Getting More from America's Academic Medical Centers by Making Innovation and Entrepreneurship Natural and Expected Academic Behaviors

While a politically sensitive topic, few can argue that hydraulic fracturing or "fracking" has moved the United States significantly toward energy independence. Many of us can remember sitting in long lines at the gas pump in the 1970s during the energy crisis and claims that the world's oil and gas supply would quickly dwindle in the coming decades. So, what happened?

Well, it's not that we all of a sudden discovered new deposits. A big piece of the story was developing new technologies like horizontal drilling and means to get to deposits that we already knew existed. New approaches like fracking unlocked huge amounts of natural gas and oil that otherwise would have stayed locked up or would not have been economically feasible to tap into.  However, new technologies and approaches used to extract and harness these energy resources themselves are not in and of themselves sufficient. Policies and pathways also had to be created to align and incentivize investment and to create economies of scale. To be sure, fracking required a lot of risk at many levels and certainly is not free of potential complications and controversy. Some states embraced fracking, which transformed their economies, while others did not. An argument can be made, however, that all enjoyed the benefits of lower prices of gas and oil.

What in the world does this have to do with innovation and entrepreneurship in the world of academic medicine (and why the "frack" have a title with the potentially incendiary word "fracking"?). If you are embedded in the academic bubble of medicine trying to develop new technologies for or approaches to patient care from the ground up, or if you are in industry or the venture world and have interacted with academia trying to partner, you should be able to see many similarities.

Similar to the enormous underground resources of natural gas and oil that are locked within the Earth in hard-to-get places, the same can be said of the intellectual capital that exists in Academic Medical Centers (AMCs) and universities that can and should have an enormous impact on transforming the pain and heartache of disease into cures and comfort. You would think they should…but are they really? And if not, then why not?  I mean, when you combine all those great minds with an annual $30 billion NIH research budget, one assumes we are getting huge returns. Maybe we should unpack this a bit and see if the return is commensurate with the investment.

The intellectual, administrative and cultural "geology" of academic medicine, especially those situated on larger university campuses, are complex, and in more cases than we would like to admit, can be exhaustively challenging and seemingly impenetrable to the outside world. They can also be surprisingly resistant to changes that would allow and even strategically promote innovation and access to it as the great transformative renewable natural resource that it is. On some days and in some institutions, drilling straight through is easy and seems to work. On others, it can be horizontal, tangential, and Lord knows what other drilling approaches are required. Great minds concentrated in the academy are essential but not sufficient in and of themselves to transform medicine to the degree we should expect. Contrary to popular belief, great minds do not always think alike. That’s both a blessing and also a challenge. In this same vein, there is significant confusion and expectation gaps on the part of industry on academia's roles, abilities, challenges, and constraints on technology development and transfer. 

This blog is designed to get us engaged and thinking about how we can extract more from the enormous intellectual talent that exists across our great clinical and research medical centers and universities and align expectations with industry, venture, and the market which really means our patients! What can we do to make more of those "a-ha" moments of academic discovery into impactful products of many sorts that transform medicine, including the next generation of innovators? While this would seem to be a "no-brainer," I'm here to tell you that there are some huge barriers and inertia, which require a lot of knowledge of the culture, incentives and pressures that clinicians (physicians, nurses, pharmacists, etc.) and researchers of many backgrounds in academic medicine (basic medical, engineers, data scientists, etc.), face that can forever be stumbling blocks to innovation.

Witness, if you will, the rising numbers of "innovation" programs in academic medicine. Why is that? I thought we have always been innovating in the academy. We would argue that innovation is more than just a great idea or "a-ha" moment. It becomes a lot about how to execute on that idea and that's where the disconnect is. Don’t worry…there is plenty of blame to go around, but also plenty of opportunity.

Some AMCs don't want to robustly engage in innovation and entrepreneurship in a truly meaningful way. Some find it interesting but not mission-critical.  Others simply want to enjoy and be early adopters of what others are doing. We will explore some of these programs to understand best practices and challenges. As my good friend Tom Shehab, Managing Director of Arboretum Ventures, says… "If you've seen one innovation program, you've seen one innovation program".

In this blog, I'll share our experience at Michigan Medicine, the Michigan Center for Integrative Research in Critical Care (MCIRCC) and the University of Michigan in work to develop strategic programming and culture change that intends to make innovation and entrepreneurship not only a natural but also an expected academic behavior. I'll share stories of our journey, which includes successes and failures, boredom and drama, politics, egos, culture, and more. We'll expose the movers and shakers, dreamers and doers, enablers and preventers. Sorry…no sex (except for the genotype), drugs (except the therapeutic kind) or rock n' roll (although there is some cowbell involved). We'll use some great case studies not only from Michigan but elsewhere to illustrate problems (including those Whiskey Tango Foxtrot moments) and potential solutions.  I'll even tell about my own innovation journey, including how I have been innovation roadkill, but also how we are "fracking" for biomedical innovation within U-M and beyond (of course using the latest green technologies). I and the MCIRCC team of over 150 clinicians, engineering, basic scientists and other disciplines are particularly interested in innovation and entrepreneurship in the emergency medicine and critical care space where we have failed to produce any game changing technologies for the last 30 years.  This is why MCIRCC was created.

You will get a chance to meet many of the amazing people who are critical in developing these strategies and who work with such passion and intensity. They see their roles in improving patient care as critical as those of our clinicians and researchers. Their names might be changed to keep you from recruiting them… I just have to give it a little more thought.  You’ll also get to meet some of the folks who take a contrarian view within the University and we’ll try our hardest to get them to explain their strategy in that regards as to why it would help improve patient care.

To help with this, I am going to actively engage a wide array of thought leaders in the innovation and entrepreneurship ecosystem on their experience in biomedical innovation with AMCs and universities. Many of these individuals will be from within the AMCs at many levels, ranging from the innovators themselves to those in administrative and leadership positions that either support or who may be viewed as barriers (CEOs, CFOs, deans, chairs, tech transfer directors, IRBs, Conflict of Interest Committees, etc.). We will also get insight from those in industry and the venture community to understand their views of the AMC and university and hear of some of their good, bad, and ugly experiences. We'll also get into the deep end of the pool with leaders in the NIH, NSF, DoD and other sources of big research cash to understand how and if our hard-earned tax dollars are being used to empower innovation and entrepreneurship. Lastly, we'll chat with local, state, and national government politicos to see things from their vantage or disadvantaged view point as well as those in the venture community to understand the adventures and misadventures of venture investment.

Most importantly, I want to engage you! You might be from one of the tribes above or not. Part of this is to find out what we don't know as well as what's really working. Simply put, its going to be fun for the whole innovation and entrepreneurship family and if we have left anyone out, we'll always have enough room and time to squeeze in one more. The blog and engagement is meant to be provocative and challenging. We are most certainly not going to agree on everything (heck…I don’t even agree with myself most days) and there definitely is not and won't be a one size-spandex-fits-all solution.  Only by sharing and learning from each other can we open up that big can of "Innovation Whoop-Ass" we so badly need to improve the lives of our patients and families. My hope is that through robust engagement, the blogs will turn into refined and informed "chapters" of an eventual book that you, in effect, will assist us in creating and editing.

In closing, I will offer another analogy that might resonate with those in academia as well as those in industry who come from the university. Similar to the fun (and serious) competitive athletic mentality that pervades universities where many AMCs are located, there is a natural and very healthy spirit of competition in biomedical innovation as we compete against disease and each other to develop the best solutions to problems. However, where "Defense Wins Championships" in football, only Relentless Innovation Offense from our great AMCs and universities are going to win the day for our patients. I think many of you will agree that innovation is best viewed as a team sport with our patients viewed as a part of the team. To borrow from Michigan's beloved football coach, Bo's all about "The Team, the Team, the Team!"