Why does health technology innovation go wrong?
Article in brief
- In healthcare technology innovation, there is a tendency towards a solution-ﬁrst mindset and approach.
- A better approach is to ﬁrst identify, understand, measure, prioritise, segment and synthesise the unmet needs of multiple healthcare ecosystem actors.
- Yet doing so hinges on resolving the problems of ﬂawed deﬁnitions and wrong inputs at the front-end of the healthcare technology innovation process.
- With the right units of analysis, the correct inputs deﬁned and the proper innovation sequence followed, previously hidden opportunities for healthcare technology innovation can be revealed, market-based strategies devised and new product (and service) concepts generated to address important areas of unmet need.
- In this article, we describe how to reduce innovation costs whilst improving the efficacy and success rates of novel healthcare and clinical technologies, products and services.
Today, just as healthcare markets are evolving rapidly, healthcare technology innovators must also evolve their innovation approach if they are to secure market entry, revenues and growth whilst improving health ecosystem, practitioner and patient outcomes and reducing costs.
Healthcare technology innovation is already fraught with uncertainty, ambiguity and risk. Failure is less tolerated than in other industries and, of course, safety and reliability are of paramount concern. What’s more, it is essential to satisfy the many and often competing interests and needs of different actors in healthcare ecosystems and in different geographical markets.
Healthcare technology innovators encounter most risk in the early phases of the innovation process. These initial stages include the critical activities of needs and opportunity identiﬁcation and selection, idea/concept generation, and health market and commercial case development and validation. At this “front-end”, companies and their backers face the daunting task of having to decide whether to pursue and/or invest in a health or medical technology, idea, project or business.
Adopting the right approach to the front-end of healthcare technology innovation is fundamental for ensuring the successful design, development and introduction of patient, clinical and medical technologies that address today’s market challenges. Yet in my view, the front-end of healthcare product innovation remains poorly deﬁned and is often rarely or weakly executed in practice, leading to higher-risk and greater uncertainty for all involved.
I propose two reasons why these issues persist:
First, important activities that should be undertaken up-front are often executed too late in the innovation process, and in the wrong sequence
Second, when appropriately undertaken up-front, healthcare technology innovators tend to use ﬂawed deﬁnitions of needs leading to the wrong types of inputs being used in concept, commercial and project decision-making.
Let’s take a look at each of these reasons in more detail.
Too late and in the wrong sequence
For every new healthcare technology that succeeds, there are thousands of failed or abandoned concepts with a trail of wasted investments that do not. Even when a technology makes it to market, they may fail to achieve commercial goals or may be quickly disrupted by a competitive solution.
Why is failure in healthcare technology innovation so high? I argue it’s because of a dominant solution-bias in the sequence of innovation activities and the methods adopted by companies, market researchers, providers and innovators of all types and sizes.
Put simply, solution-bias arises when innovators begin the product development task with a product idea, health technology or solution in mind (see figure 1). After some basic research into healthcare, patient or clinical need with some users and KOLs, research typically framed by the idea or solution, innovators tend to leap quickly into prototyping or clinical trial activity to test, develop, explore and refine the product or technology further. With inputs gathered in ongoing close context to the design, function and user experience of the solution, its creators can quickly become blinded by solution-biased feedback. In other words, inputs that may question its validity and the commercial merit of its continued pursuit may be massaged or simply ignored.
Figure One – Typical Solution-Biased Sequence of Healthcare Technology Innovation (click for expanded view)
After successive iterations down this path, and often after several rounds of prop-up funding, a near-finished solution or technology may only then be presented to the relevant bodies for a health technology and economic assessment review or for regulatory approval, on which its future obviously depends. At this stage, deep uncertainty can prevail as formal reviews may surface flaws and structural issues that limit the chances of user adoption and payer approval.
If only these insights into healthcare need, the likelihood of practice adoption and a solution’s potential pricing were known in the first place, before development started!
It is not rocket science to conclude that a better approach would be to ﬁrst identify, understand, measure, prioritise, segment and importantly, synthesize the different unmet needs of multiple healthcare ecosystem actors, whether end-users such as patients, caregivers, physicians or nurses, or key inﬂuencers such as payers, procurers or providers.
But an effective needs-ﬁrst re-sequencing of healthcare technology innovation hinges on resolving a second important factor that can still lead to poor results. This is the problem of ﬂawed deﬁnitions and wrong inputs on which to make decisions. Next, I look at this.
Wrong types of inputs
It is widely understood that actors in healthcare ecosystems evaluate, select, procure and use healthcare technologies on the basis of their ability to achieve a goal or job-to-be-done and do so faster, more effectively and at lower cost.
Starting the innovation task with one or many jobs-to-be-done stated independent of a concept, solution or technology provides a much more objective and reliable basis to identify, explore, evaluate and validate unmet health actor needs. Then, once a commercial and health economic justiﬁcation can be made for addressing identiﬁed unmet needs related to a job, it is much easier to generate ideas and/or apply technologies that have the potential to target and satisfy those needs better.
But, if an idea or a technology is incorporated from the outset in a health actor job 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 based on a solution-agnostic assessment of need.
Starting with a job-to-be-done - stated independently of a solution - has very important implications for ﬁnding problems and revealing unmet needs from healthcare ecosystem actors. With a job in mind, health technology 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:
- The activities performed by health actors to get a job done
- The problems or unmet needs health actors have when performing those activities to get a job done which are most problematic
- The spatial, temporal and other contexts in which those problematic unmet needs arise for the activities undertaken
Let’s look at an example of jobs-to-be-done thinking in practice.
Example: Blood glucose measurement technology innovation
Consider an insulin delivery device manufacturer who also produces insulin. Faced with the threat of disruption from novel blood glucose measurement technologies 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 jobs of key health ecosystem actors. These actors, together with their jobs remain as follows:
- 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 state “remain” because these jobs shall persist for as long as diabetes exists or the jobs undertaken have unmet need. Also, technologies come and go, but the job remains the same.
To accomplish their objectives for innovation, ﬁrst the device manufacturer sought to identify the different activities that target job executors performed to get the target job done, breaking the job down into the 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 job-based activities are deﬁned in this way, 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 get the job done. These inputs or unmet needs once captured, deﬁned and then themed together across activities were measured, prioritised and needs-based segments produced around common problems experienced by groups of users.
Once the needs-based opportunity was revealed, only then did the device manufacturer devise concepts to address the most important, frequent and poorly dissatisﬁed areas of ability and performance held by a substantive segment of actors when seeking to achieve the job. 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, the study revealed needs on the activities performed by community and other diabetic nurses when performing their job-to-be-done 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, our study uncovered, prioritised and segmented unmet needs on practitioner job activities. Both sets of unmet needs were then themed and linked to each other to deﬁne a health market needs-based opportunity for different market segments. This allowed the insulin device manufacturer to then confidently undertake, amongst others, the following innovation tasks:
- Compare patterns of unmet need based on what types of blood glucose measurement devices patients used
- Measure and compare patterns of unmet need by patient lifestyle
- 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
- Create foundations for developing a patient-centric market growth strategy
- 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
Right sequence, right inputs
With the right units of analysis, the correct inputs deﬁned and the proper innovation sequence followed, previously hidden opportunities for technology innovation can be revealed, market-based strategies devised and new concepts generated to address important areas of unmet 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 needs-based (not product-based) roadmap for market entry or share growth. By completing a multi-actor needs-capture and prioritisation exercise up-front, such a strategic assessment of a healthcare ecosystem opportunity is made possible, providing a growth path and product development pipeline for years to come.
Yet that is not all. Even more can be done with the right inputs captured and applied in the right sequence in health innovation. Using the mapped activities for targeted jobs within a current healthcare ecosystem, together with the newly revealed measures and segments of unmet need, health innovators are able to build detailed health economic models by allocating costs and resources to existing activities, scenarios and common job failures. Then, it is possible to make evidence-based claims of the effect of a new concept, device or technology intervention on existing ecosystem costs as well as their ability to improve patient outcomes by better satisfying unmet needs.
A robust and evidenced business case can also be developed. Forecast revenues, bill of material costs and margins for different concepts may be dynamically modeled and compared with each other, enabling early-phase market and commercial case evaluation and validation. In tandem with the economic and commercial case, an assessment and comparison of the regulatory path and reimbursement potential as well as IP freedom to operate for different concepts can also be made.
Importantly, all this can be done BEFORE resources are committed, concepts are developed, funds spent and investment sought or made.
Finally, with inputs aligned and market opportunities better understood, corporate functions that may have previously held different viewpoints on where to grow or what user or market problems to resolve are able to agree on the right areas of focus. Then, growth and renewal strategies as well as new value-propositions are typically executed with greater engagement and enthusiasm by cross-functional teams, signiﬁcantly improving the chance of meeting commercial objectives with fewer iterations.
In this way, the flaws in inputs, sequence and timing of assessment in healthcare innovation are addressed.
Figure two shows the revised sequence for health innovation using the above logic and methods.
Figure Two – The Revised Sequence of Health Technology Innovation (click for expanded view)
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