We live in a culture that values disruptive innovation - from smartphones to electric cars. At this moment, someone is working on the next revolutionary idea that will theoretically change everyone's lives for the better. While radical changes may work well in the industrial setting, healthcare has a responsibility to patients that requires a more nuanced approach. With the need for process improvement, how can healthcare innovate while maintaining a stable environment for patient safety?

Healthcare is inherently a culture of care, focused on the patient. Process and technology changes may have a direct or indirect effect on the outcomes of that care. EHR is a recent example of disruptive innovation in healthcare. With most innovation, the initial offering may need improvement as we are seeing with EHRs. They were hastily implemented without proper input and consideration of all stakeholders, most notably providers and patients. This is not the preferred way to make changes in medicine. The disruption was accelerated by legislation which ultimately forced healthcare to adopt EHRs industry-wide. While the upside to EHRs is tremendous (cross-organization interoperability, population health management, a vast pool for research and drawing observations using data science), it has yet to be realized. Meanwhile, we are past the initial downside of care disruption during rollout and finding our way through the second downside of disruption/burden in provider workflow.

In contrast to disruptive, another kind of innovation is iterative. Instead of one sweeping change that leaves the affected scrambling to adapt, this approach uses repetitive experimentation based on hypotheses to solve problems. Improvement is seen as a continuous learning experience. Questioning, measuring, and reviewing drive the progress. A hypothesis is chosen and documented, key measurements are determined and baseline measurements are taken, then the hypothesis is tested. The key measurements are checked against the baseline. Depending on the results, more hypotheses are generated and the next hypothesis to try is chosen. The iterative process works well in healthcare due to its steady state of continuous improvement and compatibility with evidence-based medicine. Instead of one massive disruption, change can be implemented in a controlled and tested manner. The smaller incremental changes can help fine-tune parts of the process and focus on details that initially may be missed in disruptive implementation. (This "Build-Measure-Learn" approach is adapted from Lean Automotive and Lean Startup methodologies.)

Iterative improvement is also helpful in improving workforce wellbeing. Burnout results from a feeling of disconnect between a person's work and their sense of purpose. Iterative improvement encourages input from every team member. Having a say in how work is done and what improvements to try can reconnect individuals' work with their purpose, combating burnout at an institutional level.

EHRs were put forth in a disruptive manner, but we can make iterative improvements to make efficient workflows and optimize usability for all stakeholders. Constant, measured, small changes over time will result in major evidence-based improvements without the undue risk associated with disruptive innovation.