How to Ensure Success in Digital Health Innovation
The promise of Digital Health has appeared to be straightforward, but delivery has often been disappointing and progress has been slower than many expected. Digital Health solutions don’t automatically lead to improved outcomes, or healthy financial returns for entrepreneurs and innovators. The problem is the complex physiological, psychological and sociological context in which a solution sits. That is: How digital technology fits around us physically, how it addresses both our psychological and emotional needs as well as our physical ones, and how it integrates into our social lives. Only once these factors are considered is it possible to create solutions that really resonate with their intended user communities.
Why Healthcare Needs a Digital Revolution
Healthcare is a $6.5tn industry. The OECD average spend on healthcare is around 10% of GDP so it represents a huge drain on the resources of developed countries. Unfortunately the percentage is rising as aging populations require ever more complex care and preventable diseases consume an ever greater proportion of the pie. Controlling rising healthcare costs has become one of the defining challenges of the 21st Century.
This rise in healthcare expenditure can be attributed to three main components:
- The rise in chronic lifestyle related disease such as diabetes, heart disease and cancer
- An aging population living longer and expecting to remain active longer into their life
- A rise in medical costs as more sophisticated treatments are developed, requiring more expensive drugs or equipment
However there is a paradox because today, the vast majority of healthcare is spent on treating disease and proportionally far less is spent on prevention where, arguable, greater value could be realised. Thus 20% of the population are responsible for 80% of healthcare expenditure.
So a wholescale change in approach to healthcare delivery is required away from the traditional, transactional models of treatment towards iterative, integrated relationships which support people throughout their life. Technology has obvious application to this model, providing opportunities to deliver efficiencies, integration, scalability and ubiquity to a population becoming increasingly familiar, even demanding of digital experiences.
Why Digital Health Innovation Has Failed So Far?
Given such a compelling case, why is it that Digital Health has struggled to gain traction and deliver on its promise of transforming models of healthcare delivery? It’s become well known that most innovation fails. According to the Harvard Business School most new service delivery fails to meet its objectives. John Gourville has suggested that the new product failure rate is up to 90% and David Garvin has said that the primary reason for innovation failure is the degree to which user needs were understood.
In healthcare delivery this rate is likely to be even higher due to the additional complexities of behaviours and silo-ed organisations. Health and Wellbeing is often the result of complex personal contexts that influence our behaviours, decisions, habits and routines. The relationship between our personal goals, motivations, constraints and triggers are often not considered or understood, even though they can have a significant impact on our behaviour and drive is ways which do not immediately appear rational. Care pathways can often span multiple organisations and the touch points between them can often be complex. There are multiple business models and what’s beneficial for one may be detrimental for another Building interactions between all the agencies and stakeholders involved is complex and demanding. Unless innovators take this context into account even the greatest innovation can be felled by the system and fall by the wayside.
With this in mind, it should be obvious why technology alone is not a solution, it is an enabler. As Steve Jobs said “You‘ve got to start with the customer experience and work back toward the technology – not the other way around”. And so the key to unlocking this is what we call Outcome Driven Innovation. A six stage process:
- Framing the challenge & identifying the stakeholders
- Uncovering the needs
- Solution & business model platform design
- Solution development and behaviour change delivery
- Measurement, management, data and evidence capture
- Scaling & diffusion of solutions across the healthcare system
Let’s drill into the first three of these.
Framing the Challenge & Identifying the stakeholders
The healthcare landscape is large and complex. Each part brings different challenges and opportunities. Digital Health Innovators need to decide where they want to play. For instance there is a continuum from wellness, at risk prevention, diagnosis and treatment. There are also multiple business models. Is your innovation aimed at consumers, employers, healthcare professionals, providers or payors? Some require more clinical evidence and regulatory compliance where others are more open and flexible. Then there are a multitude of ways to segment the market by disease type, discipline or physiology. There are also multiple actors including patients, healthcare professionals (doctors, nurses, ancillary specialists, etc), social care providers, family, carers, payors and government.
The key to navigating this labyrinth is to consider the following questions:
- What is the health goal we are going to focus on?
- How is this health goal currently approached and what is the nature of the problem we need to solve?
- Who are the key players in the ecosystem and what influence do they have on any new solution design?
- What are the key barriers and enablers we need to be aware of?
With these in mind it should be possible to frame the problem you are trying to solve and identify the key stakeholders you need to consider.
Uncovering the Need
Market research is often used to gain insights into what and how a solution should be designed. However this approach can usually only give very imprecise inputs and this can lead to high rates of innovation failure. If we are shooting in the dark, the chances are we will miss. Clayton Christian, author of “The Innovators Dilemma”, suggested that people select (or hire) products and services to help them get a job done. We can think of these jobs as processes made up of distinct steps for which people have a set of desired outcomes that represent their measure of how they wish to get the job done. When considering innovation, the “job” should be the focus of analysis and research in order to understand what it is that people are trying to get done. Once we understand the job, its constituent steps and the desired outcomes for each, we can direct our innovation to the areas where it is most likely to be needed.
We can use this approach as a ‘telescope’ to consider a high level example, for example the job of managing with diabetes. Or we can use it as a microscope, for example the job of administering insulin. Collecting the needs from all the stakeholders provides us with a 360o understanding of the health issue we are trying to solve.
Solutions and Business Model Platform Design
Now we can pull together the needs from all the parties and use this to give us a common understanding about the nature of the healthcare challenge and what needs to be done. Often different stakeholders can have different, even conflicting needs and only by understanding all of them can we design a solution which addresses the most important needs most effectively. This analysis enables us to identify the optimum solution options, pin point conflicts and make trade-offs, develop a roadmap for future development and understand the most appropriate business model for our innovation. Taken together this allows us to develop a Minimum Value Product. This differs from the more familiar Minimum Viable Product in that it ensures that the minimum product we create will be valuable to our intended audience. It’s not just about delivering minimum functionality, but delivering minimum value which hits the threshold of what stakeholders would consider to be valuable.
So much for the theory, let’s look at an example of the application of this framework.
The Royal Free Hospital
The Royal Free Hospital in North West London wanted to know where they needed to invest to improve the experiences of their 500,000 outpatients. They used an outcome based approach to help them determine what they should invest in.
We conducted interviews with patients in order to construct a customer journey which covered activities in pre-consultation, the consultation itself and post-consultation. From this we identified over 400 unique contexts, functional, emotional and wider support needs. Based on the needs they were able to create potential solution ideas. From this jobs based analysis what they came to understand was that huge “white spaces” exist in the patient’s world where personalised information and tools could provide significant help and improve outcomes. These are needs where digital technology is well-placed to offer solutions, providing scale and reach which other channels cannot match.
The title of this post was “how to ensure success in digital health innovation”. Of course that’s quite a bold assertion, and might lay one open to the claim of hyperbole. In truth there are no guarantees. For one thing, innovation doesn’t just fail because of a poor understanding of customer need. There are many other ways to fail. Furthermore, analysis can only get you so far and, while it is immeasurably helpful to understand the needs of your stakeholder communities, what you do with that information is what really counts. Innovation is not just a questions of process, it’s also a place where inspiration, creativity and perhaps a degree of luck play their part. But an Outcome Driven approach can help to de-risk innovation projects and provide a clear insight into where and how innovation should be focused.
We believe that a structured approach to identifying and analysing needs is a valuable tool in the innovators toolkit, and has a natural applicability to the field of Digital Health in all its complexity.
If you’d like to understand more about how Outcome Driven Innovation and Needs Analysis could apply to your Digital Health Innovation why not add your contact details to the form below and find out if we can help you.
Oh – and please add your stories of Digital Health Innovation success or failure to the comments below.