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Managing Healthcare 
Innovation as a Design Process 
Peter Jones, PhD    

Redesign Network
OCAD University, Toronto

Proj...
Peter Jones, Ph.D.
Managing Partner, Redesign Network
Senior Fellow, Strategic Innovation Lab
Faculty of Design, Strategic...
Design for Care: 
Innovating Healthcare Experience
“What if Designers were included 
as care professionals?”
Enabling thos...
The Innovation Landscape in Healthcare
• Information Technology & Online Services
• Devices & Medical Products
• Services ...
Information & Online Services

Where we expect Design
Necessary, not sufficient 

Copyright © 2014, Peter Jones
Devices & Medical Products

Zero diabetes armband concept 
Mauro Amoroso

Timesulin insulin pen ‐ courtesy Marcel Botha
Co...
Services & Experiences

Copyright © 2014, Peter Jones magazine
Philips Design, from Coroflot
Copyright © 2014, Peter Jones
Wicked Problems
Ill‐defined, evolving, multi‐factored situations.   (Rittel & Webber, 1973.)
1. There is no definite formu...
Wicked Problems in Healthcare
•
•
•
•
•
•

Large, aging & BIG demographic looming …
Expense of complex diseases
Universal ...
Healthcare Predicament
• Big Box healthcare is unsustainable 
SOA report (Sept 2013)  > Consume 100% revenues in 25 yrs
• ...
We aren’t lacking design
or solutions …

Farrow Partnership ‐ From Archinnovations
Peel Regional Cancer Centre, Credit Val...
A complex design problem.
• High‐tech isn’t helping ‐ Technology increases costs 
• Information is fragmented ‐ Too many a...
Complex care is managed like design.
Sequential

Iterative

Mission

Efficient delivery of known solution

Evaluation and ...
But very few designers
live in Healthcare
•
•
•
•
•
•
•
•

Architectural Design
User Experience / Interaction Design
Infor...
3 Locations 3 Contexts
SERVICE

16
Copyright © 2014, Peter Jones
Design process from Discover - Develop

Field Research
Design Research
User Testing
Copyright © 2014, Peter Jones
“Innovation” without Design
• Innovation Centres have exploded since 2012
• In 2010 they were only at Mayo, CCF, TGH
Are n...
Copyright © 2014, Peter Jones
Copyright © 2014, Peter Jones
Atrial Fibrillation Care
Many health services treat chronic & 
complex illness as exceptions. Patients fall 
between the c...
Atrial Fibrillation System Redesign
The improvement of individual experience is 
an effect in healthcare. Good, but not 
s...
Afib Personas & Care Tools

Copyright © 2014, Peter Jones
Demand Side Innovation
• Technology‐based innovation is supply‐driven 
• On the customer side we have wicked problems
Let’...
Influence Map of Canadian Healthcare System 
OUTCOMES

DEEP DRIVERS

Copyright © 2014, Peter Jones

Group decision 
mappin...
Solution: Innovate the Business Model
Michael Porter & Thomas Lee
The Strategy That Will Fix Health Care
HBR, October 2103...
Redesigning the Big-Box Healthcare Model
• Patient‐centred Care:  
Organizing care for medical conditions rather than spec...
A Shared Value Healthcare Business Model

Copyright © 2014, Peter Jones
Getting to Innovation
• Design 1.0 – 4.0
• Design at org / system level requires a rare 
skillset ‐ among designers or doc...
Is Innovation a New Process
Movement?
•
•
•
•

Quality movement has matured
Every hospital has PI, 6 Sigma, Lean
Lean has ...
You’ve heard about …
• Culture eats strategy?  (Attributed to Drucker)
• Healthcare must innovate the organization 
before...
Role of
Research
• Human‐Centred Design
• Observing practice in the field
• Testing multiple iterations

Copyright © 2014,...
Guidelines for leading what’s next
• Understand value of each type of innovation
Radical, incremental, disruptive, sustain...
Book discount code (20%)  DFCPMI
At designforcare.com

Peter Jones, Ph.D.
peter@redesignnetwork.com
designdialogues.com
@d...
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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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  1. 1. Managing Healthcare  Innovation as a Design Process  Peter Jones, PhD     Redesign Network OCAD University, Toronto Project Management Institute So Ontario Chapter,     Feb 18, 2014 Copyright © 2014, Peter Jones
  2. 2. Peter Jones, Ph.D. Managing Partner, Redesign Network Senior Fellow, Strategic Innovation Lab Faculty of Design, Strategic Foresight & Innovation Practices Redesign  Dialogic Design  redesignresearch.com designwithdialogue.com Publications Papers / Blog Research Healthcare Products Procedures Consult ScienceDirect Cdling.com Copyright © 2014, Peter Jones designdialogues.com  sLab.ocad.ca  designforcare.com
  3. 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. 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
  5. 5. Information & Online Services Where we expect Design Necessary, not sufficient  Copyright © 2014, Peter Jones
  6. 6. Devices & Medical Products Zero diabetes armband concept  Mauro Amoroso Timesulin insulin pen ‐ courtesy Marcel Botha Copyright © 2014, Peter Jones
  7. 7. Services & Experiences Copyright © 2014, Peter Jones magazine Philips Design, from Coroflot
  8. 8. Copyright © 2014, Peter Jones
  9. 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. 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. 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. 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. 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. 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. 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. 16. 3 Locations 3 Contexts SERVICE 16 Copyright © 2014, Peter Jones
  17. 17. Design process from Discover - Develop Field Research Design Research User Testing Copyright © 2014, Peter Jones
  18. 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
  19. 19. Copyright © 2014, Peter Jones
  20. 20. Copyright © 2014, Peter Jones
  21. 21. 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. Copyright © 2014, Peter Jones Morra, et al (2010).  Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario.
  22. 22. Atrial Fibrillation System Redesign The improvement of individual experience is  an effect in healthcare. Good, but not  systemic. Innovation should scale. Copyright © 2014, Peter Jones
  23. 23. Afib Personas & Care Tools Copyright © 2014, Peter Jones
  24. 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
  25. 25. Influence Map of Canadian Healthcare System  OUTCOMES DEEP DRIVERS Copyright © 2014, Peter Jones Group decision  mapping of factors  from Building on  Values (2002),  Romanow  report
  26. 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. 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. 28. A Shared Value Healthcare Business Model Copyright © 2014, Peter Jones
  29. 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. 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. 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. 32. Role of Research • Human‐Centred Design • Observing practice in the field • Testing multiple iterations Copyright © 2014, Peter Jones
  33. 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
  34. 34. Book discount code (20%)  DFCPMI At designforcare.com Peter Jones, Ph.D. peter@redesignnetwork.com designdialogues.com @designforcare Copyright © 2014, Peter Jones
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