NB: This is an excerpt from a forthcoming paper: Health Opportunity Design®: Re-Inventing the Front-End of Health Innovation
It is widely understood that stakeholders throughout the health care ecosystem evaluate, select, procure and use health care technologies, devices and drugs on the basis of their ability to achieve a goal, resolve problems and secure better outcomes. Health care goals can be of multiple types and are typically interrelated and hierarchical. They may be societal, organisational, economic, clinical, therapeutic or personal. Clinical and therapeutic goals may be assigned to particular parts of a clinical pathway – typically spanning prevent, screen, diagnose, treat, monitor, support and resolve goals.
If we accept that health stakeholders wish to achieve any given goal more often, more reliably, faster and as is increasingly the case, cheaper, then an ideal way to start the health innovation process is to select and carefully define a target stakeholder goal or group of goals in a single or in multiple health care markets. In other words, start with a patient, practitioner, provider or purchaser’s view of what they want to achieve or resolve. This effort may also reveal situations where different stakeholders have goal conflicts, but still will focus the approach adopted to resolve them.
Critically, defining a health stakeholder goal independent of a concept, solution or technology provides a much more objective and reliable basis to identify, explore, evaluate and validate an unmet user and health market need. Then, once a commercial and health economic justification (and sometimes political) can be made for addressing identified unmet needs related to a goal, it is much easier to generate ideas and/or apply technologies that have the potential to resolve them and improve someone's ability to achieve the goal.
I caution that if an idea or a technology is incorporated from the outset in a health stakeholder goal definition, then the risk of innovation failure increases because the evaluation and validation of any given opportunity will be corrupted by the pre-selection of a solution - rather than one based on a solution-agnostic or independent assessment of need.
Starting with a goal - stated independently of a solution - has very important implications for finding problems and revealing unmet needs from health stakeholders. With a goal in mind, health innovators must stop capturing requirements on their own concept or technology, on improvements sought in current used technologies or on ideas and solutions from lead users. Instead, they must seek to capture three types of inputs:
1) The activities performed by health stakeholders to achieve a goal. These are typically linked in the form of a routine or a process and across or within a step in a clinical pathway.
2) The problems or unmet needs health stakeholders have when performing those activities to achieve a goal and which are most problematic
3) The spatial, temporal and other contexts in which those problematic unmet needs arise for the activities undertaken
Incidentally, I have undertaken hundreds of goal- and activity-based interviews with patients and practitioners in multiple therapeutic and clinical contexts in the past eight years. They find it easy to articulate their problems, frustrations and unmet needs for the goals they are trying to achieve.
The Case of an Insulin Delivery Device Manufacturer
Consider an insulin delivery device manufacturer who also produces insulin. Faced with the threat of disruption from novel blood glucose measurement technologies (just recently such as Google’s new smart contact lens prototype) and looking to generate new device and service concepts for diabetics and practitioners, they began the innovation process by defining and framing the primary solution-independent goals of their key health stakeholders or users. These users, together with their goals remain:
- Diabetic persons who seek to Maintain blood glucose levels at a normal level
- Community nurses who are tasked to Support diabetic persons to maintain their blood glucose levels at a normal level
Note that I deliberately use "remain" because these goals persist for as long as diabetes exists or the activities performed to achieve them have unmet need. Also technologies come and go, but the goal remains the same.
To accomplish their innovation objective, first the device manufacturer sought to identify the different activities that the target users performed to achieve the selected goal, breaking the goal down into component activities then linking them in an activity map. In the case of a diabetic person using a blood glucose measurement device (irrespective of its type and form, i.e., the solution), these activities included:
- Determine the impact of food and drink on blood glucose levels
- Determine the impact of contextual events on blood glucose levels, e.g., sleep, exercise, illness, etc.
- Gather information on blood glucose levels
- Monitor blood glucose levels
- Interpret a blood glucose level
- Take action to change a blood glucose level
- Select a blood glucose measurement device
Once activities are defined in this way (and also linked in an activity map – see figure below showing some of the detail), the next step in the innovation task was to ascertain what diabetic persons would like to do better, would like to do faster, would like to do more reliably, would like to do in certain contexts or would rather not do at all, to perform each activity to their satisfaction and ultimately, to achieve their goal. These problem inputs or unmet needs once captured, defined and then themed together across activities were measured, prioritised and needs-based segments produced around common problems identified.
Once the needs-based opportunity was defined in this way, only then did the device manufacturer devise concepts to address the most important, frequent and poorly dis-satisfied areas of ability and performance that are held by a sufficiently substantive segment or segments of the target population of users when seeking to achieve their goal. Importantly, where no solutions exist for activities that users would like to perform yet cannot currently do so, those activities became the targets for potential new markets altogether.
At the same time as revealing needs on the activities of diabetic persons, our client revealed needs on the activities performed by community nurses to achieve their goal of supporting diabetic persons to manage their blood glucose levels. These activities included:
- Determine patient lifestyle and preferences
- Initiate patient on an insulin plan
- Evaluate adherence to an insulin plan
Then just as for diabetic persons, the innovation task uncovered, prioritised and segmented unmet needs on these practitioner activities. Both sets of unmet needs were then themed and mapped to each other to define a health market needs-based opportunity for different market segments. This allowed the insulin device manufacturer to then perform the following innovation tasks, amongst others:
- Compare patterns of unmet need based on what brands and types of blood glucose measurement devices patients used
- Measure and compare patterns of unmet need by patient lifestyles and other factors
- Overlay health practitioner and pharmaceutical touch points onto patient activities and unmet needs and identify opportunities for practitioner education and support services
- Compare patterns of unmet need across different health care systems and markets and understand how they influenced the degree of unmet need
- Create foundations and understanding for developing a patient-centric market growth strategy that slipstreams and influences trends and development in global health markets
- Conduct an internal technological, capability and commercial assessment using the unmet needs of patients and practitioners as a guide to concept generation and feasibility assessment
Put Unmet Needs Before Health Technologies: Summary
A bold statement, yes? But with the right units of analysis, the correct inputs defined and captured, and the proper innovation sequence followed, previously hidden opportunities for innovation can be revealed, market-based strategies devised and new product and service concepts generated to address important areas of unmet health care need. In addition, when multiple needs and opportunities for innovation are identified, compared and scored, it is possible to generate several related concepts for development, forming a portfolio of options or a roadmap for market entry or share growth. By completing a multi-stakeholder needs-capture and prioritisation exercise up-front, such a strategic assessment of a health market is made possible, providing a growth path and product development pipeline for years to come (see the ZinC case-study Using Health Opportunity Design to Formulate a Product-Technology Roadmap for an example of how we did this).