Particularly in the NHS constraints are everywhere. Take this example
The NHS needs to meet £30bn funding gap expected by 2020-2021. Chronic condition costs will rise by £5bn per year by 2018.
Here are just a few pressures that Health Innovators in the NHS need to absorb
I finished my essay one hour before it was due
Every student ever
At University my worst essays were ones that I finished ahead of time. Where I was working up against a deadline I was forced to be creative and think on my feet. In reality the hours of reading I had done up until that point fed into that moment but the hard deadline was a constraint that delivered results for me.
My point here is the Health Innovation is a constraint heavy environment and for Innovators this is a blessing in disguise.
Internet start-ups are usually created by people with many ideas and a vast number of constraints. They are normally constrained by three main factors:
This sounds familiar to the pressures facing Innovation in the NHS. So how do they get it right? The most popular philosophy that pervades start-up culture is Lean and there is no doubt that Health Innovation can learn a huge amount it.
Lean promotes the build, measure, learn philosophy. This proposes that the quickest and cheapest way to understand whether you are building the right thing is to get on and build it. Forget lengthy planning sessions, specifications and endless meetings. Propose a hypothesis and get on and create something. A crucial part of this process is being able to measure your hypothesis. A simple technique for measuring your hypothesis is to create a statement
I know that [your hypothesis] is true when I see that [your measurement criteria]
If you cannot create this statement at the start of the project then it is unlikely to travel far. Crucially having your hypothesis disproved is not a bad thing. Because you know what does not work you are more likely to know what does work. Testing an idea does not have to be a lengthy or expensive process. Sometime a paper prototype can prove a hypothesis and encourage further investment or effort. By the same token understanding that a hypothesis is wrong before major investment is extremely valuable.
Health, perhaps more than any industry, is about people. Start-up mentalities advocate placing users at the centre of the design process. When building a people-centric service understanding what is valuable can only be achieved if you place people at the centre of the process. As such advocating User Experience (UX) design, design thinking and regular focus groups is likely to deliver results faster than sitting in a room thinking you have all the answers.
With time being a major constraint for many start-ups delivering working software quickly is paramount. If you are late to market an inferior product could well blow your chance of getting off the ground. The idea of a Minimal Viable Product therefore has strong traction. By asking the following questions frequently throughout a creative process a focus on what is valuable to end users remains central:
The MVP approach can help get to the nub of what is really important quickly.
The quickest way to understand if you are delivering value is to put working software in the hands of users. Too often organisations hold endless meetings and write lengthy specifications. This traditional approach to delivering software is hugely risky for several reasons:
By releasing software at the earliest opportunity and measuring whether it is useful we can bring evidence-based decision making into play.
The Lean Philosophy draws heavily on lessons learned from manufacturing and in particular Toyota. The idea that maximum efficiency can be gained by encouraging everyone to continuously improve a process has been proved by the defect rates of the cars that Toyota puts out. But it is also a powerful cultural lever. The idea that we are never finished and that collectively as a group we can improve has strong benefits for culture, teamwork and creativity.
For an organisation to become innovative this challenges traditional structures of power and management paradigms. Taylorist management practices are replaced with flat hierarchies, town halls and favouring autonomy over micro-management. This can be a bitter pill to swallow for managers used to slicing up pieces of work based on a master plan and reporting on how fast it was delivered. But unless an organisation adopts a culture fit for innovation it has significantly less chance of ever being innovative.
Coupled with the idea of Continuous Improvement is the concept of organising around goals. The encapsulates the idea that we are more interested in the result than how we get there. Goals might inform the measurement criteria that help teams to understand whether they are delivering value or they might help innovators understand what the desired outcomes are. Without clear and measurable goals however projects have a distinct disadvantage and even worse risk going on longer than they should if they are failing.
With the Health Industry offering so many constraints and pressing problems to be solved it would appear to be an innovator’s dream. But there is bad innovation and good innovation. Establishing a good framework, culture and governance for innovation is crucial to accelerate discovery and maximise return on investment.
Thankfully this is mostly a solved problem. By the Health Industry learning from start-up methodologies we can accelerate Digital Transformation in Health.
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