By SHANTANU NUNDY

In 1980, Apple gave a small California design firm (that later became IDEO) a simple yet incredibly complex task: do more with less. The challenge: take a computer mouse that cost $400 and make one that cost $25 while simultaneously improving the quality, functionality and user experience. The result: IDEO not only delivered an exceptional product, but also pioneered a design thinking approach that has allowed it to make innovation a regular occurrence.

This month, as part of the first Evolent Health Clinical Innovation Summit on high-value health care delivery, we visited IDEO at its Palo Alto headquarters. Twenty health care leaders from across the country visited the IDEO toy lab, heard the story of the first Apple mouse and marveled at a 3D-printer. The question on our collective minds: could the design thinking principles that produced the first Apple mouse be used to transform U.S. health care?

Design thinking is a process that harmonizes rational and analytic problem solving with the natural human ability to be intuitive, recognize patterns and construct emotionally meaningful ideas. IDEO carries out their design thinking approach across a three-stage innovation process:

So what’s the deal with health care delivery?

Despite the desperate need to “do more with less” in health care delivery, we as an industry have been slow to embrace design thinking principles, and as a result innovation has been stymied.

Instead of embracing the full three-stage design thinking process, innovators in health care delivery have resorted to only innovating in the final stage — validation.

There are confounding factors in the health care delivery space that render soup-to-nuts design thinking difficult, to say the least.

• Health care delivery is filled with experts. Due to the widespread proliferation of evidence-based medicine in health care, we know there’s a standard, and we know that we need to follow it. When a better standard is developed, it takes on average 14 years from the time of a new recommendation’s initial publication until it achieves broad adoption.
• Lack of disruption. Health care delivery in the U.S. has experienced slow progress over the last several decades. Because the field has not yet been dramatically disrupted, there has been no “reset” button to up-end the knowledge hierarchy.
• Health care delivery has different risks. We haven’t figured out rapid prototyping in the care delivery space—and possibly for good reason. When you’re making a smart phone app, perhaps the worst side effect of an underdeveloped prototype is low adoption in initial release, a bug or a couple of frustrated customers. In health care delivery, patient welfare is the risk.

At the same time, continuously cycling through the “validate” stage is like repeatedly drinking your own Kool-Aid. Or in the case of health care delivery, it produces innovations that don’t take into account the nuances of our complex health care system and that don’t achieve buy-in from the multitudes of stakeholders involved — these programs hit road blocks early, and are often DOA. On the other hand, process that takes into account the perspectives of all stakeholders early in the innovation lifecycle will help to develop solutions more likely to be accepted and promoted, scalable and sustainable.

Using IDEO’s three-part framework for design-thinking, here’s how:

Inspire:

• Solicit perspectives of all stakeholders to understand the definition of the problem. It is imperative to involve physician leadership, as well as patient advisors, early in the process to understand how to make the program meaningful (i.e., show clinical impact) and how to develop engagement and ownership with these cohorts.
• Rough prototypes, such as videos and workflows, are critical to understanding how a new care delivery program will interact with the existing system.

Evolve:

• Build prototypes. At Evolent, we start with a Model Office process to help develop new clinical models. In health care, there’s a lot of subjective input and nuances — at its core, we’re dealing with individual physicians, patients and offices. By developing prototypes in different local settings, you can elicit feedback on the ground that helps to inform the final product, and how to customize it for specific situations.
• Create a process to test and curate your ideas — try it with one doc, one clinic at a time.
• Work with physician champions, who are motivated by the mission and who can influence peers to achieve scale it when the time comes.
• Be honest about what works and what doesn’t. Don’t be afraid to let some ideas die in the process.

Validate

• Build the final prototype with input from the prior stages. In health care delivery, it is critical to figure out how to adapt the prototypes at the local level, even in the validate stages.
• Set up proof points early and demonstrate effectiveness (and refine) as you go.

So will design thinking be the key to unlocking the enormous potential for the health care system to improve health care while lowering costs? It’s too soon to know for sure, but in the spirit of innovation and with the potential benefit to individuals and communities – indeed to our overall economy – it’s definitely worth a shot.

Shantanu Nundy is  Director, Clinical Innovation with Evolent Health