Connecting Strategy & Design – McCracken + Buchalter

November 14, 2007

One of the intriguing conversations during the symposium has been the discussion of systemic innovation involving a number of institutions and then within an organization multiple types of coordinated innovation.  These sorts of distributed big ideas have the best chance of being truly disruptive and creating meaningful change and new value. For me the work of Texas Children’s & IDEO highlighted this type of innovation within an organization. The team not only addressed the visual & environmental design of new pediatric centers across the organization, but looked closely at the business model, culture, and brand.  The work considered not only the patients but included a significant focus on the needs of the physicians and the staff who would be providing care. This connection between strategy, brand, and design is something that is too often overlooked or perhaps mismanaged with innovation happening in each but poorly coordinated across an organization. Texas Children’s vision to address the whole is leading to some exciting and innovative outcomes. 

J. Paul Neeley


Engage & Empower – Jane Fulton Suri

November 14, 2007

One of the concepts that was discussed with the group was the idea of design as a way to engage and empower non-designers in the innovation process.  She shared an exciting example of work with Kaiser Permanente focused on nursing and the transfer of information during a shift change.  In addition to some of the interesting solutions, one of the real successes in my mind was to see nurses completely engaged and empowered by the process.  Excitement about the project spread by word of mouth throughout the nursing staff, and nurses even began creating some of their own unique innovations. 

What was thrilling to me about the stories Jane shared with us was the belief that everyone can think in this way, and that inspiration and ideas can come from anyone and anywhere. I think too often we consider innovation as an activity undertaken by only a select few.  Too many times we judge the merit of an idea based on the source. The realization that many voices are needed and that design can engage and empower those who are often left out of the process is something we need to understand and take advantage of.  Being able to “harness the expertise and creative energy of non-designers” will allow organizations to creatively respond to change.

J. Paul Neeley


Virtual Consults – Banks + Stump

November 14, 2007

MaryAnn Stump shared with the group the work of Virtual Consults being completed by the Mayo Clinic and Blue Cross Blue Shield of Minnesota. This project allows remote primary care physicians to consult with Mayo Clinic specialists on cases through email and over the phone.  The results have been very exciting with patients finding more confidence in their primary care physician because of their willingness to get a second opinion, primary physicians increase their familiarity with unique cases and the latest treatments, and the system is able to much more quickly respond to patients with acuities that can’t be cared for by a primary physician.  The process also eliminates many unnecessary specialty consultations, saving time and money for patients, providers, and payers.  

Too often our delivery models think about care in terms of physical location.  With the virtual consult we realize that the expertise of consulting specialists is perfectly exportable in many cases.  This knowledge and expertise need not be confined to a physical location.  The Blue Cross Blue Shield / Mayo Clinic innovation starts to hint at new models in delivery that allow for a more fluid response to patient acuity, not confined by physical location or traditional resource groupings.   

J. Paul Neeley


Tom Dierking – Director of Design Innovation at P&G

November 14, 2007

P&G is a purpose driven company with a mission: Touching lives and Improving life. As the Design Innovation Director, Tom Dierking employs a number of valuable principles to the P&G design process in order to fulfill this mission.

– Understand real people
– Have deep empathy

These first two principles talk about understanding who people really are by uncovering their desires, wants and needs. This involves doing deep dives, going where people live, doing what they do, eating dinner with them, getting to know them. Observing details, body language, interaction with others and interactions with products helps develop insights. This, he says is also necessary internally as well as with consumers. I would agree with this wholeheartedly, building strong, effective and communicative teams comes from understanding and empathy.

– Have a point of view (POV)

Ask, “what are we trying to solve?”. This seems like something we think we already do, but often when we don’t clearly define the POV, outlining the exact thing we are trying to solve, we soon discover that each team member has a slightly different perspective. This can have a huge impact on the efficiency and outcome of any project.

– Consider what is possible

Use brainstorming effectively and go from ideas into action so that they may be implemented.

– Prototype
– Sharing and learning

Express ideas quickly with “lo-res” prototyping and then share these prototypes with consumers.

In addition to using the above principles in the design, development and innovation processes, Dierking also discussed new organization capabilities, sites away from the main P&G campus that allow teams to work for longer durations and focus on projects while developing new ways of thinking and communicating. Sites like Clay Street, The Gym or The Loft where the focus is on narrative design. Teams spend 3 – 4 weeks at The Loft working on the story behind the product experience so that they may better understand the consumer and create robust frameworks.

It takes the right kind of people capabilities to innovate as well and Tom outlined the kind of people that have what it takes. These people: think differently, they have passion, have excellent observation skills, are highly curious, take ideas from everywhere and this group of individuals are “ T “ shaped people. “T “ shaped people have well developed skills in one particular area but are capable of branching out to many other areas.

Dierking outlined another important element in people capabilities – diversity of thinking. Get everyone’s ideas out not just the loudest voice, give everyone an opportunity to speak because a team must work together and be non judgmental.
The following guidelines can be applied –

– Accept and add
– Build on the ideas

The principles and capabilities Tom shared can be applied to innovation teams in all areas including health care. When people set out to innovate, they dare to imagine what could be and they must be empowered to make a pathway towards the imagined state. Assembling the right team for this kind of work and developing an organizations capabilities to support and foster the team and their work is crucial.

What can we learn from Tom’s presentation?

– Disruption is hard
– Build to learn
– Understand users
– Tell a story
– Assemble the right kind of people
– Enable people to learn new skills and ways of thinking so they can share this with others
– Be open to everyone ideas
– Use brainstorming effectively in order to move towards implementation

Thank you, Tom for providing excellent perspective and considerable insight into the process of innovation.


Michael Howe on MinuteClinic

November 13, 2007

Michael sees three Healthcare Imperatives

  • Quality of Care
  • Access to Care
  • Continuity of Care

MinuteClinic turned the traditional concept of integration on its head. Instead of one-stop-shopping for any and every healthcare need, the MinuteClinic was designed to put a limited number of services in the path of where people are doing their other shopping. Integrate into the consumer’s lifestyle instead of into the bricks and mortar of ful-service systems.
MinuteClinic seems a lot like Southwest Airlines. It takes patients in the order they come, with no appointment necessary. Most visits take 15 minutes. Like Southwest with only one kind of jet, MinuteClinic doesn’t have a lot of capital equipment.

Michael says their consumer satisfaction is 99 percent satisfaction, with 98 percent likely to recommend, and this has been validated through some external, independent studies.

For a fuller exploration of this topic, see today’s Star Tribune.

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Lou Carbone Presentation

November 13, 2007

Lou Carbone, Founder and Chief Experience Officer of Experience Engineering, is the first speaker in this morning’s Delivery theme. You can read the summary from his pre-symposium interview here.

Working at an ad agency participating in the demise of Howard Johnson’s and in the same week with the “clued in” organization at Disney was like a lightning bolt for Mr. Carbone. He says it changed his life forever, because Disney was all about creating a satisfying customer experience.

He shared a hierarchy of consumer behavior, that goes from

  • Satisfaction, to
  • Loyalty, to
  • Commitment, to
  • Apostle-like behavior, to
  • Ownership

Creating a great customer experience moves them toward the Ownership end of the spectrum.

His experience preference model goes from

  • Rejection, to
  • Acceptance – commodity zone, to
  • Preference – positive differentiation – people will go out of their way and pay extra because they enjoy the experience so much

The old days were the “make and sell” industrial age, like Bethlehem Steel. Lou says the world has changed radically to become a “sense and respond” world. The experience is the value.

Best practices leads to homogeneity and leveling. We need to look for “next practices” not best practices.

The Brand Canyon

  • Brand – what customers feel about company vs.
  • Experience – what customers feel about themselves when they use your product or service.

How Customers Think by Gerald Zaltman talks about how tangible product attributes have less contribution to consumer preferences than emotional connections.

You cannot NOT have an experience. What matters is how you manage experience clues.

This was a fast-moving presentation, but thankfully he has a book called Clued In for remedial reading.

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Rushika Fernandopulle – Vision, Passion and Persistence

November 13, 2007

When Rushika Fernandopulle, Founder of Renaissance Health, imagined a new kind of primary care delivery he took action. He did not wait for someone else to give it a try, he did not shy away from the certain risks or challenges, Rushika moved forward and built his vision of primary care delivery.

Making a leap from what is, to what is imagined becomes a key ingredient for innovation and transformation. Other key ingredients are passion and persistence and having both meant that Rushika did not waiver when his practice met hostility from others in the medical community. He simply changed his strategy while still holding his vision constant. He found supportive partners and began working in a more conducive environment. He developed a new business model and found new ways of exploring primary care delivery.

Two new experiments include:

The Ambulatory Intensive Care Unit which serves the part of the population (10%) that accounts for the majority of health care costs (65 %).

The Concierge Care for the Uninsured is using the idea of competing against non-consumption. Seeking to deliver care to those that can’t afford the monthly payment for health insurance, but can afford a small monthly payment for high quality primary care.

These experiments are putting into practice principles that are both basic and complex. The first, meet the needs of the patients, seems to say something simple and direct. But what if the needs of the patient don’t always match up with their medical needs? Rushika used an example of a woman who had a grand maul seizure, she went to the ER and when no reason for the seizures could be found, she was sent home and instructed to follow up with her primary physician. When the woman tried to make the appointment, her primary care physician determined that the patients medical needs, ( the facts about her condition ) where not acute and that she could wait to be seen. The medical needs did not match up with the needs of the patient. In Rushika’s model, this patient would be seen immediately, her personal needs as well as her medical needs would be met. The second principle is that the physician can’t manage a patient’s health the patient must manage their own health. With the tools and resources that a physician can provide, a patient can be expected and capable of managing their own health.

In addition to the principles above, Rushika is applying new processes such as – Jointly created strategic health plans, In depth education, Unfettered access to help and Proactive management. He is also using new structures like – Different staffing, Robust information and technology platforms, Physical design of space and a new business model and culture.

These principles, processes and structures combine with a passion for transformation are helping Rushika take extraordinary steps towards a new way of delivering primary care.

What can we learn about innovation and transformation from Rushika?

– Look outside ourselves, look at the small groups doing incredible things.
– Break the rules
– Its about the patient / provider relationship
– Hire the up and coming, the creative rule breakers and then tell them its okay to break the rules
– Learn not from the mean, but from the extreme
– Backload constraints instead of frontloading them
– Build before you are ready
– Design space and workflow to create
– Build slack into the system
– Be accountable – find ways to measure what you do
– Seek feedback
– Have a vision
– Be persistent
– Be brave enough to act on your passion

Thank you, Rushika, for an incredibly inspiring presentation.


Rushika Fernandopulle on Innovating from the Garage

November 12, 2007

The founder of Renaissance Health, Dr. Fernandopulle says the way we deliver primary care is “fundamentally awful.” He is experimenting on small scale and wants to see how what he has learned can be applied more broadly.

The focus in most places has been on incremental changes to the existing system instead of fundamental change. His analogy is improving Transatlantic travel in 1902; instead of figuring ways to build better boats for incremental improvement; what we need is something like the Wright Brothers.

His take-aways:

  1. Learn not from the mean but from the extremes
  2. Don’t get the usual suspects around the table
  3. Backload constrains instead of frontloading them
  4. Break the rules
  5. Build before you are ready

Renaissance developed a primary care “skunkworks” group. Innovation in practice delivery tends to be a couple of doctors who got fed up with their lives and opened a

Objections they heard:

  • “You are changing too many variables at the same time”
  • “Where is the evidence that this works?”
  • “This is too risky”
  • “Our practices are full and we are making money. What’s the problem you are trying to solve?”

Opened a private practice affiliated with Mass General in 2004. The Renaissance paradigm is based on:
New Principles

  • Meet the needs of our patients – e.g. patient who had a seizure and was told she can come in for a primary care consult in a week.
  • We cannot manage our patients’ health; they must, and we can provide tools and resources.

New Processes

  • Jointly created strategic health plans
  • In depth education
  • Unfettered access to help – secure and unsecured email, having them email blood pressure readings instead of making them come in to have the MD take the BP
  • Proactive management – follow-up calls after appointment to check on issues, medication compliance, etc.

New Structures

  • Different staffing
  • Robust Information Technology Platform
  • Physical Design
  • Business model – “the current model is awful.” They developed a model in which patients pay a membership fee of $20-$40 per month instead of just paying per visit.
  • Culture

“Building in” continual innovation

  • Choose people who innovate
  • Create space and workflow to innovate
  • Build slack – give time to think about different ways of doing things
  • Encourage (planned) variation
  • Try everything – don’t let “we can’t” be the answer.
  • Be accountable
  • Seek feedback – patient advisory dinners

Success Measures:

  • Cold call conversion rate of 60 percent
  • Renewal rate of > 95 percent
  • Great way to practice, they tried and learned a lot, with lots of positive local and national press coverage.

Hostility of Environment

  • Corporate practice of medicine laws severly restrict our ability to get capital
  • Required to contract through a larger organization
  • Originally rejected by credentialing committee
  • Cut out of health plan network from Harvard Pilgrim
  • Health system would not allow them to grow
  • Legislation proposed to prohibit membership fees

“You sign my check, and I work for you. Other doctors get their pay primarily from health plans, so that’s who they work for.”

Guaranteed 15-minute wait times, with free monthly membership if you wait more than that. They only paid off twice on that guarantee over two years.
A Change in Strategy – They decided to:

  • Go to a more conducive market
  • Find supportive partners
  • Start with a different business model
  • In particular, can this better care also lower overall costs?
  • Be able to prove this works

New experiments include:

  • Ambulatory Intensive Caring Unit – 10 percent of patients who consume 65 percent of health care costs. Now piloting in three practices supported by Boeing in Seattle.
  • Concierge Care for the Uninsured – Compete against non-consumption, not for others’ best customers. It’s Blue Ocean Strategy. SEIU in Houston workers can’t afford $300/month for insurance, they can pay $30/mo for high quality primary care.


  • Small independent startups can be a real source of innovation.
  • Large organizations can partner with or incubate such efforts.
  • We need to change the environment to support and not oppose such innovation.

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Keith Strier Presentation

November 12, 2007

Keith Strier is Principal of the National Life Science and Health Industry Practice with Deloitte & Touche. He says the key to getting science discoveries and clinical practice innovations to patients is translation. Discovery + Dissemination = Translation. Here is his pre-symposium interview summary. He mentioned the Center for Translational Science Activities, and Mayo Clinic’s leadership as one of the first of these NIH-designated centers, as an example of how the federal government is seeing the importance of translation.

He told the story of Ignaz Semmelweis and how many people died in the 1800’s as a result of his inability to get the medical profession to adopt his solution to prevent flu spread: hand washing. Today organizations like fastercures.org have been organized to help disseminate information about better treatments.

Translational bioinformatics is the latest buzzword. John Glaser, CIO of Partners Healthcare, did a survey in 2004 to find out how well clinical and research enterprises are merged from an IT perspective. The answer: almost not at all. Many clinical trial slots are not filled because there isn’t an automatic way to identify which patients would qualify.

He says we need to have convergence at the protocol layer (like we do on the internet with IP), to enable biological data to be made “open source” (with privacy and anonymity protections) so the information can be shared efficiently to promote discoveries (and translation.) That would enable someone to form what he calls “a Facebook for health care.”

He says one of the reasons we aren’t doing better is because of the nature of the business. You create data and there is little incentive to share. The problem isn’t mainly an efficiency issue; it’s about creating networks and sharing knowledge. It’s Wikinomics.

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Larry Keeley Presentation

November 12, 2007

Larry Keeley‘s task (see his pre-symposium interview here) was “Unteaching what you already think you know about innovation.”

His first question: Is the US Healthcare field innovative? Answer: in a $1.9 trillion industry, tremendous innovation is happening, but it is diffuse and trapped in “a value web.”

He says three conditions are negatively correlated with innovation:

  • Complexity
  • Ambiguity
  • Volatility

Conversely, these factors help to lead to innovation:

  • Curiosity
  • Confidence
  • Courage

Mr. Keeley says effective innovation blows up many cherished myths…

  • Abandon the brainstorming!
  • Ditch your segmentation…
  • Think inside the box…
  • Share your patents!
  • Build concept prototypes
  • Crash the stage gates…
  • Study non-users
  • It isn’t playful, it’s brutal
  • Do financial analytics after prototypes…
  • Use discipline above creativity…

The real keys to innovation, according to Keeley:

  • Apply multiple diagnostics
  • Pursue platforms, not products!
  • Use several innovation types
  • Use explicit step-by-step protocols

Ten types of innovation:

  1. Product performance – a new basic product
  2. Product System – extended system that surrounds an offering
  3. Service – how you service your customers
  4. Enabling process – capabilities you buy from outside – Innovation is when you imagine how they can be used in unprecedented ways
  5. Core process – proprietary processes that add value
  6. Channel – how you connedct your offering to your customers
  7. Brand – how you express your offering’s benefit to customers
  8. Customer experience – how you create an overall experience for customers
  9. Business model – how the enterprise makes money – e.g. Dell
  10. Networking – enterprise’s structure/value chain – e.g. Wal-Mart

If an innovation uses three or fewer types of innovation, it’s likely to be sustaining, not disruptive, innovation. In development of the iPod ecosystem, for example, Apple used eight types of innovation. Dittos with Google. The Boeing 787, which is the most successful airliner ever (although it hasn’t yet flown), likewise has eight distinct types.

Understanding the revolution in health – Health 2.0. Communities of support for patients and physicians. For example, using “crowdsourcing” for tracking pandemics – the flu wiki.

He also gave the example of Rapid City Regional Hospital vs. Black Hills Surgery Center. The latter is using eight types of innovation. Surgery and Safari and PinnacleCare and MD VIP are examples of high-end innovation for cosmetic surgery and more serious care. Minuteclinic uses six types of innovation for convenience care. Employer-sponsored onsite clinics like Whole Health are another new model that could be disruptive.

So what does Mr. Keeley see as the future battleground? Key trends are:

  • Demand, increasing complexity and demographic shifts pushing costs up.
  • Overwhelmed purchasers and payers are pushing back for cost containment, predictable outcomes and more consumer responsibility for healthcare and payment

He sees several key “battlegrounds” for innovation in this challenging environment:

  • Stretching resources in new ways
  • Using information and techonology
  • New models for service
  • Delivering consistent quality outcomes
  • Advocating for quality choices
  • Tailored and personalize dhealthcare
  • Transparency and enhanced choice

Although he presented lots of challenges, Mr. Keeley ended on an upbeat note, suggesting that with courage, curiosity and confidence there are great opportunities.

For those who heard the presentation, what did you think was most interesting?

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