achieve those goals.
Rewards and Recognition: Innovation is self-rewarding and intrapreneurs aren't looking for the same returns on investment of their effort as entrepreneurs (if they were, they would be "out there" rather than inside) - but a culture of internal recognition, encouragement, and appropriate monetary or "in kind' rewards signals that the organization values initiative and innovation. Token investments of time, money, or resources put towards celebrating accomplishments may be all the fuel that is needed to keep the intrapreneurial machine running.
In this environment of scarce investment resources for health care as well as industry, it just makes sense to follow Macrea's advice.
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