Healthcare as a Platform
A check-up of healthcare industry in a globalized and connected world
Creative innovation in healthcare services is happening at a fast pace worldwide as a response to organisational bottlenecks and financial restrictions that the sector has been experiencing since decades. Besides unlucky policy-making, the crisis that many healthcare systems are facing is due to a failure in coping with a set of intertwined and urgent issues: among many other causes, a growing and aging population and radical budget cuts in the overall healthcare expenditure have shown to be central to this crisis.
Drawing a picture of contemporary challenges in health, might also give us some indications on where the disruption should come next. In particular a set of challenges comes from a highly globalised world that is in continuous transformation and under a rising performance pressure. To number a few:
- Increasing demand of healthcare services from a growing and aging population
- Epidemics and sudden health emergencies
- Increasing of nutrition related problems and metabolic diseases
- Unequal access to care and health services
- Increasing number of refugees that have implications for the health systems in many countries around the world
Many healthcare systems generate waste throughout their value chain due to low adaptation capabilities at the organisational level. The failure of current healthcare systems is partly due to old management practices that operate both at local and national level: to innovate while keeping public healthcare expenditure at a relatively stable growth rate is being an hard challenge in the frame of existing bureaucratic setup. Among the many organisational and operational complexities we can name:
- Highly structured and regulated system of subsystems with redundant roles and responsibilities
- High accountability and liability of every professional involved
- High operating infrastructural costs
- Challenges in leveraging on human capital
National structural reforms could certainly tackle complex issues, but it’s also now up to local and contextual players to understand how to build more leaderships, invest in building design-innovation capabilities and leveraging on accessible technologies to generate impact while keeping budgets low: the platform design approach can help solving this challenge thanks to the high potential of ecosystem leverage and typically lower operational costs.
Beyond cost reduction, the challenges of increasing productivity has often implied an inherent impact on reducing availability of labor per patient through automation, computerization and scheduling efficiency. A major drawback of dedicating less time and resources to each patient has been to dehumanize healthcare: not only on the patient side but also and especially on care provider side. The number of healthcare professionals that are encountering chronic fatigue and burnout syndromes is increasing every year in many countries.
“Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations.” (1)
To put it straight, we need a more human healthcare but we lack of resources to do so. Where can we find them? It’s time for a platform/network model of care.
Healthcare services depend on large networks of knowledge-intensive agents and infrastructural bricks which act in concert to continuously produce, consume and co-create value with no downtime. Despite the management and design practices in today’s healthcare, the industry itself is far from being monolithic. From a design perspective, health care is made of compounded and interdependent systems resulting from the combination of needs, human-centered activities, knowledge and information technology.
Initiatives that would attempt to interconnect shortcomings in health care systems with untapped human and social capital that lies in society could achieve manifold impacts. Those initiatives could leverage collective intelligence and contribution to promote local connection, social innovation, more social integration and foster the achievement of sustainability and well being in creative and participatory ways.
Could local innovation around health care be scaled through digital platforms? There is a strategy of course and it’s about creating more bridges between professionals, caregivers and patients/consumers.
Platforms in Healthcare: beyond pure marketplaces
In the seminal post: From Social Networks to Market Networks, James Currier explains what is a Market Network and how they will be central in the economy of the next 10 years in every industry. In short, market networks combine the main elements of both networks (such as Facebook, Twitter and Linkedin) and marketplaces (such as eBay, Etsy and Uber), they use SaaS workflow software to focus action around longer-term projects and they promote the service provider as a differentiated individual, helping to build long-term relationships.
From Social Networks To Market Networks Posted Jun 27, 2015 by James Currier
In the drafting of the new Platform Design Toolkit 2.0 the concept of Market Networks was central to our model: the lens of the market network is applicable to a much wider set of contexts per respect to the purely marketplace one which tends to apply to wannabe global monopolies such as Uber and Airbnb .
“Companies like Uber, Mechanical Turk, Thumbtack, Luxe and many others make it efficient to buy simple services whose quality is judged objectively. Their success is based on commodifying the people on both sides of the marketplace.
However, the highest value services — like event planning and home remodeling — are neither simple nor objectively judged. They are more involved and longer term. Market networks are designed for these types of services. […] With complex services, each client is unique, and the professional they get matters. Would you hand over your wedding to just anyone? Or your home remodel? The people on both sides of those equations are not interchangeable like they are with Lyft or Uber. Each person brings unique opinions, expertise and relationships to the transaction. A market network is designed to acknowledge that as a core tenet — and provide a solution.” (2)
So, would you handover your health to just anyone? Probably not. This is why imagining healthcare platforms as mere marketplace feels awkward. Instead, if we think to them as being market networks, lots of interesting possibilities arise.
In market networks: collaboration happens around a long term project and this perfectly fits with the basic principles of the care process. Speaking of the end of life care, terminal illness, chronic diseases, the care of the elderly, people with disabilities or lonely people with social care need — just to name a few: they all requires care and follows up continued over an open-ended time. Market networks help build long-term relationships and increase transaction velocity and satisfaction.
By exploring the design and implementation of the platform paradigm to support market networks in healthcare we might then get the chance to not only drive down costs, but also to create systems that better consider the motivation of all parties involved in delivering and receiving care.
Application of the Platform Thinking in healthcare
A network model of care
In the field of care it is important to consider not only professionals but also caregivers, families, friends and all the people in relation with the person at the center of the care process. If we can leverage on the deep understanding of this relational ecosystem, we can indeed deliver a system of cure which goes beyond the mere protocolar execution of the medical praxis. Health is in fact defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization). As such, we have to consider not only the physical but also the social and psychological side of the care process. Ultimately, in the process of healing besides doctors/therapists and patients there’s a wide network that includes many more entities.
The present approach to healthcare is still dominated from and individual model of care in which a (patient or caregiver) person’s network is usually not included in any process. In the whitepaper “Accelerating a Network Model of Care” Cammack and Byrne present a different scenario, featuring a shift from an Individual Model of Care to a Network (ed: Platform) Model of Care:
“There is enormous value and wealth inherent in our social convoys. These networks of individuals keep us safe, secure, and healthy by contributing instrumental, informational, and emotional support. The value of our networks is evident through multiple studies demonstrating that people heal more quickly, get sick less often, and use health and human services more efficiently when they have a supportive network” (1)
In the platform/network model of care all the entities in the person’s network are included and professionals, friends, family members and neighbours can cooperate towards the benefit of the person in need, by complementing and collaborating with more traditional systems of care:
“The challenge is to facilitate communication […] between two very different systems of care. Our formal systems operate with a systemic lens of efficiency, effectiveness, expertise, and accountability. In contrast, our family, friends, and neighbours contribute from a lens of love and care — frequently operating with passion, creativity, wisdom, and spontaneity. It is not surprising these two pillars of care struggle to work together. Creating bridges and pathways between these two systems that empower and enable the contributions of our personal network is a critical element in network centric care.” (1)
While design thinking in general should help us to identify and consider all the relevant entities/stakeholders in the context, platform design can help us to produce a leaner, less expensive and and human-centered framework of empowering services to enable communities to contribute a relevant chunk of the value needed in the care process.
Using the Platform Design Toolkit to model the Tyze case study
The Platform Design Toolkit (PDT) is a simple set of design tools to help those involved in designing (or better co-designing) a Platform. It’s based on a core set of three canvases (Ecosystem map, Motivation Matrix, Platform Design Canvas). Plus some more advanced tools for additional analysis. PDT can be used to model an existing platform as well as to design a platform from scratch, around an ecosystem (a problem, topic, company, geographical area, mission, etc.).
Essentially, the PDT can help designers :
- identify what are the key entities in the ecosystem and their motivations to join
- define multiple value propositions in the platform
- understand what are the key exchanges/transactions between ecosystem entities and what channels exist for this transactions to happen flawlessly
- understand how the platform supports and empowers participants and helps to drive their evolution toward better performances and better results
For a full description, definitions and context of the PDT please refer to our website and introductory guideline post.
In the case study below you’ll see an example of how the PDT can be used to analyze existing platforms. In this case we chose to model the highly successful social-health platform Tyze, which is currently operating in Canada and UK.
Tyze, a digital platform supporting collaborative care
Tyze enhances and promotes the care of the individual considering not only the medical but also the social and psychological sides of the process of care, bringing people (health professionals, family caregivers, family & friends and neighbours) together around someone receiving care.
Tyze is a social venture aiming to accelerate the adoption of a network model of care that is inclusive, accessible and affordable and helps caregivers share the burden of supporting elderly people who want to remain safe and cared for at home.
In his book Design, When Everybody Designs Ezio Manzini explains that:
“To go further into what design for social innovation does, and what it could do, we must focus on the protagonists of each particular innovation. This means looking at the people who take part and the social forms they generate, and especially at the social forms in which people collaborate in order to achieve a result they would not be able to achieve alone, and that produces or could produce wider social value as a side effect.” (3)
And, on Tyze specifically, Manzini adds that:
“Tyze is a collaborative organisation supported by a digital platform to share vital health information and provide a fluid and easy way to connect the complicated lives of friends, family, and neighbours who are willing to give care to someone in need. At the same time, it is a practical way to cultivate family, neighbourhood, and friendship links in contemporary fluid contexts of life and therefore, most probably, to increase the possibility of their lasting over time. […] what in my view make it so interesting and contemporary, is that it enhances a valuable resource that otherwise would have been lost. In fact, the care outcome it offers could not happen without the hearty and active participation of friends, family, and neighbours — the precondition for making this whole initiative viable. It is also true that, without this digital platform, these friends, family, and neighbours would often be unable to give this care because their complicated lives would make it impossible.” (3)
Tyze is then a digital platform that holds up a social innovation process bridging people around the one in need and helping the whole ecosystem to perform better in the particularly challenging environment of today’s life.
In the past, it used to be easier to care for relatives or friends and neighbours, simply because you would have been living nearby, you would have more spare time or the possibility to stay at home, holding the responsibility of the care. Nowadays, it is often difficult to cope with the many activities and needs in the daily life and, when someone needs care, providing it might be a frustrating challenge. The solution proposed from Tyze leverages on the potential in all the entities who are in the person’s network by offering tools to ease communication among all the players in the network and organise caring activities more efficiently.
Tyze is particularly focused on giving support to caregivers and, in this way, impacting not only on the patient but, in a bigger perspective, on the society as a whole: “A burned-out caregiver cannot help anyone. He or she may become another person for the system to support, and without the extensive involvement of a primary caregiver, the home care recipient will need to move into a long-term care facility sooner.” (4)
Below you can see the three essential canvases of the Platform Design Toolkit modeled after Tyze platform.
IMPORTANT DISCLAIMER: The Tyze model is subscription based, meaning that organizations like hospitals, long-term care facilities and home health care providers, buy a license to use Tyze as a white label version of the software to create their own platform. A license includes often online training and mentoring on how to create networks for the people they serve. Pricing varies based on the size of an organization and the number of networks created. This is Tyze’s business model: exploring Tyze’s platform model will be more about understanding value flows inside a single “instance” of the Tyze network, created for one of Tyze’s customers.
The ECOSYSTEM MAP
This canvas is to be used to map all the actors in an ecosystem. In the case of Tyze we could identify:
- Family, friends and neighbours as peer producers who participate in the process of care with help, support and companionship.
- Caregivers and patients as peer consumers. The patient is in fact the one who benefits from the platform use but also the caregiver will benefit from it using the platform to get help and logistic support in providing care and connecting a wider network around the person in need.
- the partners are doctors and other health professionals that operate inside the related network. They are professional peer producers who seek strategic improvements in their work through the platform
- many stakeholders both internal and external
- the platform owner: the platform owner could be a local or a national health provider, or a private health trust that buys the white label version of the software to create their own platform.
“A primary caregiver is the person who takes primary responsibility for someone who cannot care fully for themselves. It may be a family member, a trained professional or another individual. Depending on culture there may be various members of the family engaged in care.” Wikipedia, the free encyclopedia
Caregivers are, of course, care providers but, in this case they have particular benefits from the use of the platform. The platform brings in fact a network around the person in need but it’s often administered by someone else, usually the caregiver who is usually identified in a close family member.
MOTIVATION MATRIX
One of the strengths of the platform model is that it includes all the different entities and it allows to consider their statuses and motivations (which may vary depending on the entity) and to leverage on them.
Through the Motivation matrix we analyse the intrinsic motivation of each entity of participating to the ecosystem value creation plus what can entities give to each other.
PLATFORM DESIGN CANVAS
After mapping all the actors in the ecosystem and their motivation, it is easier to complete the Platform Design Canvas that you can see below.
Desirable scenarios for a networked model of care
We can now draw some conclusions for this first (long!) post of our series on the broader topic of healthcare.
Taking an hospital as a classic scenario in this field, a first step for innovation is that one or more parties in direct contact with needs reach some sort of initial agreement that some change in a particular area is needed. This first little step open up the mind (and the eyes) of others that something different is not only possible but also desirable. Yet, overwhelmed by daily routine pressures and bottlenecks, most of the labor involved in the value chain of providing care is still too disempowered and disconnected to propose any change. A way to walk through this complexity might starts from those in the above positions. As always it’s a matter of perception: those in charge should understand that is very difficult for those working in the current systems to spark new possibilities. Enabling contexts for safe and fruitful experiments should be created if we want to allow different segment of society to naturally conspire towards new radical solution in this field. Indeed, we can extend this consideration to all the healthcare system as it is nowadays. Moreover, the willing of change should be diffused inside and outside current care contexts.
Tyze give a blink to the idea of socialising the care process. Yes, it’s challenging, but it’s also a big opportunity. Of course there are still many issues and boundaries but we can start to imagine a desirable future where, in healthcare all people join the conversation and are empowered to imagine, propose and find solutions in creative and participatory ways.
We’re actively looking for partner organizations that want to finance more research papers. If your Organization — or one that you know — is interested on a specific aspect around Platform Design — and Platform Design in healthcare — please reach out to us
Follow this publication we will use the PDT to model examples of platforms, in different industries to help you better understand common traits, strengths and weaknesses in your sector and eventually focus on things that might be improved.
This post was written by Chiara Agamennone and Eugenio Battaglia
Bibliography
- Cammack, V. and K. Byrne, M. 2012. Accelerating a Network Model of Care: Taking a Social Innovation to Scale. Technology Innovation Management Review. July 2012: 26–30.
- Currier, J. 2015, From Social Networks To Market Networks, techcrunch.com, posted on 27–06–2015 (last accessed 25–05–2016)
- Manzini, E. 2015, Design, When Everybody Designs: An Introduction to Design for Social Innovation
- healthcouncilcanada.ca
