Managing Healthcare Innovation as a Design Process
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Talk at Southern Ontario PMI Healthcare Group on leading Healthcare Innovation as a design-led process, including contexts of design in complex problems, value-based business models, and innovation centres.
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Managing Healthcare Innovation as a Design Process
- 3. Design for Care: Innovating Healthcare Experience “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 Copyright © 2014, Peter Jones designforcare.com @designforcare Rethinking Care 1. Design as Caregiving 2. Co‐Creating Care 3. Seeking Health Rethinking Patients 4. Design for Patient Agency 5. Patient‐Centered Service Design Rethinking Care Systems 6. Design at the Point of Care 7. Designing Healthy Information Technology 8. Systemic Design in Healthcare Innovation 9. Designing Healthcare Futures
- 4. 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? Copyright © 2014, Peter Jones
- 9. Wicked Problems 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. Copyright © 2014, Peter Jones
- 10. 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 Copyright © 2014, Peter Jones
- 11. Healthcare Predicament • Big Box healthcare is unsustainable SOA report (Sept 2013) > Consume 100% revenues in 25 yrs • Cost drivers for US & Canadian healthcare are similar Megatrends of: A generation of > 70M aging over next 10 years Increasing obese, diabetic, & chronic patients Entitled & expecting better health services … AHRQ, Research in Action 19, 2006 • 5% patients incur up to 50% all care costs. • Increasing complexity in IT, policy, hospitals, research Copyright © 2014, Peter Jones
- 12. We aren’t lacking design or solutions … Farrow Partnership ‐ From Archinnovations Peel Regional Cancer Centre, Credit Valley Hospital Copyright © 2014, Peter Jones Bridgepoint Hospital Toronto Star photograph
- 13. 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 Copyright © 2014, Peter Jones
- 14. Complex care is managed like design. Sequential Iterative Mission Efficient delivery of known solution Evaluation and management of complex care for difficult problems Beliefs and values An ideal exists Uncertainty is reduced before care Ideal state is unknowable Uncertainty is reduced during care Scope of service Narrow Higher capacity (throughput) Diversified Lower capacity Processes Standardized Assembly‐line model Nonstandard, or no protocols Job shop approach Management policy Centralized Broad span of control Reduced variation in performance Decentralized Narrow span of control Improvements learned by variation Human resources Conforming, conservative employees Repetitive tasks Problem‐solving experimenters Development 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. Copyright © 2014, Peter Jones
- 15. 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 Copyright © 2014, Peter Jones
- 16. 3 Locations 3 Contexts SERVICE 16 Copyright © 2014, Peter Jones
- 17. Design process from Discover - Develop Field Research Design Research User Testing Copyright © 2014, Peter Jones
- 18. “Innovation” without Design • Innovation Centres have exploded since 2012 • In 2010 they were only at Mayo, CCF, TGH Are 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 … Copyright © 2014, Peter Jones
- 23. Afib Personas & Care Tools Copyright © 2014, Peter Jones
- 24. Demand Side Innovation • 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 treated 37% 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 Copyright © 2014, Peter Jones
- 26. Solution: Innovate the Business Model Michael Porter & Thomas Lee The Strategy That Will Fix Health Care HBR, October 2103 Toby Cosgrove CEO, Cleveland Clinic Value‐Based Health Care Is Inevitable HBR, Sept 2013 Brookings Institution, RWF Bending the Curve, 2013 Copyright © 2014, Peter Jones
- 27. 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 Copyright © 2014, Peter Jones
- 28. A Shared Value Healthcare Business Model Copyright © 2014, Peter Jones
- 29. 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! Copyright © 2014, Peter Jones
- 30. 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 Copyright © 2014, Peter Jones
- 31. 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. Copyright © 2014, Peter Jones
- 32. Role of Research • Human‐Centred Design • Observing practice in the field • Testing multiple iterations Copyright © 2014, Peter Jones
- 33. Guidelines for leading what’s next • Understand value of each type of innovation Radical, 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 Copyright © 2014, Peter Jones