The foundations of designing value in health and care ecosystems

Note the perspectives and arguments in this article have been superceded in my later work. This can be found in my 2021 book Interactional Creation of Health: Experience Ecosystem Ontology, Task and Method.

Today, organisations require advanced capabilities for understanding complex system problems, finding improvement or transformational opportunities, developing ecosystem strategy, designing compelling value propositions, and executing valued interventions.

This is particularly true in complex markets or systems such as healthcare, communications, transport, energy, and in many industries. In healthcare for example, despite ongoing improvement and intervention efforts, and high rates of scientific, technology and treatment innovation, there remains a great struggle to improve outcomes at scale. Under conditions of increasing resource pressure, the imperative to design root cause, systemic-level — rather than piecemeal, symptoms-focused — interventions has never been greater.

Complex system problems have contributing factors or parameters that are hard to identify and difficult to separate from their effects. This means that attempts to address one often worsen another; the problem is pushed onto another stakeholder or into a different part of the system. Often, problem owners and stakeholders disagree over the nature or even existence of a problem; they assign different meaning and interpretation, they give them varying priorities, and they experience conflict over how to address them. Intervening to improve or more boldly, transform complex system problems is a challenge itself, with high failure rates. Typical causes include limited problem understanding, a lack of system-wide vision, an absence of common language, entrenched behaviour and assumptions, and misaligned innovation, strategy and change management plans and action.

What can be done?

How can organisations achieve more effective and sustained impact when seeking to address complex system problems? How can they adopt a more strategic mindset to design multi-stakeholder interventions? How can they widen their frame of problem search to look into new adjacent possibilities beyond the status quo? What does value even mean from a systems perspective, and how should it be designed and delivered? Most of all, how is it possible to build and deploy a dynamic organisational systemic design capability, one that realises much greater ongoing potential to address complex system problems?

To answer these questions, below I offer some core principles or foundations for developing a systemic design capability together with how they align within a dynamic design process model (click to open in a bigger window).

Frame your ecosystem of interest carefully

First, adopt an ecosystems view as this helps to define a frame for not only identifying your ecosystem of interest, but also to understand how they function, their structure, the nature of value and their dynamics. It is critical to carefully frame your ecosystem of interest using certain loosely-defined contexts that organise actors (or stakeholders), interactions, resources and practices. In effect, an ecosystem is your market so be sure to know how to define it, where its boundaries lie and which other ecosystems it is adjacent to, or overlap it.

Separate problem learning from solution design

Next, take a solution-independent view. Put aside the ideas, products or technologies you have or are thinking of developing, and make a clear separation between problem analysis and solution design and experimentation. Why? Because looking at a complex ecosystem problem through a solution lens always introduces bias, narrows your problem insight and can fatally lead you to draw the wrong conclusions about the value of your idea or product. Instead, learn how to understand ecosystem problems, discover, define and design value free of solution-thinking and ideas-first logic. Doing so will reveal a greater number of possibilities for intervention and lead to smarter validated insights about where, with who, how and what to intervene.

Seek to understand the complex problem and its diversity deeply

With a solution-free lens, you are now better able to understand a complex system problem more deeply, especially its diversity. All complex systems have a rich variety of ecosystem actors with different needs, resources and capabilities. Also, there are multiple types of ongoing interventions by different actors, there are various diverse contexts of interaction and high variation in performance measured by outcomes. Before solution design, it is essential to understand this variety as it will guide you to a better frame for designing interventions.

Design “Ecosystem Value Frames”

Building on the deep problem learning, you can now confidently narrow down to explore attractive possibilities or what what we call at Umio, Value Frames. These are thematic, visual “possibility frames” that define where to play in the ecosystem, and what the value potential is (for you and the ecosystem). Value Frames are used in design workshops as well as on an ongoing basis to guide the design of multiple value propositions, shape ecosystem strategy and ultimately, co-create solutions and interventions. Value Frames are learning tools for informing smarter dialogue, collaboration and engagement around ecosystem possibilities with both internal and external stakeholders. Having them short-cuts excess iteration and learning cycles in the solution design phase.

Shape your dynamic ecosystem strategy

Using one or more attractive Value Frames, now it is time to shape your dynamic ecosystem strategy. This defines the starting point and anticipates the future with which to evolve and realise ecosystem value at scale. Too often, systemic interventions are made without a view to their evolution and are defined within a limited short-term horizon. Umio’s dynamic model of ecosystem value evolution can guide you to the design of dynamic ecosystem strategy.

Scope the intervention

With problem, value and evolutionary strategy defined, it is now possible to scope and sequence specific ecosystem interventions consisting of the actors, outcomes, needs, resources, contexts, practices you are targeting and the capabilities needed to build a series of solutions.

Co-create solutions and prototypes

With the above activities complete, you now have all you need to co-create solutions, not just in isolated workshop settings but on an ongoing basis too. Solutions are guided by where you wish to play in the ecosystem and require multi-disciplinary design approaches.

Learn, flow back and adapt

To be able to design value repeatedly in ecosystems, and address complex problems, organisational leaders must seek to nurture dynamic learning and adaptation, promote diversity and continuously challenge internal status quo thinking. After all, any organisation functioning within an ecosystem is part of the ecosystem itself, and is subject to the same forces of adaptation as all other actors in the ecosystem.

In this sense, ecosystem design never stops; it always necessary to keep the problem space open, flow back to the start and continuously adapt.