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General Advice for Companies


Developing Solutions for the Healthcare System


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Published: 2018
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Summary


 “It is not technology for the technology’s sake; it is for the patient’s sake we are working!”
Peder Jest

In their prioritisation of future research and development activities, companies that develop solutions for the Danish healthcare sector of 2025 are advised to consider how to:

  • Solve the Users’ Needs
  • Co-Create with the Users and Stakeholders
  • Understand and Document the Value of their Solutions
  • Contribute to Implementation

Solve the Users' Needs


Just bringing in new solutions and declaring that innovation will do it is not enough for a public healthcare system. Who is against innovation? Nobody! But we need to have solutions that can help us running the system.
Erik Jylling

It is not technology for the technology’s sake; it is for the patient’s sake we are working!(Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark

Peder Jest underlines that serving the patients is the primary purpose for the healthcare system. The development of new solutions should be centred around the users and their needs.


Companies that are developing technology for technology’s sake will not win!”
Hal Wolf

The users are the experts! A common challenge for development of successful solutions is lack of knowledge about the users. Investing the time and resources in identifying and understanding the needs and challenges of the future users of your solutions may be a worthwhile investment.

Erik Jylling says:

“Just bringing in new solutions and declaring that innovation will do it is not enough for a public healthcare system. Who is against innovation? Nobody! But we need to have solutions that can help us running the system. And we have to have the ability to assess that the solutions are also in favour of being integrated in the system. So it should benefit the patient, the outcome, and it should also benefit the spendings of the public economy” (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark.

The healthcare sector is interested in solutions that match their needs and challenges.

Hal Wolf underlines:

“Companies have got to figure out how to help integrate and develop innovations that are not just interesting, that can be utilised by the health systems themselves. And that is the big challenge that companies have, it is not about simply developing (…) technology. Companies that are developing technology for technology’s sake will not win!” (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark

For companies it may be relevant to look into the fields of user-centred design and -innovation, anthropology and design. These fields may offer approaches and essential tools to uncovering unrecognised needs and transforming these insights into valuable solutions.

 


Technology by itself without the process piece and the people piece that sits behind it, it’s useless, it means nothing.
Hal Wolf

The technological development offers many opportunities for new solutions, and there is undoubtedly a vast national and international market for healthcare solutions (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark, however it is essential that companies and developers focus their efforts on developing solutions that address and solve the actual needs and challenges of the healthcare sector and their daily operations.

Hal Wolf goes as far as to say:

Technology by itself without the process piece and the people piece that sits behind it, it’s useless, it means nothing(Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

When designing new technologies it will be important to accommodate the users  and design for user preferences and capabilities. John Christiansen argues that:

“for new technologies, in the future I (nurse) will not need to educate myself for new technologies but technologies will be ready to incorporate us all, whoever I am, without needing to read piles of manuals but that it will be more intuitive” (Christiansen, 2017)Christiansen, J. (2017, December 5). John Christiansen. Interview performed by Health Innovation Centre of Southern Denmark.

He continues:

“if systems are so complicated that we have to educate ourselves to understand the systems that we use for reporting, then maybe we are not the ones who need to be educated, maybe it is the way we think systems that is not intuitive enough (Christiansen, 2017)Christiansen, J. (2017, December 5). John Christiansen. Interview performed by Health Innovation Centre of Southern Denmark.

In other words, technologies should be adjusted to fit the capabilities of the users and not the other way around.

Co-Create with Users and Stakeholders


You should work together with people who have quite as different backgrounds as possible and engage in as many collaborative networks as possible, but still have the focus on the citizen and the value creation in focus.
Carsten Obel

There is a general trend towards open innovation, in the acknowledgement that the benefits of pooling resources and knowledge allow 1 plus 1 to equal 3.

Peter Watts argues the importance of a multidisciplinary approach. He argues that companies:

“need to get a balance of skills (…) My team is made up of technical people, medical people, financial, legal, and I think that healthcare is so complicated, it needs understanding, it needs empathy, it needs lots of different skillsets. (…) I’ve been in technology all of my life, and I’ve been very lucky to see many good things happening in that time. And I’m very aware that technology isn’t the solution to anything, it’s the use of it that’s the value. And you need smart people to do that, and you need multi-discipline people(Watts, 2017)Watts, P. (2017, December 19). Peter C. Watts. Interview performed by Health Innovation Centre of Southern Denmark.

Carsten Obel agrees that multidisciplinary collaboration is a good strategy:

[/iquote]“You should work together with people who have quite as different backgrounds as possible and engage in as many collaborative networks as possible, but still have the focus on the citizen and the value creation in focus” (Obel, 2017)Obel, C. (2017, December 21). Carsten Obel. Interview performed by Health Innovation Centre of Southern Denmark.[/iquote]

A company should not be an island in itself but acknowledge that others may have knowledge and expertise that is worth utilising to accelerate and improve development of new innovation. Especially large corporations could benefit from collaborating with SMEs/ smaller companies to a greater extent, by e.g. auctioning their needs for small companies to develop on (Munksgaard, Johnson & Patterson, 2015)Munksgaard, K., Johnson, R. & Patterson, C. (2015). knowing me knowing you: self- and collective interests in goal development in asymmetric relationships. Indutrial Marketing Management, 48, July 2015. . This is both the fastest process as well as the most cost-effective in the long run. Both large and smaller companies can utilise their best skills, which are e.g. the enthusiasm and ideating skills of small, entrepreneurial companies and the grounded strategy and long experience of larger corporations, which also often have more conservative professions and less resources for experimentation and new thinking (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark.

Peter Watts agrees that large companies and smaller companies could benefit from collaborating:

”Big companies can explain their roadmap and where they are going and what they need, and the benefit to the industry is fantastic. They may have big money for R&D but they don’t always have the time and they don’t always have the enthusiasm that small companies have. So bringing those together I think, is a real big key, and I think the role of government is really important too” (Watts, 2017)Watts, P. (2017, December 19). Peter C. Watts. Interview performed by Health Innovation Centre of Southern Denmark.

from a company perspective collaborations are a long-term strategy to achieve a) insights into needs and organisational structures, b) further needs-based development of a solution, and c) networks with relevant stakeholders.

There is a growing general interest from public partners in Scandinavia in opening up and collaborating with private partners in Public-Private Partnerships (PPPs), Public-Private Innovation Partnerships (PPIs) etc. This openness enables companies to get access to and collaborate with the public healthcare sector (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark. Collaboration with public partners presents a significant opportunity for private companies. However, it is important that companies are aware that the healthcare system is a ‘supertanker’. Things take time; e.g. rules and regulations, particularly within public procurement, are time-consuming. Quick wins are not possible and companies should expect a long lead time from the first dialogue to a contract (Øllgaard, Riis, Boding-Jensen & Garsdal, 2016)Øllgaard, S., Riis, K., Boding-Jensen, . & Garsdal, G. (2016). 10 skarpe om at mødes – en håndbog om hvordan virksomheder samarbejder med kommuner. . This timespan may clash with the shortterm focus of many companies, particularly SMEs. Companies are advised to invest in the long term when collaborating with public partners.

The Capital Region of Denmark argues that bidding on a tender does not start with writing the bid. They advice companies to: Communicate with the municipalities leading up to a tender and influence the process. Prioritise which tenders you want to invest in” (Øllgaard, Riis, Boding-Jensen & Garsdal, 2016)Øllgaard, S., Riis, K., Boding-Jensen, . & Garsdal, G. (2016). 10 skarpe om at mødes – en håndbog om hvordan virksomheder samarbejder med kommuner. . The primary focus and outcome of public-private collaborations is not sales/procurement. Helle Nissen argues that from a company perspective collaborations are a long-term strategy to achieve a) insights into needs and organisational structures, b) further needs-based development of a solution, and c) networks with relevant stakeholders (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark, all of which can influence future sales potential for a solution.


The challenges will be having the energy and courage to fail many times.
John Christiansen

Fail fast, succeed sooner! A prototype is not a tool to prove that you are right. It is a tool to help you learn. User testing is an essential part of innovation processes within healthcare. Getting new insights and knowledge about stakeholders through testing and co-creation can ensure that a solution meets the user needs and demands.

The general rule of thumb is to test early, fail fast and learn cheaply. Helle Nissen recommends that companies:

”test it! Have different kind of user groups to test it. Not only focus on one user group, but have different kind of stakeholders test the solution. And have a dialogue also with different kinds of stakeholders to understand what they value, and then you can adapt the solution so that it fits these kinds of values among the different stakeholders(Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark.

Carsten Obel argues that the possibilities of testing is special and very valuable for Denmark:

”Testing approves that it actually works and gives an ‘approved in Denmark’ sign. So I think this is a great opportunity that health providers have in Denmark, because this doesn’t exist in any other place in the world, except for the Nordic Countries (Obel, 2017)Obel, C. (2017, December 21). Carsten Obel. Interview performed by Health Innovation Centre of Southern Denmark.

Have different kind of user groups to test it. Not only focus on one user group, but have different kind of stakeholders test the solution.
Helle Nissen

John Christiansen believes that there are so many needs in the healthcare system that new solutions can address, however companies need to prepare to fail and learn, and they need to investigate the market:

”The challenges will be having the energy and courage to fail many times and having an overview of whether what one is developing is already out there” (Christiansen, 2017)Christiansen, J. (2017, December 5). John Christiansen. Interview performed by Health Innovation Centre of Southern Denmark.

Each public region in Denmark has established a ‘single-point-of-entry’ for the industry (En indgang), similar to the single-point-of-entry for organising collaboration between public and private partners that many municipalities have. These access-points are specialised in public-private collaboration and matchmaking. They have insights into which departments and health professionals may be interested in collaborating within a specific field as well as access to test facilities and clinical trials, saving companies the time-consuming task of knocking on multiple doors.

Understand and Document the Value of Solutions


They have to take into account that the product should be scalable, and the product should bring us not only new products but it should bring us solutions that helps us solve the big fundamental structural problems that we see in the healthcare system.
Erik Jylling
“Some firms get to know how the system actually works and they get to know that in the healthcare system there are lot of different actors who influence the decision to buy a new innovative solution. So some of the firms who succeed to commercialise solutions across hospitals and regions, they actually take into account that there are a lot of different stakeholders at different levels within the healthcare system, and they use that when they promote their innovative solutions. So that they remember to take into account the different needs and the different values which different actors want to have taken into account (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark.

Selling solutions to the public sector can be a lengthy and complex process due to the stakeholder complexity and procurement processes. It is important to understand the value of a solution for the relevant stakeholders, and to document this value.


firms have to interact with these different actors in some sort of way in order to adapt the development of their solutions, so they fit with the different kinds of users in the healthcare system.
Helle Nissen

It is important to be aware of the direction that incentive- and payment structures are moving in Denmark and how it will affect your solution. Company business models should contain the flexibility and agility to incorporate this development. This agility is even more necessary for companies aiming to bring their solutions to international markets where the financial structures are considerably different.

Erik Jylling argues the relevance of ensuring scalability of your solution:

“They have to take into account that the product should be scalable, and the product should bring us not only new products but it should bring us solutions that helps us solve the big fundamental structural problems that we see in the healthcare system, not only in Denmark but internationally, today and especially in the years to come” (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark.

As previously described in Fail and Learn Early through User Testing  there are many opportunities for testing solutions in a Danish context. It is, however, important to be aware that testing a solution in e.g. one hospital department with a few healthcare personnel representatives is unlikely to cover the organisational diversity across all Danish hospitals. Even less so across international hospitals.

Companies should develop solutions that incorporate appropriate flexibility to accommodate the diversity of organisational needs, nationally as well as internationally. According to Helle Nissen some “firms as a strategy choose to engage in new collaborations (Public-private partnerships) in order to improve their product or in order to adapt it to a specific context”  (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark. She argues that:

“firms have to interact with these different actors in some sort of way in order to adapt the development of their solutions, so they fit with the different kinds of users in the healthcare system (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark.

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Helle Nissen underlines the importance of understanding your stakeholders and procurement processes (Nissen, 2017)Nissen, H. (2017, November 28). Helle Nissen. Interview performed by Health Innovation Centre of Southern Denmark. Healthcare budgets are under increasing pressure and the healthcare sector is interested in the proven value and effect of solutions.

Erik Jylling argues that:

“companies that are concerned about developing new solutions for the Danish healthcare system should take into account that the economical pressure for public economy now and in the years to come will be quite substantial(Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark.

He underlines that the healthcare sector:

 “have to have the ability to assess that the solutions are also in favour of being integrated in the system. So it should benefit the patient, the outcome, and it should also benefit the spendings of the public economy“ ()General Advice for Companies. .

This necessitates not only an understanding of the value of the solution but also evidence of this value.

Business cases and technology assessments are often required prior to a sale to a public partner. Business case processes can be both time- and resource consuming. Therefore it is relevant to consider to what extent the results, criteria, quality and validity of business case results are transferrable to other settings and customers. Companies should take into account that a public partner will usually have a primary interest in business case results for their own specific context, so it will, as a general rule, be the responsibility of the company to ensure the focus on transferability of results.

The Danish healthcare sector is mainly governed by politicians. Continuously assessing and following the political and public opinion, which is dynamic, may enable companies to utilise e.g. political waves to strategically time initiatives and communication in favour of the solution. It is also relevant to keep an eye on and utilise the many funding possibilities for innovation.

Contribute to Implementation


You can invent anything and you can find evidence for everything but if you cannot implement it, it doesn’t matter.
Peder Jest

It is crucial to be aware of the importance of implementing solutions. Peder Jest underlines:

“You can invent anything and you can find evidence for everything but if you cannot implement it, it doesn’t matter(Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

Like many others, Hal Wolf argues that implementation is much harder than the actual technology development:

Well, I think the implementation of any technology at the hospital level, moving into the next generation of healthcare, just like in any industry, always comes down to three basic things; it’s people it’s process and it’s technology! (…) the technology inevitably is the easiest part. It is changing the processes necessary to take care, or utilise the technologies, and then the cultural components of how to integrate them into daily work habits, and our expectations” (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

Solutions that support the healthcare sector and contribute to implementation may have an advantage.

Jørgen Løkkegaard, CEO, The Danish Technological institute and Innovation Manager in Patient@home states in Mandagmorgen:

“Our experience is that technology represents only 20 % of the task with successful implementation, while the culture of technology accounts for 80 %” (Mandag Morgen, 2017)Mandag Morgen. (2017). Adgang forbudt til guldminen af sundhedsdata.
[Translated from Danish]
.

It is a common challenge in the public sector that some new solutions, which have been procured to save time and increase quality, are not fully implemented or adopted. This affects both the public sector, who do not fully realise the intended benefits of the solution, and the company, for whom the case becomes a poor reference.

It is clear that implementation is important and difficult (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark. Companies that are able and willing to support the public sector and co-create a strong implementation process for their solution are more likely to achieve a mutually beneficial outcome for all stakeholders.

Technology overall is never the answer! In any situation. In any industry. In any moment in time. You know, technology is a component of a full answer(Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

Hal Wolf makes it crystal clear that technology is just one part of the puzzle; a much bigger part of that puzzle is the full service design. According to Hal Wolf the value of new solutions diminishes if the processes and culture are not changed (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark. According to Christian Bason, CEO at Danish Design Center, in order to succeed companies must challenge their assumptions regarding their company and solution and take their point of departure in the user perspective as a motivating force for change (Bason, 2017)Bason, C. (2017). Service design som forandringskraft. Retrieved from http://servicedesignignition.dk/program/.


There are thousands of technologies available, they mean nothing until you load them into your own domain and begin to use them as a part of how you deliver care.
Hal Wolf

Service design is active planning and organisation of people, infrastructure, communications, media and services. Service design contributes to good coherent service experiences. It helps to read, understand and identify users’ needs and expectations so that you have a solid foundation for developing new workflows, services and products that actually work. Service design puts the user at the centre and  gives you a fresh look into your own organisation, its habits and challenges (Schneider & Stickdorn, 2012)Schneider, J. & Stickdorn, M. (2012). This is Service Design Thinking. .

Designing the full solution is therefore about combining the technology and service components into an integrated solution, and Hal Wolf underlines that what matters is integration of a technology into the daily operations and workflows:

“There are thousands of technologies available, they mean nothing until you load them into your own domain and begin to use them as a part of how you deliver care(Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

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