Healthcare innovation - whose health is it anyway?
They tell me that this year has been a good year for wasps; I found that of little consolation sitting in a London A&E on the night of the World Cup Final, having been attacked by a swarm of them after inadvertently chopping the top off a nest. Despite the game being shown on a rather tired-looking TV in the waiting area, I found myself more engrossed in the production line that I was being processed along. And being processed was certainly how it felt. The mark of lean production was stamped all over it, all in the name of service innovation.
Innovation is a well used word these days, and rightly so, if we go with the old Department of Trade and Industry’s (DTI) definition as being “the successful commercialisation of a novel idea.” We need new ideas and we need to get them to “market” (a term I use in the very broadest sense) – perhaps more so now than ever. And whilst a huge amount of energy and money has been spent in this arena in recent years, my instinct is that we have been looking in the wrong place. I say this partly as a result of working in the health innovation space in recent years as a design consultant, and partly because when the DTI was reshaped in 2007, it became the Departments of Innovation, Universities and Skills (DIUS) and Business, Enterprise and Regulatory Reform (BERR). You see, I can’t help thinking that Innovation should have gone in with Business, Enterprise and Regulatory Reform. Universities, amongst many other sources, have the ideas, but it is business that commercialises them within the boundaries of regulations. Spinning out technology start-ups invariably leads to a well-trodden path of technology push rather that needs pull. Successful commercialisation (again, a term used in its broadest sense) really only comes about when it meets a demand. Some say it has to meet a need or solve a problem, but I’m not convinced. I didn’t need an iPhone, life wasn’t a problem without one. Once it appeared, however, and I understood what it could do for me, I wanted one.
In healthcare, we have rather neglected to consider what people might want – not just the patient, but also the people who work within the system. In recent years the Design Council tried to address this with projects such as Design Bugs Out and Patient Dignity – although the former was a rather grand title for what was really a design-better-bedside-furniture challenge. And, on reflection, that is a shame as it detracts from the fact that having better functioning, better performing and better looking hospital furniture must have a positive impact on staff moral and patient recovery. It’s about delivering things that actually work, in every dimension – in this case wiping it, working it and wanting it. Therefore, when asked, as I frequently am, what design is, I use two words – usability and desirability. In a recent article in the Financial Times, entitled ‘An experiment in design’, Andrew Jack explored how pharmaceutical groups are using consumer industry techniques to better understand their patients’ needs. He cited the example of Unilever’s development of Clearblue, the now de facto standard home pregnancy test. It was the designers, more than the scientists, who really understood the customer and made the difference.
Perhaps one area of healthcare where the patient should really be at the heart of the matter, but where they are rarely even mentioned, is telehealth. I’ve known about telehealth for as long as I can remember. It was one of those classic Tomorrow’s World case studies – in the future we will be able to do this! Of course it is here now, and people will tell you that it saves money, it means the clinician can be in several places at once, it’s completely technically feasible, it can generate income through bandwidth, it benefits the local authority or the community nurse… But what about George, wouldn’t he much prefer it if someone popped around more often now that he is on his own? What about Sue? She actually quite enjoys chatting with the practice nurse, and really benefits from getting out despite it taking a bit of effort. Whose health is it anyway?
Our health services have largely evolved around the people who work in them, with the clinician at the top of the tree. My recent experience in A&E made that very evident. I didn’t enjoy the fact that I had to interact with five different people and a self-service vending machine for the tablets I had to take away with me. I didn’t enjoy the fact that I had to sit back in the waiting area once I had a canuala in my arm, just in case I needed drugs administered intravenously at a later date, as it would save time. Of course one doesn’t go to hospital to have fun, but it would certainly help if the experience was more enjoyable – everyone would benefit.
The Coalition Government has thrown down the gauntlet to the health service to save money, but at the same time as being more accessible and more accountable. We will have to come up with new ways of doing things, and get them adopted and diffused around the system quickly – perhaps like never before. We will have to innovate. We will have to successfully “commercialise” novel ideas. We will have to both create and satisfy demand. We will have to put the patient, the “consumer” first. We will have to create a “consumer” health service.