Creating a ‘culture of yes’ in medical research

The health care community’s response to COVID-19 has been heroic and transformative.

Since early 2020, physicians, nurses, sta members and researchers have pushed themselves to their limits while organizations have found new ways to provide and streamline care — especially with the sudden and broad embrace of telemedicine.

Even as we stand in awe of this grace under pressure, this necessary focus on the pandemic has exacted sti prices. While much attention has been paid to the crucial issue of burnout, I also think a creeping cultural shift has occurred at academic medical centers like the one I lead at Michigan Medicine. Call it the “culture of no” as in, no we cannot do this or that because we must muster our limited resource to battle the crisis. In response, we must work to foster a “culture of yes,” one that inspires our brilliant colleagues to feel the freedom to pursue big ideas that can create transformative improvements in patient care.

We must cultivate this culture of yes across our organization, creating channels so that every member of our community knows that their good ideas will be heard and can ourish. It is in this spirit that I want to highlight one of the most exciting initiatives percolating not just at Michigan Medicine but at academic medical centers across the country: support for high-risk, high-reward research.

As the name implies, such research often takes place on the edges of science. It often involves a Eureka moment concept for which there is little proof of its e cacy. Such outside-the-box thinking poses a challenge to the traditional funding mechanisms — especially those used by the primary funder of research, the National Institutes of Health — which quite properly seek to direct resources to established ideas.

But, as a post last year published at the website operated by the Good Science Project observed, “A common complaint is that NIH’s peer review process can be overly conservative, because it is so focused on preliminary data guaranteeing that a project will work.

at e ect of peer review is probably even worse in today’s hypercompetitive environment, where it isn’t unusual for only the top 10 percent of grant applications to get funded.

High-risk, high-reward research often gets shunted aside in this funding model. To draw an analogy from Silicon Valley, it is like a startup with a great idea that may or may not work out. As venture capitalists know, you have to drill many dry holes to nd the unicorn success story like a Facebook or Spotify. But the world of high-tech also shows us that a culture that says yes to innovation — one that encourages visionaries to think and dream big — can change the world. e NIH has recognized this need through its High-Risk High-Reward Research Program, which supports “exceptionally creative scientists pursuing highly innovative research with the potential for broad impact in biomedical, behavioral, or social sciences within the NIH mission.” In 2022, the NIH gave 103 such awards totaling approximately $285 million. at might sound like a lot, but consider that each year the NIH awards more than $30 billion to 60,000 research and training grants.

To power innovation, several academic medical centers have developed their own programs to support high-risk, high-reward research. Michigan Medicine’s e orts, for example, are being turbocharged by a $20 million grant from the Maxine and Stuart Frankel Foundation. Open to innovators at all stages of a research project, the Frankel Innovation Initiative o ers nancial support and expertise and guidance from an advisory committee consisting of world-renowned scientists and technology development professionals to help researchers develop their ideas.

Recipients include Dr. Paul Cederna, whose pioneering work is revolutionizing the eld of prosthetics. As Cederna explains, while we have long had arti cial limbs, they have been hard to control. His Eureka moment — it literally came to him in the shower — was that by connecting the existing nerves (which have relatively thin pathways) to muscles (which have relatively wide pathways) he could vastly increase the signal sent from the prosthetic to the brain. is provides users with a range of ne motor skills that can vastly improve their lives and livelihoods.

Another grant supports the work of a team led by Dr.Molly Stout which seeks to combat the crisis of premature births — which complicates more than 10 percent of the country’s nearly 4 million annual births and costs over $26 billion annually. Despite the high burden of disease and signi cant costs, meaningful progress is hampered by the inability to predict, with accuracy, when labor will occur. Stout and her team are being supported in their e ort to improve the standard transvaginal ultrasound probe now in use to more accurately predict the time of delivery and save the lives of mothers and their babies. is and other pioneering work would be hard to sustain without a commitment to high-risk, high-reward research. At root, our systems must be as inspiring as the people who work within them.

Creating a culture of yes will stimulate and encourage everyone in health care to nd new ways to improve patient care.