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5 Principles of Systems Thinking for a Changing Healthcare Ecosystem

Adopting a systems thinking approach to product development can help medical device manufacturers embrace new opportunities in a rapidly changing marketplace.

 Clayton Christensen, author of The Innovator’s Dilemma and The Innovator’s Prescription, has shown that failure results from being slow to react and embrace new opportunities in the market in a way that addresses the disruptive impact of rapid changes in technology. 

The healthcare industry ecosystem is changing –with potentially radical implications for your products. The distinctions between medical devices and information systems are blurring, with devices increasingly managing more data and information systems increasingly connecting directly with medical devices. Value is shifting from standalone devices and information systems to integrated, interoperable information exchange capable solutions that directly contribute to better care outcomes.
How can you make sure that your product development efforts are focused in those areas that provide the greatest value? It all starts by adopting a “systems thinking” approach to your product and the environment in which it operates.
Why Use Systems Thinking?
BIOMEDdevice San Jose will be hosting a session, "Optimizing Medical Device Development with Quality in Mind" on Dec. 4, 2013
Systems thinking is fundamentally different from other analysis and solution construction techniques. It is an approach in which the goal is the synthesis of a whole product solution as opposed to a focus on a system decomposed into solution components. Where other techniques focus on breaking down a problem into smaller constituent parts, systems thinking takes an expanded view to understand the set of relationships and interactions needed to create a complete solution – or to fix longstanding problems.
A vendor of hospital and clinical information systems encountered tremendous problems when trying to move a mature client-server product to the cloud. They needed to rethink security, data integrity, customization, software upgrade, and a raft of other needs. Stepping back and taking a systems thinking approach allowed them to more quickly see how all these challenges were connected and to more quickly and comprehensively understand the impact of each solution decision on the whole.
Systems thinking provides a rigorous way of aligning stakeholders, purpose, process, and expected behaviors to drive solution development, resulting in the following benefits:
  • Solves complex problems, by bringing a consistent, big-picture view to all stakeholders that focuses on the prioritized value needs of the complete solution.
  • Addresses recurring problems such as those that arise from ever increasing technical debt and changing expectations.
  • Ensures higher quality early-stage product conception and design.
  • Integrating multiple stakeholder perspectives in the process.
  • Creating a shared understanding of the overall problem and the solution purpose.
  • Establishing value-driven priorities to guide architecture, design, and development.
  • Identifies where you may need to partner to address capability or core competency challenges.
  • Identifies additional (often hidden) business value and opportunity.

Systems Thinking – Basic Principles

Principles of Systems Thinking

The principles of systems thinking address:

1.) Purposefulness – capturing not only what your product does or intends to do, but understanding why the users and other stakeholders do what they do with your product within the context of completing their tasks and activities.

2.) Composition – the ability to reach the right compromise among seemingly contradictory needs and interdependencies. Some of these opposing needs are well known: security vs. performance, customization vs. standardization, and others. Some are more subtle – but the point is always to achieve the right balance among the full set of these needs. This requires a holistic view, for this balance cannot be managed by any individual component of a system alone. In addition, the relationship of your product with other products and systems within the ecosystem will change over time, and this evolution needs to be anticipated.

3.) Connectedness – understanding the behavior and value of your product within the context of the ecosystem within which it operates, and to understand the influences and implications of that ecosystem on your product. The concept of “connected” here addresses the inter-connected, inter-operable nature of your product or system in the overall delivery of healthcare.

4.) Perspective – the ability to see that actions intended to produce one outcome actually cause the opposite results. For example, an hospital information systems (HIS) vendor added capabilities to allow the end user to self-customize and self-configure the product, ostensibly to reduce support and development costs. The result – customers were so confused by the complexity that the vendor ultimately had to add support staff (and cost) to train and help configure the system for each customer.

5.) Emergence – the result of the set of interactions within your product that can yield additional capabilities and values that are not always apparent on first consideration. For example, one radiology information system / picture archiving and communication system (RIS/PACS) vendor added remote diagnostics and monitoring to reduce customer and field support costs. While this achieved its immediate goal, it unexpectedly led to the ability to inform customers of work queue challenges and patterns of use among radiologists and technicians in a way that provided great value to the customers.

When to Use Systems Thinking

Systems thinking intervention is most appropriate in these situations:

  • Conceptualization or “ideation” of a new or next generation product.

  • Ongoing chronic problems with reliability, support, upgrades, and/or maintainability.

  • Challenges in cost of goods or development brought on by hardware/software obsolescence or third-party changes that require value engineering to realign the product with business goals.

  • Need to shift or add focus and context – such as solutions that need to address patients and payers as well as providers.

  • Inclusion of or movement to “disruptive” technologies – cloud, mobile, social media, and so on.

  • Need for higher level interoperability with other systems than previously provided – the difference between merely sharing data and exchanging semantically rich information.

  • A desire to realize additional sources of revenue or a new/improved business model – such as predictive and advanced analytics, business intelligence and reporting, quality compliance, and other possibilities.

Systems thinking does not replace good software or systems architecture and engineering. In fact, it directly feeds into these disciplines by providing a stronger foundation to integrate and align stakeholder interests, technology, and leverages existing assets while helping to manage uncertainty, risk, priority, and opportunity.

Healthcare continues to move to an outcomes-based, cost-conscious ecosystem with ever-increasing patient empowerment and greater payer influence, marked by the growing use and influence of emerging/disruptive technologies – cloud, mobile devices, big data, advanced analytics and others.

The key for real, value based growth – and maybe for survival – is to embrace innovation. While continuous iterative development based on learning from your customers and the market may have served you well so far, the shift to patient-centric and payer-savvy outcomes driven world will disrupt this business model. Ignore this at your peril; the same forces you are facing now have rocked other industries before -with scores of mature companies unable to hold on, despite their best efforts.

Avoid these failures by focusing your future development investment strategically on how you can create value in these changing times. Adopting a systems thinking approach will allow you to achieve value driven solutions with innovative, “big step” changes to cost and capabilities beyond what your current products and development approaches are able to offer.

Tim Bosch, vice president and chief architect at Foliage, has been with the company since 1999. He directs consulting and development efforts for a variety of projects including both medical devices and medical information systems.
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