The Future of Neurocritical Care Research:
Looking for a Blue Ocean
By Sara Hocker, MD; Shraddha Mainali, MD; and Andrew Naidech, MD
The fifth Neurocritical Care Research Conference, “The Future of
Neurocritical Care Research: Looking for a Blue Ocean,” was held
in Boca Raton, Florida, on Sept. 25, 2018. The primary aim of
this interdisciplinary scientific symposium was to bring together
scientists and healthcare professionals from diverse fields with
a common interest in understanding and advancing research in
neurocritical care and to set the agenda for the future direction
of the Neurocritical Care Research Network (NCRN) and the
Neurocritical Care Research Central (NCRC). The meeting had
125 registrants and 103 attendees from all parts of the world
including the United States, Brazil, Israel, Canada, Colombia,
Argentina, Chile, Japan, Italy, Germany, Austria and the UK.
Attendees were 46 percent women, 39 percent minority and 28
percent junior members.
The conference opened with a review of the history and aims
of the NCRN presented by Dr. Jose Suarez, followed by special
lectures on the current status and innovative ideas in NCC
research. The concept of using ideation techniques such as
the blue ocean strategy to challenge the status quo was then
introduced, and a lively discussion on the application of the
concept to healthcare followed. Blue ocean is a concept from the
business world developed by John Mullins and first published
in 2005 by W. Chan Kim. It seeks to identify undiscovered
markets, a “blue ocean.” Alternatively, a red ocean is an existing
competitive workspace in which groups compete for the same
customers. The Neurocritical Care Society is in fact, a blue ocean
society, as its development created a new market space without
existing competition. By comparison, the society journal,
specialty certification, meetings and guidelines exist within red
oceans because, while these are valuable and important products,
there are many other societies and funding agencies pursuing
All participants were expected to read the book “Blue Ocean
Strategy” and attend one of two webinars presented by Lawrence
Aronhime, MBA, MS, an expert in ideation techniques, before
the meeting. Three multiprofessional and multigenerational
working groups (made up of five members each) were created
and separately used the blue ocean strategy to answer questions
posed within three broad topic areas, including: 1) NCRN driving
the science, 2) NCRN driving research, and 3) NCRN driving
the profession. These groups met regularly via teleconferences
during the six months prior to the conference and drafted
recommendations to be presented at the conference to a jury and
all attendees. The five-member jury (Mike Diringer, Robert Stevens,
Gisele Silva Sampaio, Lori Shutter and Claudia Robertson)
was tasked with advising the NCRN leadership on which
recommendations presented by the working groups should be
most heavily considered.
A wide array of ideas was debated, resulting in the following
• We have not fully defined our diseases.
• It is too soon to focus on implementation strategies given the
limited number of evidence-based strategies to implement.
• There is a tension between protocolized medicine and
• A translational link from the lab to the patient is needed.
• Optimal research strategies in NCC have not been defined
(e.g., randomized controlled trial, clinical accelerator,
creative trial designs such as comparative effectiveness).
After deliberation, the jury proposed the following seven
recommendations for the NCRN:
1. Establish the right balance between game-changing scientific
breakthroughs versus incremental discovery.
2. Enable/support the backwards translation of fundamental
3. Actively engage in new research methodologies such as big
data, computational modeling and personalized/precision
4. Support development of grant proposals.
5. Partner with colleagues in other medical domains, basic
science, engineering, government and the industry.
6. Develop infrastructure to train the new generation of
NCC investigators (e.g., online, embedded research time,
7. Actively engage with partners in low-resource settings to
conduct science and improve care.
Following the meeting, NCRN leadership met to discuss the
recommendations generated in the meeting. The goal is to create
a proposal for NCRN that will take NCS to the forefront of
neurocritical care research and set a platform to address major
problems faced by our patients.
Sara Hocker, MD Shraddha Mainali,