Case Study: Leading Change
From science to societal impact: How one public servant led the charge to make kidney disease a national health issue
When Sandeep Patel launched his career in government nearly a decade ago, he knew little about his new job at the Department of Health and Human Services. As an open innovation manager, his mandate was as abstract as it was critical: to help the agency use new tools and strategies to find innovative solutions to serious health challenges.
Today, Patel is a leading federal innovator who has elevated kidney disease as a key national health priority. In 2017, he launched KidneyX, a multimillion dollar public-private partnership between HHS and the American Society of Nephrology that accelerates new ways to treat, diagnose and prevent kidney disease. Two years later, he helped draft an executive order—the Advancing American Kidney Health Initiative—that requires HHS to meet ambitious benchmarks for improving nationwide kidney health.
This monumental shift would not have occurred without Patel’s ability to lead change. By encouraging innovation and creative problem-solving, embracing risk and uncertainty, and using his power of persuasion to influence others, Patel mobilized stakeholders across government and the private sector to develop better interventions for the roughly 40 million Americans who suffer from chronic kidney disease.
“I think people tend to put limits on what’s possible,” Patel said. “We need to put ambitious problems out there and rally the resources to solve them—even if we don’t know how that’s going to work exactly.”
From the start of his career, Patel has taken a “no risk, no reward” approach to his work. He became interested in the federal grant-making process as a doctoral student in physical chemistry and later witnessed how certain health processes and interventions could shape people’s lives as co-founder of OmusonoLabs, a Uganda-based company working to empower local residents to design and implement new 3D printing services.
Patel said both experiences led him to become “acutely aware of the transition from science to societal impact” and motivated him to work at HHS.
“The department had its hands on the levers of all the things I was interested in,” he said.
Still, Patel knew little about government, the agency or his specific job when he started as an open innovation manager at HHS. He recalled struggling initially to “wrap my brain around who does what” in the department and admitted to having only a vague sense of how to drive open innovation—a strategy organizations use to tap new ideas and resources from external partners to solve problems.
“I couldn’t tell you what that meant when I applied for the job,” he said. “I did my due diligence, but it was still a slightly foreign concept,” he said.
From the story: What challenges do you see in your organization, field or agency that people think are too big to tackle? Why do they believe that?
For reflection: How have you taken risks in your career or job?
For action: Where might you take more calculated risks as you choose projects, plan solutions or embark on career shifts?
Helping others take risks
To learn more about the job, Patel talked to people across HHS about how open innovation could address the agency’s biggest health priorities.
He soon realized, however, that not everyone was comfortable with the idea of open innovation. Instead, people tended to work on more concrete projects within specific teams and silos—a behavior often rewarded in government, according to Patel.
“What I noticed is that people get blinders on very quickly. You have your thing in front of you and you just do it. People are very stuck on the way of doing things—unintentionally most of the time.”
Patel overcame this hesitancy by focusing on the problems people were trying to solve, rather than promoting open innovation by name. He also established trust and rapport with people across the department through frequent—and often impromptu—conversations.
Designed as free-flowing learning sessions without a set agenda, the discussions helped Patel gather information about the agency’s health priorities and enabled him to demonstrate how open innovation tools—prize competitions, crowdsourcing, new types of partnerships and more—could serve employee needs. Working within the Office of the Secretary also gave Patel the credibility and “air cover” to make staff feel more comfortable taking risks.
“I usually started with a big problem and let people talk about what they do. It became more of a dialogue instead of me coming in with an agenda, which would have made people get tense and react.”
Patel said the strategy made people more receptive to the concept of open innovation and helped him learn about the agency’s work more broadly. In turn, he became a “connector,” someone who could spark innovation by pointing people toward useful resources and potential partners.
“One of the biggest barriers [to innovation] is that people need to be inspired. And the easiest way to inspire people is to connect them with someone who can help inspire them,” he said.
Patel also inspired others by sharing his own thoughts about a given problem—even if he did not have a perfectly formed solution first. He said the approach has encouraged agencies to lean into risks and institutionalize more experimental ways of addressing health issues.
For example, Patel helped the Maternal and Child Health Bureau launch a challenge program that has focused on promoting remote pregnancy monitoring and better access to healthy food for low-income families. He also supported the development of a new initiative at the Centers for Medicare and Medicaid designed to illustrate how artificial intelligence can be used to predict health outcomes for Medicare beneficiaries.
“People tend to keep things close to themselves because they want to get it perfect before they bring it into the world. I like being hyper-transparent about everything that I’m thinking about. I sort of take the risk for people and they come follow me.”
From the story: What tactics did Patel use to influence people? How were they effective?
For reflection: What barriers currently exist to working across your organization? How do you contribute to these barriers?
For action: How might you introduce open innovation—even on a small scale—within your team?
These conversations eventually led Patel to the topic of kidney disease. He was surprised by what he learned: Millions of Americans are on dialysis every week with no access to a transplant—hooked up to a machine for hours while experiencing lasting side effects.
He also learned that dialysis is costly. Recent reports show that about 20% of Medicare funds are spent to treat those suffering from kidney disease and that patients on dialysis have an average life expectancy of just five to 10 years.
When Patel talked to these patients, he decided it was time to act. “You talk to enough dialysis patients and you’re like, ‘This is crazy. How are we letting this persist?’”
In turn, he met with people across government and the private sector to discuss better alternatives to dialysis—even tracking down the person who wrote dialysis policies for the Centers for Medicare and Medicaid Services: Abigail Ryan, currently CMS’ deputy director of the Division of Chronic Care Management.
“As soon as I talked to her, something clicked. She got exactly what we were trying to do. She was doing her own thing, but we connected with her. She felt inspired and saw what was possible,” he said.
Still, getting others to buy in to the need for action proved challenging. Some believed the government had already invested enough in kidney health research. Others believed that scientists lacked the technology to enable a real breakthrough. And several more found alternative approaches to reducing kidney disease too risky and unproven.
He also realized health experts in government tended to work on isolated aspects of kidney health that made the issue seem overwhelming and impossible to tackle.
“It was a third rail issue,” he said. “Nobody wanted to touch it.”
To overcome this skepticism, Patel knew he had to create a platform that brought people together to develop “holistic” solutions to kidney health—including researchers and innovators from the private sector who were developing new solutions to kidney disease.
A core group of federal health leaders championed this vision and worked to make it a reality, including Jarah Meador, former Innovation Sourcing Lead at the Department of Veterans Affairs and a fierce advocate of open innovation.
Nevertheless, he recognized that some in government would take the new initiative as a sign of criticism that they had failed at their job. As a result, he was careful to pitch the initiative as something that capitalized on work already being done.
“It happens a lot in government where anytime you propose something new, it’s seen as a zero-sum game,” he said. “We tried to frame this more positively by saying ‘Everybody’s doing what they’re supposed to be doing—we just need to accelerate your efforts.’”
From the story: How did Patel try to ensure that others wouldn’t view his program as a criticism of their own work? How might you apply this to an idea you’re trying to implement?
For reflection: How do you think the status quo is rewarded in your organization? How could you reward new ideas on your team?
For action: How could you connect staff more with those who benefit from specific services, programs and policies?
Taking a moonshot approach
The strategy paid off. In 2017, Patel launched an ambitious public-private private partnership—the Kidney Innovation Accelerator, or KidneyX—that redefined how the federal government tackles kidney disease.
The initiative began as a “moonshot approach to developing alternatives to dialysis.” According to Patel, it’s goal was to provide a platform for groups that rarely worked together—both within and outside government—to solicit, design and implement new innovations in kidney health.
It took little time for KidneyX to dispel lingering questions about whether finding alternatives to dialysis was possible.
Attracted by funding and networking opportunities, kidney health researchers from the academic and private sectors flocked to the initiative. They attended summits, participated in listening sessions with KidneyX leadership and submitted their work to prize competitions designed to incentivize the creation of improved dialysis products, more patient-driven kidney health solutions and the world’s first artificial kidney.
Realizing that these interventions composed just “one piece of a larger problem,” the initiative has also expanded its focus to building a more efficient organ transplant system.
“We created this space where everybody came to us—we had investors all over the country and companies coming in. People saw the issue as exciting.” he said.
The new program also led to a shift in national policy. Just two years after KidneyX launched, President Trump signed an executive order that established the Advancing American Kidney Health initiative.
The order—the only in U.S. history that focuses specifically on a disease—called upon HHS to achieve goals that align with the KidneyX mission: preventing kidney failure through better diagnosis and treatment, encouraging the development of an artificial kidney, and creating Medicare payment options that help patients better prevent kidney disease and incentivize kidney transplants for those on dialysis.
Five months later, Trump signed a spending bill that included $5 million in funding for KidneyX—the first time Congress supported prize competitions in kidney health and a sign that national policymakers had taken note of the initiative’s innovative work. Feature stories on dialysis and organ transplants on hit shows like “Late Night with John Oliver” and “Full Frontal with Samantha Bee” also signaled growing popular interest in the subject.
For Patel, the catalytic effect of KidneyX illustrates the benefits of taking risks and embracing uncertainty. While the initiative started as an untested public-private partnership with a broad goal, it nevertheless provided key players with the platform they needed to collaborate and experiment with new ideas in kidney health.
In the last two years alone, these ideas have included the development of a new bioabsorbable wrap that supports cell growth after dialysis access surgery, a telehealth device that detects blood clots for patients on dialysis and a small internal filtration device for the body that performs all the actions of a dialysis machine—a critical technological component of an artificial kidney.
Another KidneyX prize winner has also helped make regenerative kidneys a viable health option for patients suffering from chronic renal failure.
“That was the lesson—don’t make [investors and stakeholders] do the work. Create the forum where they can plug in,” he said.
From the story: What was Patel’s vision for advancing kidney health and how did he get others to buy in to it?
For reflection: How have you successfully created a vision around projects or programs you’ve overseen? Where might you have strengthened that vision, and how might that have helped the project?
For action: How can you create space for stakeholders to engage with each other? What benefit would that provide to your programs?
Applying lessons from KidneyX
Today, Patel applies the lessons learned from launching KidneyX to his work as director of the Division of Research, Innovation and Ventures at HHS’ Biomedical Advanced Research and Development Authority—or BARDA DRIVe.
The group funds new medical innovations, forms public-private partnerships and deploys teams across the U.S. to support the development and procurement of drugs, vaccines and other products critical to our country’s national health.
Its portfolio currently includes an impressive range of programs that support this goal. One aims to develop vaccines and therapeutics without using needles and syringes; others hope to create better at-home testing services and digital health tools like smartphone apps and web platforms; and still another is working to create tissue chips—small 3D chips designed to show how human cells respond to drugs and other variants—that model components of the human immune system.
Recently, three BARDA leaders oversaw the development of a vaccine, two therapeutics and a diagnostic test designed to stop the spread of Ebola in Africa. The leaders were recognized as 2021 Samuel J. Heyman Service to America Medal® finalists for these accomplishments.
Patel believes the work—like his work at KidneyX—provides people with better service and a more favorable impression of government than they had before.
“People’s impressions of government are acute—an accumulation of little interactions that we have with people. We try to leave people with a good impression of who we are.”
He said that none of this would be possible had he and his colleagues not been willing to innovate, take risks and develop a vision for change.
“I think the general idea is that you take a lot of shots on goal and something eventually works and makes an impact. Then you can point to that and say it was worth the other hundred shots you took.”
From the story: A key to Patel’s success was taking risks. Why was he able to do so in ways others could not?
For reflection: Have you shared lessons learned and best practices with other teams in your agency? How can you proactively do so in the future?
For action: How can you help build adaptability, innovation and risk-taking into the culture of your team?