managing healthcare innovation as a design process

Copyright © 2014, Peter Jones

Managing Healthcare Innovation as a Design Process

Peter Jones, PhD Redesign Network

OCAD University, Toronto

Project Management InstituteSo Ontario Chapter, Feb 18, 2014


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Peter Jones, Ph.D.

Managing Partner, Redesign NetworkSenior Fellow, Strategic Innovation LabFaculty of Design, Strategic Foresight & Innovation


“What if Designers were included as care professionals?”

Enabling those who serve people seeking care: Health practice & care organizations.

• People not patients. • Systemic, touches every sector• Connects across disciplines • Cases, Methods, Experiences

Rethinking Care 1. Design as Caregiving2. Co‐Creating Care3. Seeking Health

Rethinking Patients4. Design for Patient Agency5. Patient‐Centered Service Design

Rethinking Care Systems6. Design at the Point of Care7. Designing Healthy Information Technology8. Systemic Design in Healthcare Innovation 9. Designing Healthcare Futures

designforcare.com@designforcare

Design for Care: Innovating Healthcare Experience


The Innovation Landscape in Healthcare

• Information Technology & Online Services• Devices & Medical Products• Services & Experiences

How might we design for …• Clinical practice / Care models?• Organizational structures & Business models?• Government Policy & Shared Services?


Where we expect DesignNecessary, not sufficient

Information & Online Services


Devices & Medical Products

Zero diabetes armband concept Mauro Amoroso

Timesulin insulin pen ‐ courtesy Marcel Botha

Copyright © 2014, Peter JonesPhilips Design, from Coroflot magazine

Services & Experiences


Ill‐defined, evolving, multi‐factored situations. (Rittel & Webber, 1973.)

1. There is no definite formulation of a wicked problem.

2. Wicked problems have no stopping rules (you don’t know when you’re done).

3. Solutions are not True/False but Good/Bad (value judgments)

4. There is no immediate and no ultimate test of a solution to a wicked problem.

5. Every attempt to solve counts (one shot op)

6. Wicked problems do not have an enumerable set of potential solutions.

7. Every wicked problem is essentially unique.

8. Every wicked problem can be considered to be a symptom of another [wicked] problem.

Wicked Problems


Wicked Problems in Healthcare

• Large, aging & BIG demographic looming …• Expense of complex diseases• Universal Health Records / Platforms• Coordination of Care• Managing costs at practice AND payer levels• Medical Innovation – costs & integration of tech

• (It should be easy to name others …)• Useless to manage by traditional analytical means


Healthcare Predicament

• Big Box healthcare is unsustainable SOA report (Sept 2013) > Consume 100% revenues in 25 yrs

• Cost drivers for US & Canadian healthcare are similarMegatrends of: A generation of > 70M aging over next 10 yearsIncreasing obese, diabetic, & chronic patientsEntitled & expecting better health services …

• 5% patients incur up to 50% all care costs.• Increasing complexity in IT, policy, hospitals, research

AHRQ, Research in Action 19, 2006


Farrow Partnership ‐ From ArchinnovationsPeel Regional Cancer Centre, Credit Valley Hospital

We aren’t lacking design or solutions …

Bridgepoint HospitalToronto Star photograph


A complex design problem.

• High‐tech isn’t helping ‐ Technology increases costs

• Information is fragmented ‐ Too many apps (> 70K!)Too many IT systems (> 750 EMRs in 2010)

• Care experience is fragmented ‐ Risks to quality, care delivery, population health, cost of care

• Healthcare business models fragmented, fragile

• (In most cases) Installing old care models into world‐class facilities


Complex care is managed like design.

Sequential IterativeMission Efficient delivery of known solution Evaluation and management of

complex care for difficult problems

Beliefs and values An ideal existsUncertainty is reduced before care

Ideal state is unknowableUncertainty is reduced during care

Scope of service NarrowHigher capacity (throughput)

DiversifiedLower capacity

Processes StandardizedAssembly‐line model

Nonstandard, or no protocolsJob shop approach

Management policy Centralized Broad span of controlReduced variation in performance

DecentralizedNarrow span of controlImprovements learned by variation

Human resources Conforming, conservative employeesRepetitive tasks

Problem‐solving experimentersDevelopment of new variations

Technology Specialized General purpose

Adapted from R. Bohmer. Designing care: Aligning the nature and management of health care. Boston: Harvard Business Press.


But very few designers live in Healthcare

• Architectural Design• User Experience / Interaction Design• Information Design• Service Design • Evidence‐Based Design• Environmental Design• Visual Design• Industrial Design


3 Locations 3 Contexts

16

SERVICE


Design process from Discover - Develop

Field ResearchDesign Research

User Testing


• Innovation Centres have exploded since 2012• In 2010 they were only at Mayo, CCF, TGHAre now being explored everywhere

• Without a real customer, innovation is just creative process improvement

• Without design, innovation is shallow. • Without research, innovation impact is blunted.• Consider the best cases …

“Innovation” without Design


Atrial Fibrillation Care

Many health services treat chronic & complex illness as exceptions. Patients fall between the cracks & are shuttled around, getting fragmented care. By not adapting to the changing reality of the chronic demographic, costs rise as hospitals increase their exception cases.

Morra, et al (2010). Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario.


Atrial Fibrillation System Redesign

The improvement of individual experience is an effect in healthcare. Good, but not systemic. Innovation should scale.


Afib Personas & Care Tools


• Technology‐based innovation is supply‐driven • On the customer side we have wicked problems

Let’s just pick one: Lack of effective primary care. • Results in avoidable blindness, amputations, strokes, heart

attacks, & premature death.• US residents receive only ½ recommended medical services.

Only 43% of diabetics are treated37% with hypertension

• Care delivery hindered by Electronic Records (EMRs)

Frieden, TR and Mostashari, F. (2008). Health Care as If Health Mattered. JAMA, 299 (8):950‐952

Demand Side Innovation


OUTCOMES

DEEP DRIVERS

Influence Map of Canadian Healthcare System

Group decision mapping of factors from Building on Values (2002), Romanow report


Solution: Innovate the Business Model

Michael Porter & Thomas Lee

The Strategy That Will Fix Health CareHBR, October 2103

Toby CosgroveCEO, Cleveland Clinic

Value‐Based Health Care Is InevitableHBR, Sept 2013

Brookings Institution, RWFBending the Curve, 2013


Redesigning the Big-Box Healthcare Model

• Patient‐centred Care: Organizing care for medical conditions rather than specialties

• Value‐based Care: Measuring costs & outcomes for each patient• Bundled prices for the full care cycle

• Distributed Care: Integrating care across separate facilities• Expanding geographic reach• Building enabling IT platforms

Obamacare policies have positioned the US for Value‐Based Care


A Shared Value Healthcare Business Model


Getting to Innovation

• Design 1.0 – 4.0• Design at org / system level requires a rare skillset ‐ among designers or doctors

• Risks outcome of other “deep” practices(BPR, Systems thinking)

• Innovation must be driven by real needs –Patient pop, Care models, Technology

• Not just improvements!


Is Innovation a New Process Movement?

• Quality movement has matured• Every hospital has PI, 6 Sigma, Lean• Lean has optimized value streams ‐• (And) now metrics are universal

• Analytical mindset optimizes• Design mindset synthesizes


You’ve heard about …

• Culture eats strategy? (Attributed to Drucker)• Healthcare must innovate the organization before it can radically innovate

• Today’s drivers are cost, efficiency (cost), risk, & patient satisfaction.

• All cost drivers.


Role of Research

• Human‐Centred Design• Observing practice in the field• Testing multiple iterations


Guidelines for leading what’s next

• Understand value of each type of innovationRadical, incremental, disruptive, sustaining

• Lead by innovating the organization! • IT is a partner, not the lead.New service & business models drive new IT

• Don’t layer “design thinking” onto a process improvement model. Hire designers.

• Discover your own value‐based models


Peter Jones, Ph.D.

[email protected]@designforcare

Book discount code (20%) DFCPMIAt designforcare.com

managing healthcare innovation as a design process

Health & Medicine

healthcare large

wicked problems illdefined

redesignnetwork seniorfellow

innovation landscape

lacking design