Taking the Risk Out of Innovation
On October 28, 2016, the Heart and Stroke Foundation of Canada and Federal Health Minister Jane Philpott announced a program that was years in the making. The ambitious goal of the program — the Community Hypertension Prevention Initiative (CHPI) — is to help older Canadians manage their blood pressure.
On top of tackling a massive, systemic public health challenge, the CHPI also incorporates an innovative funding model. In this ’pay for success’ model a group of investors covers the full costs of the program upfront. If Heart & Stroke is able to show that CHPI is effective in managing blood pressure, investors will recoup their costs plus a modest return. If the program doesn’t prove effective, investors will lose most of their money.
As Heart & Stroke gears up for a launch in early 2017, eyes across the nation are watching to see if this new model will be successful. With this much attention, how is Heart & Stroke managing the risks that come with innovation on this scale?
A Service Design Approach
Heart & Stroke has strong clinical evidence that demonstrates how small changes to diet and exercise are key to reducing blood pressure for older adults. But clinical evidence is just one part of managing risk. They also sought to tailor the CHPI to ensure that the program will be both effective for those who use it, and also widely adopted.
Together, Bridgeable and Heart & Stroke collaborated to approach the program from a service design lens, with a focus on helping them reach their enrolment targets, a key metric for success. We sought to understand how the program could be improved and framed in a way that would make it compelling and engaging for older adults. In short, how would this program “fit” with their lives?
Design Begins with Understanding Context
Through ethnographic home visits, co-creation sessions, and user testing with older adults we realized that they already understand the importance of diet and exercise. Their age cohort has been heavily messaged about the importance of behavioural health throughout adulthood and most of the people we spoke to are already familiar with managing chronic illness. We discovered that education is not the problem. What we needed to understand was how a health program could be delivered in a unique and compelling way. Surprisingly, day planners provided a major clue to that challenge.
Older adults repeatedly showed us their day planners as health management tools. Many walked us through their weeks and showed us evidence of busy lives full of babysitting, working, volunteering, exercise, and taking care of friends. But more importantly, day planners prompted stories that revealed anxieties about life transitions. We heard that older adults are struggling to adjust to fixed incomes, new social expectations from friends and family, and are worried about being able to live in their homes unassisted.
For older adults, conceptions of “health” are embedded in the broader context of this identity shift. Older adults care about health because it is central to independence, the enactment of meaningful social roles, and the ability to age-in-place. If we hadn’t spent time engaging older adults in a service design process we would have missed this insight and continued building educational tools aimed at minimizing clinical risk. Instead, we focused our efforts around peoples’ desires to to maintain independence, to live in their homes as they age, to be free to make their own care decisions, and to be socially valued. Ethnographic research and a service design methodology were important tools in identifying and managing the innovation risk associated with the CHPI program.
Healthy Aging and Heart Health
Armed with these insights, Heart & Stroke decided to anchor the program in the concept of “healthy aging” — encapsulating a vision of health that included heart health but also things like community involvement and play. In effect, “healthy aging” expanded the problem space of heart health away from clinical risk to more broadly incorporate the social and cultural contexts of older adults. Every element that we designed, from brochures to interactions with volunteers, was grounded in the principle of connecting healthy aging to heart health.
Older adults don’t make behavioural changes to avoid high blood pressure, they make changes so that they can stay in their homes, remain active in their communities, and maintain activities that give their lives meaning. In order to help Heart & Stroke build tools that older adults would actually use, we needed to build for older adults’ context, not for their biology. Building for people through service design was an important way for Heart & Stroke to mitigate risk. Engaging older adults in the design process gave confidence that they would hit their recruitment targets and be able to demonstrate success and recoup costs for investors.
Managing Risk in the Health Space
The challenge faced by Heart & Stroke is familiar to many organizations in healthcare. Chronic illness makes up an increasingly larger proportion of healthcare spending and a crucial challenge in managing chronic illness is in ensuring adherence to prevention and treatment programs. This matters to health organizations because it impacts profits and funding streams that follow expensive research and development. Yet adherence is a narrow frame — it suggests that actually using a product or service is about psychological comprehension and motivation.
Whether we’re thinking about taking medication or behavioural health changes, the ways in which people act on their health depends on their sociocultural contexts. Taking the time to understand how people make sense of their health within the broader context of their lives, and engaging them in the design process, are important tools for managing risk and ensuring that products and services actually “fit” with people’s lives. When developing new health services, innovation is not inherently risky. Not understanding users’ context and perspectives is.
Click here to learn more about the Community Hypertension Prevention Initiative
