Susannah Fox is working to hack red tape and create opportunities for developing creative ideas at HHS and beyond.

Susannah Fox is the chief technology officer at the U.S. Department of Health and Human Services, where she oversees the agency's IDEA Lab, a space where staff can bring their ideas and develop a plan for bringing them to fruition. In this Public Manager interview, she talks about the importance of innovation in government and shares how the IDEA Lab is working to bring great ideas to life.

What does innovation mean at HHS? How do you structure your innovation work?

The leadership acknowledges that the world is moving incredibly fast and we need to find ways for HHS to create small experiments and use more entrepreneurial methodologies to do our work better. That's what innovation means here. The HHS IDEA Lab methodology entails taking an idea, conducting small experiments, building the evidence, and then creating a minimum viable product to test with your users. Throughout the process, we help people to better define and validate the problem being solved.

That's not the usual way government works. Very often, projects start when someone in a high position has an idea or there is a mandate from Congress. Then, you put out a contract on the streets, and people bid for it. You set a goal and just move toward it, instead of experimenting in a small way and gathering evidence.

In a lot of ways, the standard process works. But when it doesn't work or when somebody has an idea for doing something differently, that's when we come in.

We maintain an open door in the IDEA Lab. We have this big table where people can spend the day working or just come for lunch and hash out an idea. Sometimes people need help describing the problem. That's the first phase of the innovation pipeline, when someone has an idea and we can help that person or team "workshop" it and see if there's something there.

Then we recommend that they apply to one of our programs that make up the second phase of the innovation pipeline: the Ignite Accelerator, HHS Competes, or the HHS Entrepreneur-in-Residence program. Those programs all help solve different kinds of problems.

For instance, the Ignite Accelerator program is great if you're pretty sure you can implement an idea internally, but you need a little extra time and some mentorship. It's a three-month program that we kick off with a three-day boot camp. During this time, we assign a mentor and work with the University of Maryland's Academy for Innovation and Entrepreneurship to bring in instructors to do some training.

Ignite Accelerator is now in its fifth round, so we really know what we're doing—and it's expanding. One of our divisions, Health Resources and Services Administration (HRSA), started up its own version of the Ignite Accelerator last spring, and the Centers for Disease Control and Prevention (CDC) has plans to start its own version. When people want to copy your model, that's really a great form of validation to an approach.

In the third phase of the innovation pipeline, some graduates of the Ignite Accelerator and other teams across the department can apply to the Ventures Fund. These are teams with programs who have a product that solves a problem, and it has been tested, but they need a little bit more coaching to take it to scale. They also need a little bit more money—in the range of $100,000. We have a class of five groups funded in our current round of Ventures.

What gets in the way or keeps people from stepping forward with their ideas?

I literally have had someone come to me, close the office door, lean over my desk, and whisper, "I have an idea." And I said, "That's great. You should tell your boss." But she replied, "No, I can't. It's above my pay grade, which is why I'm telling you. You are the chief technology officer. You are the one who can have ideas this big." So I assured her, "We're going to do this together.

There always needs to be a place at HHS, and frankly any organization, where people can go if they have an idea. That's what the IDEA Lab is. It's a physical space, but it's also a safe place within the leadership where people can talk about their pain points.

How do you know you're making progress?

We now have about 200 people who participated in our Ignite Accelerator program, and they're spread throughout the regional offices, in the Indian Health Service; the CMS (Centers for Medicare and Medicaid Services); and the CDC. All over the department, there are now people who have the design-thinking skills that have come from the IDEA Lab.

There also has been a marked increase in the number of data sets that have been liberated, all across the agency, and that work has led to creative applications and analysis that, in the end, benefits the American people by raising awareness of health system performance and sparking community action to improve health.

The other sign of progress is how many other federal agencies are following our lead and creating their own innovation labs. We have a robust set of tools for creating change here at HHS, and we are very happy to help other agencies learn how to use them.

You also have Innovator-in-Residence and Entrepreneur-in-­Residence programs. How do those programs work, and what are some of the positive outcomes?

If you want a crowd to help you solve a problem, then you use a prize competition. If you think that, with a little bit of help, your team can solve a problem, then you get involved with the Ignite Accelerator and Ventures Fund. But if you're thinking, "There's no way. I do not have the talent in-house to do this, but I think it could be done in a year with really focused work by a talented person," that's when you ask for an entrepreneur-in-residence.

My favorite example involves the organ donation tracking system in the United States. During organ procurement, surgeons and nurses handwrite labels that go on the bags that go in the coolers that get on the helicopters. They handwrite 30 to 70 labels per procurement. You can imagine the possibility for error; somebody writes left kidney, but it's the right kidney. Plus, doing all that writing is not how these folks should be spending their time. So they came to my predecessor, Bryan Sivak, and said, "Could you get us somebody who knows about package tracking?" We presented the opportunity and got help from David Cartier, a 10-year veteran of the United Parcel Service.

Something that's really cool in UPS culture is that everybody starts out driving a truck. When David arrived at HRSA, the agency that oversees the organ donation program, he said that instead of sitting at a desk for four months, he wanted to go out and do the equivalent of driving a truck. He wanted to embed with the team—ride on the helicopter and see what happens. What he saw is that there is no space; any solution had to be handheld. So David came up with a handheld scanner and printer. The person types in the information once and it prints out a label that has a QR code that shows much more information than you can possibly put on a handwritten label. Within four months, David had a prototype of his idea, which he gave to three teams around the country to use. After the initial testing, he went back to collect his prototypes. They refused to give them back. They said, "We will not go back to the old way of doing things. You can make new prototypes. We're keeping these."

The tour of duty for an entrepreneur-in-residence is usually 13 months, and we are able to extend it for two more years. David, for example, was with us for a total of three years. His solution is now being rolled out nationwide, and it's wholly because this office was able to bring in this person who had the right skills.

How can government tap citizens to spur innovation, and how can agencies involve citizens in innovating government practices?

Citizens are the end users of all that we do. We need to make sure that citizens have a way to learn about what we do and contribute to what we do. That is something that is near and dear to my heart.

For many years, I was at the Pew Research Center doing fieldwork with online patient communities. I believe that if we want to see the future, we need to go to the hackers and artists and what are called "lead users" in any industry. The lead users for healthcare are patients and caregivers. They are way ahead of us in using data, particularly people with rare disease and life-changing diagnoses. Patients have a role to play in helping to make healthcare better, and that goes toward daily health practice and the work that we all do at HHS.

One of the stories I like to share is of an early initiative called "Blue Button," which first rolled out at the Department of Veterans Affairs and then for Medicare beneficiaries. A Medicare beneficiary can just press a blue button on a website and download a data file that contains the essentials of a patient's medical record. We have an entrepreneur-in-residence at the CMS who is creating an API (application program interface) so patients can direct that data to an app of their choice.

I've heard stories about people who are snowbirds, who spend the winter one place and the summer in another place. They would have one suitcase for clothes and another suitcase for their medical records. Now they don't need that second suitcase. Blue Button also helps with things like trying to remember if someone has had their flu shot. That information should be digital. It should be available. It should be available to you.

Listening to patients, citizens, and consumers and bringing that feedback into the work we do is something we teach in the Ignite Accelerator. A lot of what we do is process improvement that doesn't necessarily have a direct effect on consumers. But when there is a direct effect on consumers, we require a minimum number of open-ended user interviews so we can be sure that the solution works for them.

Do you think that the program has helped the perception that you can get an idea implemented? How does work by the IDEA Lab fit into talent development?

The Federal Employee Viewpoint Survey includes questions related to creativity and innovation and how they are incentivized internally. The National Institutes of Health scores very well because it's a place of discovery. Other parts of the agency do not score very well on those innovation measures, though. What we are hoping is that through our programs, we will not only raise the scores, but truly improve how people feel about their workplace.

At the end of one of our boot camps, somebody said, "I know this isn't really meant to be a training, but this is the best training I've ever had." We teach skills that participants can apply to the problem they're trying to attack during the Ignite Accelerator class, but also in other work they do. It's giving them creative confidence—confidence that if they have an idea they might be able to conduct the user interviews and testing to gather data to convince their boss to try a new way of approaching a problem.

What I hope is that no matter who is elected president (or who the next secretary is), the idea of opening the door to technology and new ideas will be bipartisan. I hope that the culture has shifted enough to recognize that great ideas can generate from deep in the hierarchy, as well as among entrepreneurs who want to come and serve.