Great Transitions create the flux for fundamental change and they offer us unprecedented opportunities to influence the future and to design the world that we want. These transitions could be used as an opportunity to start living at a human scale, with connections to our environment that can be sustained within the limits of the earth's life support systems.
The ultimate expression of innovation is innovation of meaning.
Re-imagining the future of healthcare challenges us to think differently about health and care, to create a vision for the forms of healthcare experiences we should all expect to produce and to receive.
Elon Musk, the South African born contemporary pioneer, has shown how it is possible to make aspirational visions of the future become realities. He is successfully innovating radical reinventions of the car (Tesla), renewable energy (SolarCity), space exploration (Space-X) and the concept of travel (Hyperloop). To innovate successfully, Elon believes that we have to go back to fundamental universal principles, such as the law of thermodynamics. Rather than trying to incrementally improve on other people’s historical inventions, fundamental understanding takes us back to all things being possible (within the constraints of nature).
So what fundamental principle could we start with to innovate healthcare? Could it be the deep societal value of ‘caring’ that we all identify as a basic human need?
Caring can be a core benefit of healthcare - for both the giver and the receiver of care. Innovations that enable us (people in the healthcare system) to 'care more' or to ‘provide better care’ could bring about some of the biggest disruptions in how healthcare is delivered and experienced.
Caring is inclusive. So to innovative more inclusive healthcare, we should be imagining new and better ways to include the ‘social technology’ of caring into the mix of other technology innovations that will enable us to make better use of information, deliver smarter treatments, make healthcare more affordable and connect more people to the health services, information and care that they need.
Applying the human-centred design (HCD) approach to healthcare is a recent innovation that should be credited for changing the most lives in the developing world. This is in the opinion of Melinda Gates, who describes HCD as “Meeting people where they are and really taking their needs and feedback into account”. Viewing ‘innovation’ from this design perspective seems especially relevant to healthcare, which is (or should be) essentially about people.
Most problems in healthcare are found ‘in the field’ and are directly experienced (and created!) by people in the system. Enabling the people who feel the pain to participate in the design process and to contribute their own ideas and insights about what innovations could really help to overcome their problems is at the core of Human-Centered Design and is the basis for the idea of Inclusive Healthcare Innovation.
We expect these approaches to bring more realistic understanding of the challenges people encounter in the ‘whole system’ of their lives. For instance, introducing a great medical innovation at a clinic might not produce the better health outcomes we expect if people don’t have transport to get there! Truly ‘inclusive’ innovation is not the same as the ‘participatory’ approaches practiced in the past (when the main focus was on bringing stakeholders together). Inclusive innovation requires iteration and interaction, so that the hard questions can be refined from each learning experience (success or ‘failure’) and potential solutions can be discussed and prototyped ‘in the field’. This demands shifts in organisational culture within our healthcare system, but it feels like now the time is right for this.
Inclusive healthcare innovation can build new problem-solving competencies over time.
For individuals in the system who share this journey, the experience of how to make their own ideas happen can inspire them to continue persevering and iterating proactive ways of engaging with and fixing the system ‘from the inside out’.
We should be pragmatic about the cumulative effect of solving ‘small’ problems (such as how to make healthcare more efficient and effective) through incremental innovations and improvements over time. This is where Human-centred Design excels, with its emphasis on iterated observation, ideation and testing.
But we should also dream big, to re-imagine healthcare by tackling the biggest challenges in our current systems. This needs radical innovations that are unlikely to come from Human-centred Design processes. Radical Innovation comes from changes in either technology or meaning (Norman & Verganti, 2012). Inventors and tinkerers produce technology innovations and we can admire the genius of their inventions, when these give us (sometimes unexpected) new solutions. However, meaning-driven innovation has the potential to be driven through research and by creating the spaces for people to explore new meanings and interpretations that can give rise to fundamentally different ways of perceiving the possible solutions.
With all the information we now have available at our fingertips and the means to connect to highly qualified ‘solvers’ from all over the world, we should find problem-solving through these various forms of design and innovation becoming more routine.
But finding the most relevant and critical problems to tackle will remain the real challenge to innovators. ‘Crowdsourcing’ and ‘open innovation’ have become buzzwords for these more inclusive approaches to design and innovation, so how about crowdsourcing problems and new meanings, not (just) technological solutions?
I am part of a small University of Cape Town team preparing the first annual Health Innovators Review that will be published in January 2014. Our current review focuses mainly on what pioneering South African innovators/solvers have achieved. A worthwhile focus for the future could be to find much more innovative ways of the surfacing better insights from more people into the real problems that millions experience. So the thousands of creative solvers - including designers and innovators locally and globally, can start to work on these problems in much more systematic and connected ways!
This could be a relevant role for the Inclusive Healthcare Innovation initiative I am helping to build at the University of Cape Town. Based at an academic institution, this could serve as a connector of people, ideas, meanings, problems and ways of solving these.
It was my pleasure recently to meet well-being researcher Nic Marks for a conversation over breakfast in Stellenbosch and share ideas about Design Happiness.
Since first meeting Nic a few years back, it has been interesting to discover how we have both been influenced by the work of Manfred Max Neef, who has given the world the intellectual framework for human-scale development (economics as if people and the planet matter).
Manfred has certainly provided profound inspiration for my own work over the past decade and now for my latest startup, 9Needs, where we promote human-scale, social innovation and design to help create places, products and services that will produce better health and wellbeing for all people and for the planet.
Nic is well known for developing the Happy Planet Index and National Accounts of Wellbeing, from the Centre for Well-Being that he founded at the leading UK think-tank, New Economics Foundation (NEF). He has led pioneering work to gather statistical evidence about what ‘makes us happy’. The results of this work have been used to promote policies that put the well-being of people and the planet first. There can be no doubt that Nic’s work over the years has contributed to the Commission on the Measurement of Economic Performance and Social Progress and more recent UN resolution on Happiness: towards a holistic approach to development.
My conversation with Nic helped prepare a pitch to the organisers of next years World Design Capital 2014 in Cape Town, to use this event as an opportunity to demystify and further popularise design that truly enhances wellbeing for people and the planet.
We propose to facilitate dialogue amongst designers to identify qualities of design that can contribute to wellbeing and examples of ‘Design Happiness’.
This could lead to measures being developed, to objectively assess designs to start setting benchmarks for better design.
The result could be something like a ‘Design Happiness Index’
Reflecting on the buzz and the novelty factor surrounding all things ‘innovative’, I am beginning to think we both concurrently overrate and undervalue innovation and underplay the conditions that need to be in place to enable innovation.
When we prioritise evaluation of innovation primarily by the outcomes it delivers in the form of external impacts, we could be ignoring important positive internal organisational impacts. Many of these come from learning from failed innovations!
There could be unintended consequences of evaluating the innovation performance of organisations by only looking at their positive external impacts. This could stifle risky experimentation that is necessary to make progress in difficult and unpredictable environments.
The question then arises, what might be the type of principles or conditions that foster innovation and learning from both failure and success in innovation? I don’t think there is a distinct set of criteria or a checklist of conditions that works for all, given the nature of innovation, but I think exploring facets of organisational culture will shed light on the innovation orientation of an organisation. Here are a few facets of this that I think might be helpful:
- Foster senior-level leadership in innovation
- Promote and support an innovation culture that engages staff, customers and partners
- Create a place for safe-fail experiments
- Protect space for learning
- Don’t ignore the value of and the need for strengthening more routine activities
- Use results information for learning and managing, as well as for reporting and accountability
- Build an adaptive, co-designed measurement system that provides regular feedback to lean and make decisions to adapt innovations.