The Job of Storytelling

It’s my seventh day as the Patient Experience Lab Associate at the Business Innovation Factory (BIF) and I’m lucky: I was hired onto a passionate, creative team.

The Patient Experience Lab is a group of imaginative design thinkers. They are avidly examining our healthcare system through the lens of its users. They are seeking opportunities to re-imagine the business models that directly affect patients’ well-being and providers’ care, and the insights that form the fertile ground for transformational changes to take root.

They are also eloquent, engaging, and have good taste in coffee shops.

This is plenty of stuff for a new employee to digest, to feel excited about, and to be inspired by. But for the first six days on the job, I found myself spending all of my waking hours not thinking about business models or health care at all.

I was thinking about stories.

The Utility of Story

What makes a compelling story?

And if, as self-professed “researcher-storyteller” Brené Brown so poetically suggests, “stories are just data with a soul”, then how can we identify the patterns in the stories we hear, tell, and co-create that lead to insights with the potential for impact?

These are the questions that defined my first few days on the job, the unceasing consideration of which left me feeling vaguely guilty for not devoting more time to researching healthcare business models. I was working at the Business Innovation Factory…

But with the limited hindsight of seven days, I’ve realized that the Patient Experience Lab has evidence that my burning questions about stories actually reveal something important about innovation – in business or elsewhere:

Storytelling is an essential tool in the toolbox of anyone who seeks to create sustainable, positive change.

A shot of the Dallas brainstorm board.


Stories from the Patient Experience Lab

The Patient Experience Lab’s current projects have been both focused on and revealing the power of narrative in healthcare.

On my second day, I took part in a brainstorm to codify insights from a recent Participatory Design Studio, “The Power of Narrative”, into a tangible tool for the users of our healthcare system.

Can story be used to help patients, providers, hospital administrators, caretakers, and other stakeholders to better understand one another? With support from the Robert Wood Johnson Foundation, and the participants in the design studio, the PXL had been tasked to explore that very possibility.

One result of this brainstorm? A lively discussion about the books, from Tim O’Brien’s The Things They Carried to Alice Water’s The Art of Simple Food, loved and used by our staff.

In seeking to design a narrative playbook that would be both useful and memorable, staff cited all of the reasons the books impacted them: they were accessible, they inspired fond memories of loved ones, they changed their perspectives, they were stained with butter from their last dinner parties.

Listening to this, I realized that stories lurk in the small moments of all of our lives — in the objects, ideas, and memories that contain meaning for us — but have the potential to reveal big things about our values, experiences, and beliefs. The conversation in the PXL was, and is, how to harness that potential in healthcare settings.

Story also touches the research being conducted in the Patient Experience Lab on family well-being. In partnership with Children’s Health, Patient Lab Experience Designers have collected stories from and engaged in conversations with Dallas families, to explore how families define their own well-being and how communities and institutions interact to shape it.

In asking these questions, the Patient Experience Lab is using families’ stories to expand traditional notions of well-being in order to improve care. What role do hope and possibility play in well-being? How can healthcare acknowledge spiritual, social, and emotional needs? These are only some of the questions that have emerged from the stories heard.

So this is why I’ve been thinking about stories:

Story is a key component in the BIF arsenal for generating new insight, that helps us transform our practices and shared systems for the better.


The Work of Telling Stories

The power of a story is a buzz-worthy topic not just in healthcare, but in other industries, too. Researchers are finding that, more so than data, it is an artfully communicated story that successfully conveys value — of a product, a process, or an idea. It is likely for this very reason that BIF is charging me with the task of sharing the work of the Patient Experience Lab.

In a sense, I’ve been hired to be a storyteller. Story obsession vindicated!

In the past seven days, many people at BIF have told me that we believe in “working out loud”. Now I know why, and what this means: the work of the Patient Experience Lab demonstrates that neglecting to share our labs’ stories would be denying ourselves of opportunities to synthesize key insights — especially the ones we didn’t know we had. In the act of sharing my thoughts with you about my first days on the job, I gained insight into the greater purpose of my position; working out loud is transparency, with the knowledge that our communities make our narratives richer.

This gets at another key element of stories: they are collaborative acts of interpreting meaning.

I hope you will co-author the stories of our Patient Experience Lab, their mediums, and the emerging shared visions.

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Signaling Intent

I’m big on signaling. Whether explicit (turn signals) or implicit (body language), signals help me navigate the world — usually granting me either some form of opportunity, safety, or both.

Signals are our most basic communication platform. Be it 0’s and 1’s or smoke signals, we humans often find the ways to communicate simply what we can’t otherwise say.

And often, we can’t, or won’t, say a lot. In innovation work, not everyone is comfortable sharing (or “working out loud” as we call it at BIF). It tends to go against the traditional mindset that argues for innovation being the secret sauce of competitive advantage. Further, innovation is a messy process, full of failure which we don’t want to make visible to the public. Nobody wants to let the sausage be made publicly. Finally, many would consider it harmful to an institution’s market position to reveal that it was considering shifting to a new focus (e.g. would you go to a doctor if you knew he was interested in closing his practice?).

However, if we want to have a significant chance at re-imagining our education system, transforming the health of our citizens, and making our communities more prosperous, silence is not an option:

Signaling intent and working out loud is a critical component to social system transformation.

Here’s why:

Signaling and Social Systems

First, signals are a critical tool for building and transforming complex social systems. We all know how ants use signals to build complex colonies and organize resources. They use pheromones to signal danger and food sources, the need for troops, and opportunities to attack prey.

In short, signals help the ants work in the dark and without words. Signals enable the ants to, as Len Schlesinger would say:

Act their way into knowing.

This ability is critical when it comes to innovation — a sport that is inherently about not knowing what the future state should be, about working in the dark, about being able to iterate our way into new possibilities. This can be a scary and intimidating prospect.

In our social systems, BIF creates open platforms that signal that transformation is possible. Our mission is to help leaders get better, faster at transformational change in the places that touch people’s lives the most — healthcare, education, and community. Our labs are real-world platforms for the R&D of new business models. These are public platforms — that share learnings to inspire and help leaders across social systems.

To this end, we believe in working out loud; we tweet, blog, and share the design happening in real time. We create real-time visibility into the exploration of new business models. Seeing the “sausage being made” inspires others, provides a “we can do that too” mentality. In short, it builds the understanding that business model innovation is not as scary and hard as we tend to think.

Signals and Value Chains

Second, signaling enables value chains (and infrastructure) to evolve around an emergent business model. At BIF, we use the business model as the unit of system transformation. If a business model is a network of capabilities woven together in a sustainable business model, a system is a network of business models also woven together through a sustainable value chain.

If a company or institution is going to transform its business model, it has to signal to the system that a specific shift is ahead — otherwise, it will be left dead in the water without access to markets, supporting capabilities, and enabling infrastructure (like supply chains).

Consider the deployment of sustainable technologies into electronic vehicles. The technology enables significantly new business models — which entrepreneurs and incumbent car manufacturers are exploring. In this exploration, there are several different directions that companies are experimenting with in order to create, deliver, and capture value in new ways. Some companies are transforming themselves into service companies — which lease batteries. Other companies are transforming themselves into supporting infrastructure, e.g. charging stations.

Market players are watching these models — exploring how they can rearrange their own capabilities to provide new value to these emerging systems, and thereby transform themselves. In short, they are looking for SIGNALS of where the industry is going, and how they will be able to profit from adding value in new and different ways.

This is how system transformation happens.

So if a college is intent on transforming how it educates students or a hospital is intent on transforming how it keeps people healthy, it needs to signal to a number of stakeholders that (a) a shift is afoot, and (b) what new opportunities that shift will create and require.

Signals & Self-Organizing Purposeful Networks

Finally, social system transformation requires cooperation — amongst individuals and institutions, and signals are the foundation for cooperation.

In The Penguin and the Leviathan, Yochai Benkler describes how most of today’s business models and social systems were built on the fallacy that people are most motivated by self-interest, and thereby required a top-down, punitive approach to ensuring compliance with any particular model.

We see this almost every day, in every context. Consider:

  • We punish kids who can’t sit still in school, rather than exploring whether human movement might help them learn better.
  • We shame patients into hiding unhealthy behaviors (drinking, smoking) rather than partnering with them to understand their triggers and curb these behaviors.
  • We fine citizens who litter rather than engaging them in the wellbeing and ownership of their communities.

Benkler makes a strong case for systems designed around, and for human cooperation — and how this phenomena — when designed well — is giving rise to a new generation of business models (ZipCar) and social systems (Conscious Capitalism). At BIF, we would call these self-organizing purposeful networks, and we believe they are key to social system transformation.

Signals are a key component of their design. Self-organization requires that people be able to (1) signal interest in working together, (2) signal something about themselves that indicates they are reputable and credible, and (3) signal the rules of cooperation. This enables the identity and commitment of a purposeful network to emerge, and, more importantly, encourages people to contribute to the network’s goals. According to Benckler’s research — from music downloads to open source technology:

“People care a lot about conforming with others about what is seen as ‘normal’ behavior. People are looking for signals that will tell them what is normal — not just what is normal on average, but also what is normal for a person who wants to be seen as better than average or generous.

So if we want to encourage good social habits, we need to do more than institute norms, we also need to set clear signals of what counts as normal and appropriate behavior.”

This is as much true for enabling cooperation between people and enabling cooperation between institutions. In both cases, signaling catalyzes cooperation and action.

At BIF, we are fond of saying:

It sums up perfectly our belief that people — citizens, patients, students — are crying out for transformational new experiences in government, health care, and education, and recognizes that tweaks won’t get us there.

But getting there requires new thinking and new partners.

System transformation requires that we give leadership a wedge of possibility, that we signal direction and opportunity, and that we are able to enlist collaborators and co-conspirators.

We can’t do this from within the cone of silence.

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BIF Kicks Off Project With The National Association of Community Health Centers

On November 15, BIF launched a new project with the National Association of Community Health Centers (NACHC) which serves as the national health care advocacy organization for America’s medically underserved and uninsured and the community health centers that serve as their health care home.

Community health centers provide critical health services to vulnerable populations across the United States. One in fifteen Americans use the services of a community health center in both urban and rural areas. Today, community health centers serve 27 million Americans in over 10,000 communities.

As each community center is independent, NACHC provides critical services across the network –  including research, training, and technical infrastructure. Increasingly, NACHC is recognizing the power of community health centers to drive innovation on many different fronts – from how they serve patients to how they influence national policy.

BIF is excited to partner with NACHC to explore the innovation opportunities. At a meeting of primary care and community health networks in New Orleans, BIF’s Chief Market Maker, Eli MacLaren facilitated a day-long design studio to define the first phase of work:

How might we shift our lens to uncover innovation opportunities that will transform how we serve patients? How might we collaboratively innovate, going farther together than we can go alone?

Following this meeting, BIF will launch an innovation exploration, using human-centered research to define the job that stakeholders need to be done, i.e. what do they value? What will enhance their work, while driving opportunities for innovation?

This work will be packaged into a set of customer insights and opportunity spaces for driving innovation at the local and national level. NACHC works in conjunction with state and regional primary care associations, health center controlled networks and other public and private sector organizations to expand health care access to all in need.


The Integration Design Consortium

We’re in an exciting time, one in which a lot of leaders, educators, families, and students are engaged in advocating for a more equitable education system. Even still, young people are falling through the cracks.

It’s not their fault. We often hear about how students are failed by a broken education system, without fully acknowledging that we are the architects of the system. The onus is on us to change because getting to the outcomes we want for young people will mean transforming the way we operate. This isn’t easy and the answers aren’t straightforward. But now is the time for all of us—from educators to philanthropic foundations—to reclaim our imagination and creativity in service of our students.

In an attempt to do things differently, Carnegie Corporation of New York has partnered with the Business Innovation Factory (BIF) to design and run the Integration Design Consortium (IDC). The IDC is an experiment for the Corporation: rather than funding programmatic proof points, the IDC is giving leaders permission to test various integrative approaches to support students throughout their journey in the education system. It consists of five teams2Revolutions, Bellwether, Education First, FSG, and The Teachers Guildworking from the classroom to the statehouse to explore the structures, mindsets, and processes that can create a more equitable education system. Instead of funding these teams in isolation, Carnegie Corporation of New Yorkwith the help of BIFis supporting the IDC as a collaborative learning network, allowing teams to share insights in real time.

Teams working at the Integration Design Consortium convening


Since June 2017, BIF has been leading the shared learning agenda for the IDC—collecting learnings and uncovering insights from across the teams to share with the field more broadly. The collaborative structure of the IDC has allowed us to observe both what is happening in the individual projects, as well as how the five teams are engaging with one another.

We’ve used the collective structure to experiment with different ways to engage the teams—including gathering project updates and sharing them with the teams, convening teams in person for collective sensemaking, and managing self-organized, cross-project exploration groups that focus on specific areas of overlap. Testing these various ways of engaging the teams will help us understand how we might spark collaboration, inspire reflection, and encourage pivots based on real-time learnings. Ultimately, these insights can be used to create field-facing learnings and tools that can reduce fragmentation in education.


It’s been over a year and a half since we first embarked on this grand experiment, so we wanted to share some emerging questions, reflections, and curiosities we’ve had over the past eighteen months.

Patterns of Fragmentation and Integration

At our second convening that took place in January 2018, we wanted to identify the key levers to integration based on the teams’ project experiences. These real-world examples provided a breakdown of the aspects that are most vital to creating a poor or an excellent state of integration, potentially helping us see how complex systems are changing over time. 

Changing Systems Requires Continuous (Un)learning

Monthly calls with teams have allowed us to peek under the hood of the individual projects and identify common themes that point to potential learnings for the field. One insight that we’ve recognized is that there is some amount of unlearning that needs to happen in order to rethink how the system can work.

These calls have served as a touchpoint for project updates but moreso, they have allowed us to ask other questions, such as: What has surprised teams? What challenges have arisen in their projects? What have they been learning that informs us about the nature of fragmentation? Having this kind of visibility into teams’ internal reflections as they are in the midst of planning and implementing their projects has fueled the collection of insights—like the significance of unlearningin real time.

The Power of Relationships

At our very first convening, Todd Kern from 2Revolutions said that change happens at the speed of trust; and at our latest convening, David Garfunkel from FSG talked about the importance of building relational fieldsor the strength, depth, and quality of how we relate to one anotherto create lasting change for young people. In both cases, it was clear that the connection between people is key when doing system change work.

The IDC is by no means the first to say that relationships are important. However, what has been apparent to us as we’ve been doing this work is that relationships should be the goal, not just a means to an end.


Going Slow to Go Fast

True systems change takes time; we need to know when to move slow and when to move fast. But we’re incentivized, through both structures (like grant cycles and metrics of evaluation) and culture (such as a bias towards action), to actand measure our impactnow. If we reframe our idea of short-term success to bias more towards learning as opposed to measurable outcomes, we can give ourselves the time we need to create the change we want to see.

Moving slowly might mean taking time to 1) build trust and relationships, 2) understand the underlying social forces at play, 3) develop new skills and practice new ways of thinking, and 4) craft a clear, compelling narrative that motivates people to act.

Taking time to build relationships and understand the underlying social dynamics at play might mean taking a look around to see who is in the room (from leaders, to students, to constituents) and valuing both their roles as well as their lived experiences. Doing this can help create a sense of ownership over the work and help people shift from self-advocacy to collective advocacy. While this increased trust isn’t always necessary for the work, it does usually strengthen it.


To learn more about the IDC and see the latest learnings from the teams, visit the website at

You can also find more information about integrative approaches and how the learning agenda operates in Carnegie Corporation’s new report: From Fragmentation to Coherence: How more integrative ways of working could accelerate improvement and progress toward equity in education. This resource—meant for practitioners at all levels of the education system, including those in the public, nonprofit, and business sectors offers practical insights into the causes, consequences, and potential remedies of fragmentation.

Read more about the five projects teams in their own words:

  1. Supporting Community-Driven Solutions to Achieve Equity and Improvement in Education | Rachel Lopkin | 2Revolutions
  2. Redefining Professional Development: Educators as Leaders and Learners | Larry Corio | The Teachers Guild
  3. To Improve the Lives of Students, Two Communities Learn to Relate Differently | David Garfunkel, Peter Senge and Jessica Pizarek | FSG, Systems Leadership Institute and PolicyLink
  4. Helping Education Leaders Build Coherence into Reform Strategies to Support Teachers and Student Learning | Jenn Vranek and Cristina Muñoz | Education First
  5. How Greater Continuity Can Help the Millions of Students Rotating Through Social Services | Hailly T.N. Korman | Bellwether Education Partners


By: Reid Henkel and Isabelle Yisak

Amazon: The Elephant in the Room

As an innovation junkie, Amazon is the elephant in a whole lot of rooms I find myself in these days. The number and variety of the rooms in which the elephant seems to be hiding in plain sight are remarkable.

Amazon either already impacts or is poised to disrupt many traditional retail industry segments ranging from books to food to consumer tech to prescription drugs. No retail segment is immune. And now Amazon has announced it will aggressively extend its platform more broadly into healthcare sending shudders through the entire industry. Amazon also weighs heavily in public sector economic development discussions with the announcement of two new locations in the DC beltway and NYC for its burgeoning headquarters functions and the devastating local impact of so many lost entry-level jobs as many bricks and mortar retailers either go out of business or downsize due to the growth of online commerce.

It’s beyond me how so many public and private sector leaders have ignored the elephant in the room for so long but one thing is clear, no one can ignore Amazon any longer. The question of what to do about it looms large for every leader. One thing for sure, it’s a good time to be an innovation junkie.

It’s been a retailers dream start to the holiday season this year according to Internet Retailer with total retail sales estimates between Thanksgiving and Cyber Monday of $143.8 billion. On-line sales commanded 15% of total retail sales or $21.6 billion. Amazon is estimated to have sold 29% of the online total for a whopping $6.25 billion. Not bad for five days of work!

Both the online percentage of retail sales and Amazon’s share continue to grow showing no signs of slowing down. Just because in-store retail sales also grew over the Thanksgiving holiday don’t be fooled into thinking traditional retailers are safe. We’re at the top of a long cycle of economic growth and when the next inevitable downturn starts retail is always one of the first industries to take a hit and it always gets hit hard. The transformation of the retail industry to online and mobile is still in its early days and the impact on communities and the retail workforce will accelerate over the next five years.

Amazon isn’t just the elephant in a lot of work-related rooms, the pachyderm has also found its way into my home, literally. Never mind the growing number of packages I trip over on the porch when I get home after work but the other night on the local news I watched a segment of a weekly series called Tuesday’s Child featuring a heartwarming story about a local child available for adoption named Alexa. Every time Alexa’s name was mentioned throughout the segment another less human Alexa in the room piped up making her presence known and reminding me that Amazon really is in the room!

Perhaps the best evidence that the elephant is on the move and can’t be ignored is today’s Amazon healthcare announcement. The healthcare industry has been on emergency Amazon watch for the last several years. Every Amazon announcement has been parsed to handicap the odds that Amazon would try to work its disruptive magic on the heavily regulated hea lthcare industry. Every comment from Jeff Bezos about Amazon’s healthcare intentions sends industry stocks reeling. To say healthcare institution leaders are nervous is an understatement.

There was no ambiguity in today’s announcement from Amazon about their healthcare industry intentions. Amazon announced the launch of a new healthcare service platform called Comprehend Medical. It’s a predictable platform play by Amazon to stampede aggressively into healthcare.

Comprehend Medical is touted as a healthcare service platform which will aggregate patient EMR data, apply machine learning and artificial intelligence, and then provide institutional health care players and professionals with the information and tools necessary to make better more economic healthcare decisions. And oh yeah, it will also integrate the world’s largest product commerce engine. Incumbent healthcare institutions and companies have good reason to shudder at the sound of the elephant’s footsteps approaching.

Disrupting healthcare won’t be as easy as disrupting bookstores or big-box retailers for Amazon. There are many institutional interests and regulatory moats making it more challenging. As Amazon sees it, our current healthcare system is vulnerable and ripe for disruption. It leaves too many individuals and families behind and delivers a fragmented, confusing, overspecialized, unaffordable, and painful experience for far too many consumers. Healthcare institutions and professionals are too slow to disrupt themselves and to take advantage of new emerging technologies to transform the customer experience. Our healthcare system as currently comprised is also unsustainable financially. The elephant likes what it sees with lots of room to forage for value creating opportunities that leverage Amazon’s superpowers.

I am curious to watch how Amazon architects its’ Comprehend Medical platform and service offerings. I’m concerned about privacy issues, control and use of individual healthcare data and believe that the long-term winning play is more like Apple (focus on consumers) than Microsoft (focus on the institutional market). It will also be interesting to see how Amazon handles the growing public backlash to its market size and influence including the risk of increased regulation or antitrust actions to slow the behemoth down.

It’s always best to recognize the elephant in any room. Ignoring elephants is an unwise strategy in an era where cycles of disruption are shorter placing a premium on reinvention, new business models, experimenting with emerging technologies and transforming the customer experience. Everyone loves innovation until it affects them. Today, innovation affects all of us. If we try to ignore it, wait it out, or lean against it we leave ourselves increasingly vulnerable to disruption. The only winning strategy to avoid disruption is to innovate from a position of strength while we still can and not from a position of weakness when it is too late.

We also have to be clear-eyed about the impact of innovation on real people and communities. That doesn’t mean we should block innovation and the promise of leveraging exciting emerging technologies for good, it means that we need to recognize the impact on real people, institutions and communities and enable them to leverage emerging technologies to get better faster and to reinvent themselves in order to stay relevant in a rapidly changing world.

Reimagining the Disability Services System in RI

BIF kicked off a new project with The Sherlock Center on Disabilities and five service providing agencies in RI to reimagine the services offered to adults with intellectual and developmental disabilities in the state.

Driven by a deep sense of commitment to better serve individuals with disabilities, they seek to transform the current provider-driven service model into one that puts personal agency and self-determination at its core.

“Our highest hopes are to re-design the system of supports for people with intellectual and developmental disabilities, “said Mary Madden, Conversion Institute Facilitator at the Sherlock Center,” and to impact the quality of their lives in very real terms. The BIF Summit has set the stage for a powerful shared learning experience, moving us out of our silo and into the realm of possibility.”

Speaking to her personal motivation for participating in the work, Maya Colantuono, Technical Assistance Specialist at Sherlock, shared the following: “My 10-year-old gets around in a power wheelchair and uses an app on her iPad to communicate. These differences have not gotten in the way of her having the same childhood experiences as our other children. As she moves toward the adult service system, it is our imperative to ensure that she continues to be a fully engaged and valued member of our community.”

Leaders from participating agencies acknowledge that current service offerings are not sufficiently providing the individuals they serve with the supports needed to have and build a great life. They are committed to a more inclusive and person-centered transformation of the system of services for people with disabilities in RI. As one participant put it during the project kickoff meeting, the shared aim is to “get past our agencies to create more agency” for individuals with disabilities to lead and take charge of their own lives.

Participating agencies are Perspectives Corporation, Whitmarsh, West Bay RI, Looking Upwards, and The Cove Center / The Groden Network. Funds from RI’s Department of Labor and Training are being used to finance the work.

Announcing: Personalized Medicine by Design

Business Innovation Factory (BIF), in collaboration with The School of the Possible founded by Dave Gray, Hatch founded by Yarrow Kraner, and Overlap founded by Michael Dila, is launching a project to explore the opportunity for a transformational personalized medicine business model.

Leveraging a network of networks we will start with a four-month exploratory phase of work to establish a deep customer experience foundation upon which we plan to design, prototype and commercialize a new model that empowers individuals and families to improve their own health and wellbeing. Our intention is to start-out-loud and to work iteratively and collaboratively to inform the development of a repeatable and scalable model. Our intention is to catalyze a personalized medicine movement.

Our U.S. healthcare system is leaving too many individuals and families behind. It delivers a fragmented, confusing, over-specialized, unaffordable and painful experience for far too many of us. Healthcare institutions are slow to disrupt themselves by leveraging new emerging technologies to transform the customer experience, and the healthcare system as currently comprised is unsustainable financially.

Healthcare is ripe for disruption. It is up to all of us to make sure that we disrupt it on behalf of those being left behind by today’s system. It is up to us to imagine a new healthcare system that puts individuals and families first. We need a new system in which families have access to the information, tools, and resources necessary to improve their own health and wellbeing. We need a new healthcare system that puts us at its core.

In the exploratory phase of our Personalized Medicine By Design project, we will establish a strong foundation of understanding of today’s healthcare customer experience. Any transformational personalized medicine business model must start with an understanding of the job-to-be-done from the customer’s point of view, not primarily from the perspective of today’s healthcare institutions and system. We will not be admiring the problems of today’s healthcare system, they are well known. We are seeking to understand how individuals and families experience the current healthcare system and their pain points as a jumping off point for imagining how we might transform, not tweak, it. A rigorous human-centered exploration phase will inform the design and prototyping of a transformational personalized medicine business model with healthcare consumers and families at the core.

We won’t start with the question, “how can we improve today’s healthcare system.” Building on a deep understanding of healthcare customer experience as an actionable foundation for design we will start with the question, “Can we imagine a new healthcare system that is in service of helping families better manage their own health and wellbeing?” We won’t get bogged down worrying about scalability and how to change the current system until we have demonstrated at a small scale that there is a better way that is financially viable. Let’s figure out what we want to change to before we obsess over how to change the way it works today. It’s time to create the conditions to imagine, design, prototype, and commercialize a transformative new patient and family-centered business model unconstrained by how healthcare works today.

I have been waiting for the stars to align for personalized medicine and to lead this BIF project for a long time. Over my career, I have engaged in and have every black and blue mark imaginable from working in and trying to change every aspect of how today’s healthcare system and business models work. Our passion at BIF is making transformation safer and easier to manage. As a leader in the healthcare industry, a strategy consultant, a government bureaucrat, and as the founder and Chief Catalyst of BIF I have led teams working on the mindsets, muscles, and tools to enable business model transformation and healthcare has always been my home industry.

I worked at Eli Lilly and Company in the 1980’s and will never forget the opportunity to witness first-hand how genomics might transform healthcare when I got to attend the opening of the world’s first commercial-scale recombinant DNA manufacturing facility. I was wowed by Lilly’s fete of tricking e-coli into producing human insulin at scale. Fast forward to today when the cost of mapping our own personal genome is rapidly approaching $100 and companies are already being launched that will offer us the opportunity to map and store our genome for free if we allow them to monetize our most valuable data set, our double helix. What if we made sure that we controlled our own healthcare information and who and how others can access it?

As a road-warrior strategy consultant, I worked with the visionary Mark Levin, founder of Millennium, who was early with a personalized medicine vision to transform the pharmaceutical and biotechnology industry in the 1990’s. Mark’s idea was brilliant but the technology hadn’t advanced enough for a transformational business model to take hold. I never forgot the boldness of his vision and have always believed that it would ultimately come to pass. I believe that personalized medicine is now a viable business model with the potential to transform healthcare. We can already see its transformational potential in the diagnosis and treatment of many forms of cancer. The changes we can now see in personalizing cancer care and treatment will expand to other diseases and care paths. The promise of personalized medicine is within reach and hugely disruptive to every aspect of today’s healthcare system. What if we made sure that personalized medicine business models were designed with individuals and families at their core?

As a geek wannabe, I’ve always lived in the space between emerging technologies and new business models. Emerging technologies including genomics, big data, artificial intelligence, Internet of things, blockchain and all things digital are at a stage where they can actually be deployed in service of new human-centered business models. They are all capabilities in our sandbox ready to be combined and recombined to enable a personalized medicine vision. I was troubled when in 2011 the National Research Council declared that personalized medicine was an antiquated term and should be replaced by the more technology friendly label of precision medicine. I’m certain new technologies will continue to fill our business model sandbox enabling us to more precisely diagnose and treat disease. Today, these new technologies are out ahead of the business models to deliver their value at scale, and their development is predominantly shaped through the lens of today’s healthcare institutions and not customer experience. We need to transform from a sick care to a wellness model. To transform healthcare we will have to put the personalized back into precision medicine.

Our collaborative exploration of personalized medicine opportunities will put individuals and families at the center of our design process. It will bridge the exciting space between enabling agency at the consumer level and leveraging emerging technologies to transform customer experience and outcomes. Join us. We’ve created a Personalized Medicine by Design Facebook group to welcome other purposeful networks like School of the Possible, Overlap and Hatch, companies and institutions that want to play and any individuals interested in project updates or engaging in our exploration process. Let’s transform healthcare together.

Personalized Medicine by Design Facebook Group hbspt.cta.load(2403798, ‘80871038-79b3-4485-9719-7c34bf1aaf2f’, {});

Catalyzing Reactions from BIF2018

There was something palpable in the air surrounding BIF2018. Like many summits that have come before it, our focus has always been to create more community than event. To share in our purposeful networks to catalyze a reaction and spark greatness within the audience, to go out there and bring a renewed sense of hope, belonging, and courage allowing participants to go home and spread their learnings with others.

Usually, by the time the Summit hits us in full force in September, we at BIF are too focused on ensuring everything falls into place to fully grasp the impact of the two-days we have set in motion. It is only until well after the stage lights have dimmed and the hoards of changemakers who have descended upon our great city of Providence have scattered back to their collective outposts across the U.S. that we get the chance to fully reflect.

But this year, there was an undeniable sense that something was different. More exciting. That the change we’ve been so desperately seeking for our most vital social systems might finally be breaking through to an even higher ground. It could just be that the timing couldn’t have been better, that this was exactly what we all needed as a community. Or perhaps this year, in particular, the caliber and diversity of both story and storyteller were far and above what we could have ever hoped for.

Whatever it may be, it’s safe to say that all of us have left changed. Inspired. Hopeful. Ready to self-organize and create the conditions necessary for all of us to freely combine and recombine our capabilities to make the world a better place.

And that change starts with you, our community, through words, actions, and movements, Here are some of the takeaways shared by our audience.

  1. Stranger in a Strange Land: An Educator’s #BIF2018 Adventure by Trevor Aleo
  2. Reflections: One Month Post BIF by Deb Mills-Scofield
  3. BIF2018: How Connection Drives Innovation from Greg Satell
  4. BIF2018: Connecting, Catalyzing And Colliding Communities by DK
  5. How Our First Instincts Can Hamper Our Capacity To Act Wisely And Innovate by Kare Anderson
  6. Design + Strategy = A New Good Story by Eli MacLaren
  7. Let’s Catalyze Something Bigger Than Ourselves by Founder & Chief Catalyst Saul Kaplan
  8. The Biotech Innovation That Will Transform Society Has Arrived: An Interview with Andrew Hessel

Our goal? We want to come together to strategically build a roadmap for transformation through our collective networks with you. Don’t know where to start? If you have a vision, we have an approach.

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10 Steps to Transform the Patient Experience

The healthcare industry is disrupting, and many organizations are struggling to keep up with the times. Often times, business model transformation feels harder than it has to be. Business model innovation isn’t about practices, it’s about next practices. Here are 10 small next practices to help you start:


1) Access

Patients and families must have easy access to unlimited and trusted information and must know that the most convenient care is also the most personal care. Even with telemedicine, it is much more valuable to the patient or family member knowing that the patient has a relationship with the doctor.


2) Meaningful return beyond clinical assessment

Care can’t just have tangible returns like shots and prescriptions anymore. Because so many families have to take time out of work and find transportation to the doctor’s office, there must also be meaningful, tangible and relevant returns on health and wellness and in order to make the benefits outweigh the costs.


3)  Motivation to engage in self-wellness

Patients and families must be encouraged to continue their journey outside the doctor’s office by providing both information and motivation to be independent agents of their own health. Patients will become better agents of their own health if they are encouraged to learn from all experiences, including mistakes and failures. Wellness should be led by the patient, in partnership with the knowledge and resources of the doctor.

4) Patient/Doctor relationships must exist outside of the paradigm of care

The patient-doctor relationship is framed by visits to the doctor’s office; the doctor usually only sees the patient when they are sick. In order to break down this silo, it is important to see patients as people with hopes and dreams, thus building rapport, trust, and engagement.


5) Bridge the gap between physical wellness and the development of personal goals

Current doctor-patient interactions are framed by the scope of preventative care. These interactions have the potential to unlock further value if the discussions centered around both their physical and personal development.


6) Patients need actionable goals

In order to provide actionable goals, it is crucial that physicians focus on healthy habits of the entire family, not just the single patient. These actionable goals must address both existing conditions as well as elements of wellness. Furthermore, it is evident that there may be more pressing matters than simply educating patients and families on wellness such as socioeconomic or social determinants to health.  


7) Overall positive customer experience and perspective on clinical visits

A positive patient experience is one in which the end user trusts that the information and service received has their best interest at heart. Additionally, patients and families must have an experience that leaves them feeling comfortable, engaged and validated through meaningful connections, cultural competencies, and a family-centered environment.


8) Patient/family centered interactions and environment

It is crucial for medical centers to recognize that the patient exists in a family. In order to value the patient as a member of a family, the physical space and staff interactions must be designed around the fact that the family is the unit.

Patient Experience Lab at BIF

9) The clinic must reflect and understand the cultural values of the community

It is necessary for a practice to understand the cultural values of the community. These values need to be reflected in both the facility and in interactions between patients, families, and staff to make patients and families feel comfortable and welcome.


10) Ease of navigating the clinic – language/ welcoming environment

It is evident that families want to be able to navigate the healthcare system in the language that they are comfortable with. In order to accomplish this, patients and families must receive medical services in their own language and have assistance in following medical resources so that they have the proper knowledge to make informed decisions about payment options, medical treatment, and wellness plans. This should be reflected in a welcoming environment.


Are you ready to transform Healthcare? Learn more about Business Innovation Factory here, or email us at

Breaking the Silence from the (Unintended) Consequence of Political Correctness

At BIF, one of our core beliefs is that a good story can change the world. By sharing our insights and perspectives, we can connect, inspire, and transform to enable purposeful networks. Guest contributor Ann Keehn shares her thoughts and emergent takeaway from BIF2018:

One emerged theme from BIF 2018:

Breaking the silence from the (unintended) consequence of political correctness.

George Carlin wrote, “Political correctness is America’s newest form of intolerance, and it is especially pernicious because it comes disguised as tolerance. It presents itself as fairness, yet attempts to restrict and control people’s language with strict codes and rigid rules. I’m not sure that’s the way to fight discrimination. I’m not sure silencing people or forcing them to alter their speech is the best method for solving problems that go much deeper than speech.”

Alan Simpson noted that “Political correctness is like wearing duct tape on your mouth because if you really are a person filled with hate, prejudice, and bias […] then that stuff comes through like a fissure through a volcano.” As a young boy, Alan Simpson’s father (a Boy Scout troop leader) took his son, Alan, to the Heart Mountain Japanese internment camp (a part of our American history we were so powerfully reminded of in Julian’s songs) to hold troop meetings because “those imprisoned were also American boys.” It was during this time that Alan Simpson and Norman Mineta (an imprisoned Japanese American boy) began their life-long friendship; Alan became a Republican senator and Norman a Democratic congressman – both fighting for freedom of speech and against discrimination.

I heard several of the storytellers putting out their own story, unpacking their own biases, and asking us to have the courage to have the conversation. Name it, talk about it, find a way to make it better for all. They called for greater recognition of structured bias in our systems, but also the recognition that “we” are the systems. That it begins not with solving the problem of the 100,000 homeless population in a city, but one person handing a token to and seeing that one man or woman who is currently without a home.

I am more hopeful for America’s future when I hear that many conversations are taking shape. That individuals are having the courage to stop the censorship, to take off the duct tape, and to have those often uncomfortable but always enlightening conversations. Sam Siedel’s image of the two worlds back-to-back and Yolanda’s poem reflect these ideas because they retain the complex beauty of our world while challenging us to see in a new way.

Ann Keehn
Health Services Director of Operations & Senior Consultant
John Snow, Inc.

John Snow, Inc., and our nonprofit JSI Research & Training Institute, Inc., are public health management consulting and research organizations dedicated to improving the health of individuals and communities throughout the world. Our mission is to improve the health of underserved people and communities and to provide a place where people of passion and commitment can pursue this cause.

Share Your BIF2018 Insights With Us 

Design + Strategy = A New Good Story

In 2010, my mind was blown by the inaugural TEDWomen — I mean literally blown. My brain hurt, and I was off-balance and discombobulated, as my brain raced with many powerful insights. I was grateful for the plane home, so I could process and make meaning of what I’d heard, creating a new practice:

Whenever I leave a conference, I make a list of no more than 5 insights that are so powerful that I must act on them. I create an intention for what that action looks like, define the barriers and risks of acting in new ways, and hold myself accountable for starting.

As Chief Market Maker at BIF, I am blessed that two days of innovation storytelling is part of our annual Fall cycle, and so this practice continues for me after each BIF Summit. I am also blessed that I get to process the learnings and insights with a team of Experience Designers, and incorporate them into our work with institutional leaders. Not everyone is so lucky, and it had me wondering how this formula of inspiration, design, and strategy could be useful to our audience too, so I wanted to make a proposition.

Here’s why:

I regularly facilitate conversations about business model innovation. I use BIF’s methodology to teach teams and groups how this methodology can make transformation safer and easier to manage. The goal is to inspire confidence in transformation (versus the well-known approaches to incremental innovation) and to teach a few fundamental behaviors required to be successful:

  • Transformation requires shifting your lens from your core business model and taking a human/user-centered approach.
  • Recognize that your initial solution design is only partially right, and move as rapidly as possible to real-world prototyping to fix the rest.
  • Focus on scale only once you have figured out what the “it” is; too often, we let questions of scale surface and create resistance to trying something new before we even know what the new is and how it works.
  • All of this is relevant to the design process — a process of seeing anew and a bias towards action.

The second part is the internal strategy, meaning:

How do even seasoned innovation leaders create the conditions for and the permission to do transformational work?

The reality is that one of two conditions will exist in institutions. In the most ideal and least common, the CEO will recognize the institutional imperative to explore new business models as part of the innovation agenda. In the least ideal and most common, the innovation leader (Chief Innovation Officer, Chief Strategy Officer, etc.) will want to ensure that transformation is part of the innovation portfolio, but unfortunately, their efforts are not supported, resourced, or declared at the leadership level.

Then what?

Building on my own experience as a seasoned intrapreneur and the work BIF has done to explore the entrepreneur experience, (a) we know how hard it is; and (b) we have a few recommended strategies:

  • Stories mobilize others to act. Share them early to test the waters. Grow them to build ground and resources. Make them visual. Make them personal — enabling others to connect through authenticity and vulnerability.
  • A sense of a belonging is hard to find within — there is a reason innovators are known as rebels and disrupters. Search for tribes. Carve out gold in the grey space — physically and virtually — across business units, silos, and disciplines.
  • You have to earn the freedom to act. Be prepared for resistance, and confront it with listening ears. Recognize that you won’t win all the time, loss happens. Know when it matters.
  • Strengthen your organization’s response system through your own actions. Overcome self-doubt. Reframe failure as intentional iteration. Have patience, and be eternally optimistic.
  • Differentiate know-what and know-how. Recognize the two types of knowledge building. Be prepared to unlearn and de-educate, especially while working within existing organizational constructs. Draw from life experiences.
  • Make it easy for others to invest. Be strategic in finding executive sponsorship. Create an opportunity to vet and evaluate routinely. Seed a sense of collective contribution.

So how does this relate to your BIF2018 experience? Because here is what is going to happen:

  • You will hear stories from 32 storytellers who will blow your mind, inspire your thinking, and shift your lens.
  • You will connect with your tribe, and be incredibly optimistic about the possibilities to transform.
  • Without the strategy part of the equation, you’ll go home and be disenchanted with the ho and the hum of business as usual.

That’s where we come in.

Following the Summit, I will happily jump on the phone with you to: (1) quickly help you identify the key challenges/barriers to transformation; (2) define the core behaviors and strategies that will help you navigate them; and (3) help you frame a narrative for how this design and strategy might come together to alter your institutional trajectory.

Design + Strategy = A New Good Story.

It’s all part of making transformation safer and easier to manage. Welcome to the community.

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Let’s Catalyze Something Bigger Than Ourselves

September is a beacon of light for us every year. At BIF, we pride ourselves in living and breathing the human side of innovation day in and day out, but it’s really our Annual Collaborative Innovation Summit that reminds us of our shared purpose.

It touches our souls, refreshes our outlook, and energizes us for the hard transformation work ahead. For those of you that are new faces in the crowd, you’ll soon experience what we mean. And for those who have returned year after year, I can’t thank you enough for strengthening our growing network of human-centered innovation junkies. Together we can change the world.  

We believe in the power of random collisions of unusual suspects, or what we at BIF like to call making a RCUS, to tap the limitless potential in the gray spaces between us. There’s no telling the heights we can reach together by coming here and connecting outside our usual silos, from all walks of life, experiences, and viewpoints – all catalyzed by the 32 incredible personal stories of transformation we’re about to experience on the #BIF2018 stage. Every year I’m reminded that this isn’t just about who attends or even who is up on stage, but that it’s about catalyzing something bigger than any one of us. It’s about engaging and collaborating as a purposeful network to unleash the adjacent possible. To connect, inspire, and transform.

True to our vision, #BIF2018 continues to remain more community than event. Our community knows that innovation is a team sport and understands the value of connectivity. We can’t get better, faster if we don’t do it together. To make change a reality, it’s up to all of us to make it happen. I believe in the untapped potential in all of us and look forward to these two days every year, knowing that the best is yet to come. Let the inspiration begin!

BIF2018 Collaborative Innovation Summit

One of our core beliefs is that a good story can change the world.  We’ve never prescribed what our storytellers have to say and nor will we. At #BIF2018 we are modeling how to enable self-organized purposeful networks. It’s up to us to accept the responsibility to convert random collisions from the Summit into powerful and purposeful collaborations. You decide what your takeaways are, what insights to act on. How to engage and inspire others. Inspiration is personal and it’s up to participants to decide where it comes from, who to connect with, and how to emerge with a renewed sense of purpose. Let’s make a RCUS at #BIF2018, because that’s how the magic happens.

I have high expectations for where we can go from here. Transformation requires an emotional connection to the work. When we feel connected and involved in the story, there’s no telling what we can do together. The time for transformation is now. Let’s make our networks more purposeful and committed to transforming our important social systems, including healthcare, education, and public services.

Together we will catalyze something bigger than any of us individually. The more we connect, share, and experiment together, the greater our impact will have on more people’s lives. What if innovation isn’t about inventing anything new after all? What if it’s about creating the conditions for all of us to more freely combine and recombine our capabilities to make the world a better place?

If a good story can change the world, let’s start with our own. Welcome to #BIF2018!

Forbes Named BIF2018 Top 5 Conferences To Expand Your Mind

An Interview with #BIF2018 Storyteller Mark Brand

We had an opportunity to catch up with Mark Brand, CEO of MB, Inc. and highly anticipated storyteller at BIF2018. Passionate and purposeful, Brand talks to us about the power of connectivity, combining purposeful networks, and some of the fascinating endeavors he’s taken on.

Last year you wowed us at the BIF2017 Summit, coming out in full force with your journey. Tell us a little about your experience and what it was like to be a part of the Summit?

For scope, I’m terrible at vetting folks and on top of that, am a Canadian who’s been buried in my work for a decade. I attend events and based on what I speak about and who I’m with, the universe and all its soldiers (I’m looking at you Saul & Yarrow) line me up with great people. I was hanging out on day two last year and a gentleman who I recognized started talking to me about real upward mobility, not band-aid entrenchment solutions, for marginalized populations. He said, “You need to help us out in New Mexico”, and it still didn’t click at the time, I just had a crush on his brain and his vision. Turns out he founded Fast Company and he’s the Mayor (of Santa Fe, New Mexico) now, so I think he knew what he was talking about.

Another discussion I had was with the team at Peace Love Studios that’s led us to partner further. What I’m getting at here is everyone at the conference is truly about change and impact. Being able to share my story to accelerate others work was a real gift that’s still giving.

Mark Brand at BIF2017

Since your time at BIF2017, we’ve seen you take on some incredible new endeavors: a new role as Professor of Innovation at USC, cooking at the Vatican as Executive Chef for Pope Francis’s Laudato Si Challenge; tell us a little more about what you’ve been up to – and where you find the time to do it all?

Time is our most valuable resource, so it only made sense for me to find out how to get all of mine back. I did, and am now focused solely on scalable projects that will impact all of society, and teaching or speaking to those who can do the same. My role as Professor at USC is teaching doctoral students of social work how to approach the work they’ve been doing, some for decades, and flip it on its head using design methodologies and no bullshit real-world experience. It’s the most rewarding work to be teaching those who are in it, with so little resource, but all the passion.

Rome was incredible. I got to cook for 400 global leaders and through my menu and words discuss solutions from agriculture and people to climate change. Folks often look at the traditionally “Barriered” as a burden, but they’ve got it all wrong. They’re the solution, and I got to share that on a stage I could only have dreamed of prior. I’m a deeply spiritual, non-religious dude, so it was extra special to have this group bring me in. It shows that purpose and impact trump affiliation, pun fully intended.

I also became certified as an Integral Facilitator this year from the Ten Directions program, which has taught me how to use my whole body as an instrument and how to mediate the hardest of conversations. When you start to use all of your senses, kind of like a tuning fork, you can achieve so much more because you don’t waste time on, well, time wasters. Intuition plays a big role, trust it.

At home in Vancouver the partnership of our Social Hub, Save On Meats, and charity, A Better Life Foundation, served its two millionth meal to those in need. Two Million. When people say small businesses can’t make big changes, we beg to differ. The programs now feed between 900-1300 people a day and we couldn’t be prouder of the work where it all started and continues to grow. I have an incredible team of people.

Where does that take you now? Talk to us about what you’re working on.

Everything is the short answer. I’m working more than ever and feel better than ever. This summer I’ve been spending a ton of time in NYC and as of the fall am bringing my company and charity stateside, with the intention of building brick and mortar centers akin to Save On Meats in every single neighborhood that needs one. We’re also taking my Greasy Spoon Diner series National and International to Australia, where I’ll serve as Entrepreneur In Residence for the City of Sydney this fall for 2 weeks.

My digital platform PAL has found partners with DOMO and Fairshare and we’ve been nonstop this last 6 months working on getting the data we need to start to end homelessness in a city by city case using emerging tech that is simply incredible.

We launched HATCH Europe a few months back and I’m super excited to see my dear friends and family Kimberly, Charles, James, Phillip, Holley, Vika, and Quentin all from the network joining BIF this year. They’re insanely beautiful and impactful people that are going to blow the audience at BIF away.

You know Saul, 5 years ago, I couldn’t get people to amalgamate impact and business mentally. It was church and state. Now it’s all anyone wants to talk to me about and I’ve seen a massive change not only in normalized vernacular but hunger from people with wealth and power to do real, sustainable good. Not just write cheques. I’m over the moon with the state of things and really appreciate how you and BIF show up to help the conversation.

We’re excited to have you back on stage at BIF2018. What are you going to share this year?

It’s all Top Secret. I’m doing a talk that’s deeply personal and that I’ve never done before. I’m very excited to share it.

What does the Summit experience mean to you? How would you describe it?

It’s an opportunity to embrace new perspectives I don’t get exposed to. The conference is challenging whilst supportive, it’s engaging whilst also disruptive. I’m certain I’ll end up in all the heated discussions I had no idea I wanted to have again.

Register for the BIF Summit to hear Mark alongside 32 remarkable storytellers and you’ll leave inspired and ready to transform yourself, your company, and even the world.
Connect. Inspire. Transform. Register #BIF2018

Revitalizing a Community through Citizens’ 100K Ideas

100K Ideas is not your average business incubator. In fact, they pride themselves on being different — on being accessible to all members of their community and welcoming to all who walk in their door. They like to describe what they do as “herding reindeers” rather than “chasing unicorns,” like most incubator and accelerator programs, because reindeer “are still mythical, but at least they exist.”

They also pride themselves on their mission to “relieve innovators of the entrepreneurial burden,” supporting community members from idea to concept in a pain-free process that leverages student talent, innovates education, and removes barriers to access.

This is our favorite type of model here at BIF because it taps into what we call “the gold in the grey space” — working across sectors and industries to meet true citizen needs while transforming each of the latter. When we heard what 100K Ideas was doing out in Flint, MI, we knew we had to go see it for ourselves. So Eli Maclaren, our Chief Market Maker, and I hopped on a plane this past month headed for Detroit and beelined it to Flint.

Flint, Vehicle City, Detroit, Michican

I had first heard of Flint from the headlines of its water crisis and had learned that it was the birthplace of GM. But despite economic hardship faced as a result of a declining auto industry and falling victim to the state’s criminal water management choices, Flint’s residents aren’t sitting around waiting for things to sort themselves out. In addition to the organizers and activists that contributed to getting the city’s crisis on the national radar, the Flint community members we met are committed to addressing some of the root causes (i.e. inequality) and systemic challenges (i.e. lack of opportunity) of which the water crisis is just one more symptom.

100K Ideas, Citizens First

When we arrived at the Dryden Building in the heart of downtown Flint, we were greeted with a banner proclaiming #FWDFlint. A quick walk around the block and we saw a shiny new Farmer’s Market, a spiffy transportation hub, a colorful childcare center, multiple churches, two university campuses, and a refurbished theater getting ready to open up. In the diner where we ate and even strangers on the street, folks were chatty, helpful and welcoming towards us New England gals — two outsiders in a new place. I realized immediately upon arrival that despite its national narrative and the assumptions it had created for me, Flint was full of treasures that I didn’t expect.

FostIr Coffee, Detroit, ME

When we entered the offices of SkyPoint Ventures, the parent company of 100K Ideas, we were personally welcomed and greeted by CEO Phil Hagerman, and were enamored when his Chief Innovation Officer David Olilla began to tell us their tales. Phil was born and raised in Flint and had helped grow his father’s family-run pharmacy into the multi-billion dollar Diplomat Pharmacy venture that it is today. David hails from Northern Michigan and is an inventor at heart — he created the first-ever helmet-camera, pre-Go Pro, and has several other products in the works. An innate problem-solver, he tinkers and toys with design challenges until he finds new ways to figure them out. Together, they are one dynamic duo that isn’t waiting for anyone’s permission to make an impact in their city and far beyond.

On its website, 100K Ideas explains itself as “community of student professionals [who] vet entrepreneurial ideas to provide a helping hand in business development to anyone regardless of their prior experience or background.” The concept is an answer to entrepreneurial elitism and the barriers that so often prevent people from getting their ideas off the ground. Rather than suffer through a grueling and exclusive application process, anyone can walk off South Saginaw Street in Flint and into 100K’s space in the city’s historic Ferris Wheel building, and be welcomed by the university students that staff much of the non-profit for a free consultation. The fact that their staff are students serves a double purpose — not only are they less intimidating to work with for your average budding innovator lacking a business or technical background, but the students themselves are also gaining real-world experience and learning through the shared process. The name of the organization comes from Flint’s 100,000 residents, fueling its social mission that “if we got one idea from every one person in Flint, we could change the world.”

The model not only democratizes entrepreneurship by making it more open, inclusive, and accessible, but it seeks to transform a city and its citizens as well. It not only provides a community and a validation system for budding entrepreneurs, but it leverages student power to create an expansive model that tackles multiple systemic issues: outdated higher education models, exclusive barriers to entrepreneurialism, inequality, and broader economic development challenges through new venture creation.

So what is 100k Ideas’ special sauce?

  • The model is open to all. Not only is it inclusive and accessible for those it serves, but the organization and its leaders are open to collaboration in all its forms: “This bus is for everyone,” David told us, “If you don’t want to get on now, it will come back around again and the doors will open back up…”
  • Dynamic leadership with an innovator’s heart: the 100K Ideas team is perpetually operating in beta, always open to improvement and iteratively working to get the model right. What they have now has been tested and tried, and David continues to tinker with the model every day.
  • The conditions are right: 100K Ideas serves a community where the need is great and there is a sense of urgency in their work. They firmly believe that “talent is equally distributed, but opportunity is not,” and recognize that Flint is a community where more citizens should be enabled to act on their innate creativity and leverage their ingenuity to generate impact. 100K Ideas acts on their belief and is working to expand the opportunities for Flint’s citizens to do that.

Most business accelerators follow a single model, but 100K Ideas is not copying anything else. Phil, David, and their team learn every day from the entrepreneurs they seek to serve. They play with what works for them and what doesn’t, and have created something wholly new — at first, we weren’t sure if they were trying to disrupt higher education or economic development, but we quickly realized that the answer is both. This is just the type of citizen-centered innovation we seek to lift up — innovation that provides a public service, that unleashes citizen agency and contributes to revitalizing a community. Visiting 100K Ideas was my first of hopefully many trips to Flint, but I hope to see more models like 100K Ideas in places all over the nation so that I won’t have to fly halfway across the country to find community-centered innovation like that. Citizen-entrepreneurs in communities across the US deserve it.

Join us in transforming public services.

Experimenting for Education Equity

Year after year, we see new big hairy audacious goals emerging for our education system. For example, by 2025, we want to see 60% of Americans attaining a higher education degree. Currently, the national average is 46.9%, up from only 9 basis points in 2008, calling the question:

What is it going to take for us to move 13 percentage points in 7 years, given our track record?

The same question emerges when you look at school readiness, 3rd-grade reading levels, and high school graduation rates versus goals. Unfortunately, we have to get our heads around the inconvenient truth:

Unless we do something dramatically different, we can’t get there from here.

So what is that different way?

In BIF’s Student Experience Lab, we understand that the problem exists on two fronts:

  1. The education gaps in attainment (from readiness to degree attainment) are largely the output of inequity.
  2. Transformational activities to close these education gaps are few and far between, and those that do emerge are local and fragmented throughout our education system.

The result is that even our efforts to close the equity gap are inequitable. This is why in the fall of 2017, BIF teamed up with the Carnegie Corporation of New York to explore this very design challenge:

How might more integrated approaches to education transform outcomes, specifically for the children who are being left beyond today? How might we reduce fragmentation in our innovation efforts to spread and scale breakthrough solutions? How might we accelerate collaborative innovation to reduce education gaps across the country?

Obviously, this is a project that is near and dear to me personally, and all of us at BIF. It is structured in a unique way, enabling us to both mirror the problem, create a petri dish for experimentation, and collaborate with some of our favorite innovative designers in education. This is how it works:

Five organizations — FSG in partnership with PolicyLink, EducationFirst, Bellwether, 2Revolutions, and IDEO’S Teachers Guild — received grants to run two-year projects, each one geared at reducing fragmentation in education and accelerating integrated approaches to equity in education. These five organizations form the Integration Design Consortium. BIF serves as the connective tissue of the IDC — connecting, convening, and collecting learnings towards our combined learning agenda. We also serve as the Chief Instigator, running small experiments to understand how we might spark collaboration, inspire reflection, and insight pivots based on real-time learnings. The objective is to create field facing learnings and tools that can enable greater integration in education.

Being 6 months into our grant, we are in a position to begin to share some of our emerging curiosities.

Download Our DEI Toolkits

Fragmentation by Design

One of the challenging aspects of our public education system, as with our government, is that it is fragmented by design. We grant local autonomy to states on many issues, and even further down the pecking order to districts. On the one hand, this enables creativity in responding to context (and much of the challenges in education are about context). Even in the classroom, teachers are often given the autonomy to respond to immediate learning needs in new and different ways. This enables “depth” as it relates to impact on individual students, but it prevents “breadth” in the scale of that impact. It is almost like we’re missing a “hyperloop” in our systems that enable us to quickly move learnings up, down, and out of the system hierarchy. Further, it is indeed a hierarchy which prevents the outward bound mobility of learnings and innovation. When we imagine systems that are well integrated (e.g. platforms), they tend to be flatter with basic protocols (e.g. common languages) that enable users to plug and play, adopt and adapt. This dynamic has us curious:

How might we enable horizontal information flows across a system that is fragmented by design?

Reducing the Hunt

It is rumored that by the time Sir Isaac Newton was 12 he had read every book on mathematics. This is less a statement about his intellectual prowess (albeit undeniable) and more a statement about the availability of information. Today, we are overwhelmed by the abundance of information. This is as true for us as individual players in our education system (teachers, superintendents), as it is for us as organizations exploring and testing innovative approaches in education. We know that innovative methods are out there, but we don’t know where to find them. Further, we are handicapped by our evidence-centric society, that frowns upon “experimentation” in education (i.e. experimenting with our children’s futures), and before innovations can spread or scale, they are put through the “evidence-based” time-consuming process of collecting proof, such that they can be deemed a “best practice.” This slows and curtails the ability for organizations and the system as a whole to get better faster. We’re not the first to ask this, but it remains a question that needs to be addressed:

How might we reduce the hunt for individuals and organizations seeking innovative methods for reducing inequity, thereby accelerating the integrated spread of innovations across the education system?

Catalyzing Learning Organizations

This leads us to a related curiosity:

How might we create the conditions that encourage organizations to learn and adapt in real time to emerging learnings and insights?

Peter Senge framed the notion of a learning organization in The 5th Discipline. It is a framework for understanding how organizations can unleash productivity and success by creating the conditions for adaptive and continual learning. Unfortunately, this is not the norm in a society that is still very much governed by industrial era models — which use business models as the organizational straight jacket in service of organizational efficiency and specifically constrain versus nurture expansive thinking by employees and business units. As a result, we have education institutions which create 5-year strategic plans with lofty success metrics (note the before mentioned degree attainment goal), measuring progress yearly, but not adapting in real time to what is working and what isn’t working.

There are three challenges here:

The first is that we lack the signaling systems and metrics to act in dynamic ways. The second is that learning is a generative act and requires a vulnerability which is often considered a high-risk proposition for organizations. For nonprofit organizations, this dynamic is exasperated by funding models. We are funded to achieve certain outcomes through a specific approach. The conditions are not good for real-time pivots; we perceive, right or wrong, that this demonstrates a weakness, a lack of expertise. Finally, learning networks don’t exist in the wild. Learning networks enable organizations to learn together and from each other, getting better faster. But they are most often catalyzed by an outside force, like a funding partner, and they are exclusive. This exasperates the conditions where some organizations learn and others don’t, and where the benefits of such a network are limited by the funding timeframe to sustain it.

Networking Business Models

Finally, if we can learn and adapt, our growth response is limited by our own organizational capabilities. Collaboration is still understood as coming together and learning together, rather than coming together to network our capabilities to deliver value in entirely different ways. The latter is hard, hard work, and requires a few key ingredients. It requires leadership who is willing and able to experiment with new approaches, and lend the organizational brand and reputation to outcomes that can not be attributed back to a single player. It requires the ability to dedicate a few capabilities, on a small scale, to a new delivery model without disrupting the efficiency of the existing delivery model. And, it requires a new revenue model which will work across organizations.

However hard, it is also essential for the integration of a system. If a business model is a network of capabilities woven together into a sustainable financial model, a system is a network of business models that have learned to collaborate. Until organizations learn how to do this, integration in our education system won’t work, and innovations that fundamentally transform outcomes will remain localized and dispersed. Leading us to wonder:

How might we create the conditions (incentives, resources, leadership, and know-how) to build organizational collaboration and integration?

Above, I framed this all as emerging curiosities, because that is what they are. They aren’t necessarily new insights about the education system or guidelines for closing the equity gap. In the spirit of working out loud, they are the thoughts and wonders that come to us as we explore the intersection of equity, integration, and education.

We do not do this exploration blindly; we are standing on the shoulders of giants who have explored it before us. Many frameworks have been developed that answer and address some of what we are finding. As such, we intentionally look at the work through the lens of these frameworks — from Adaptive Leadership and Coherence Frameworks to Learning Organization Theory and the PELP Framework. Our goal is to suss out what can be bundled into these existing frameworks, and what can’t be answered — helping us define new insights and opportunity spaces to accelerate an integrated approach to equity in education.

In the coming weeks and months, we’ll be sharing many outputs from this work — from podcasts and interviews with the other IDC grantees to videos capturing our learnings and curiosities. We invite you to help us get better faster —engaging with us along the learning journey. Help us identify more blind spots that might be an important puzzle piece; go a bit further and help us put some of these learnings into action, sharing what happens along the way.

It is, as our partners at the Carnegie Corporation of New York often say, a grand experiment.

And. Experimentation in service of education and equity might be the best alliteration, and purpose, ever.

Thanks to Jessica Brown.


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Integration Nation: Insights from the IDC

“We are in a time of great innovation.. and a time of great divides.” It sounds like the beginning of a great hero’s story, and in a way it is.

Our education landscape is at a crossroads. Too many students— often those who are marginalized based on race, ability, class etc.— are being left out or pushed out of the classroom. In response, we have created ambitious goals that seek to redesign our system— but often we aren’t fundamentally changing how we work or collaborate in order to reach these goals. As Eli MacLaren, BIF’s Chief Market Maker, mentioned in her recent blog post, the education system is fragmented by design and if we aren’t intentional it will stay that way.

One cohort working to change that is the Integration Design Consortium (IDC), a group brought together by the Carnegie Corporation of New York and facilitated by the Business Innovation Factory. The IDC exists to enable greater integration within education in order to increase equitable outcomes for students.

(Full panel discussion with the IDC)

This podcast is moderated by Eli and features: Molly McMahon from the Teachers Guild, Hailly Korman from Bellwether Education Partners, Alissa Peltzmann from Education First, Todd Kern from 2Revolutions, and David Garfunkel from FSG. Throughout the discussion, folks hit on important challenges, curiosities, and considerations for the education field. Our calls to action are clear:

  • Innovate and integrate in service of a more equitable education system — [and know that innovation is only valuable as it affects things that matter in the lives of kids]
  • Solve the toughest problems and hold ourselves accountable to results
  • Iterate quickly and intentionally
  • Embody a human-centered approach to problem-solving that prep our students to solve the complex problems of tomorrow

(Insights from Molly McMahon with the Teachers Guild)

(Insights from Todd Kern from 2Revolutions)

This story is full of complex challenges, a willingness to do things differently, and shared responsibility and urgency. We look forward to sharing the progress and ongoing learnings from this work. Let us know what resonates with your work!

Join Us in Transforming Education Together

BIF Welcomes Global Legal Services Provider Epiq as New Member

PROVIDENCE – April 24, 2018 –  The Business Innovation Factory (BIF) is pleased to announce its newest member Epiq, a global leader in the legal services, to enable transformational next practices and new business models to reimagine the customer experience.

As members, Epiq will have access to the BIF network of institutional business model innovators and unique approach to developing next practices and new business models, utilizing BIF’s Design Methodology and over 14 years of experience in the innovation space.

“We’re thrilled to welcome Epiq as a Corporate Member in BIF’s innovation community and to begin working together to integrate customer-centered business model innovation into Epiq’s product innovation roadmap. Epiq shares BIF’s passion for transforming customer experience by continually exploring new ways to create, deliver, and capture value. Epiq’s commitment to innovation will enable it to strengthen its market leadership position in providing differentiated technology and data-enabled legal services” said BIF Founder and Chief Catalyst Saul Kaplan.

“Our approach to innovation includes product innovation, process innovation, and business model innovation,” said Cliff Dutton, chief innovation officer. “We are working with BIF to bring best and next practices in client-centric business model innovation to our product innovation roadmap.”

Utilizing BIF’s innovation expertise, Epiq will be focused on building a client-centric business model innovation into their product innovation roadmap, connecting leaders with a proven methodological approach to becoming market makers, unleashing new customer and commercial value by imagining, designing, prototyping, and commercializing transformational data products, services, and new business models.


About Epiq

Epiq, a global leader in the legal services industry, takes on large-scale, increasingly complex tasks for corporate counsel, law firms, and business professionals with efficiency, clarity, and confidence. Clients rely on Epiq to streamline the administration of business operations, class action and mass tort, court reporting, eDiscovery, regulatory, compliance, restructuring, and bankruptcy matters. Epiq subject-matter experts and technologies create efficiency through expertise and deliver confidence to high-performing clients around the world. Learn more at


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BIF to Co-Host and Facilitate a Business Model Bootcamp at #ILN2018 In-Person Meeting

On May 7-10, Business Innovation Factory will be co-hosting The Innovative Learning Network’s (ILN) in-person spring meeting in Charlotte, NC with an expected attendance of over 200 healthcare leaders, with our friends and partners at Atrium Health to help top healthcare leaders in the country identify pain points from the customer’s perspective and apply transformation to next practices and new business models.

This collaboration is made possible, in part, by our newest member: The Innovation Learning Network.  “We are thrilled to engage in a joint partnership with the Innovation Learning Network. ILN and BIF have a shared vision of a transforming health care system that engages patients in their own care and employs innovative new models that improve the patient experience,” said Eli MacLaren, Chief Market Maker at BIF. We are looking forward to participating in The ILN in-person spring meeting to connect with transformational healthcare leaders.

ILN is a global, membership-based organization that exists to share innovations across systems, teach innovation and design techniques, and create innovation friendships. Its mission focuses on accelerating innovation by sharing the pains and joys of transformation. “The ILN pillars are future-forward solutions, innovation techniques, and above all, friendships. It’s these unlikely friendships that drive the magic,” says Chris McCarthy, Executive Director of ILN and BIF Summit Storyteller.

Eli, BIF’s Chief Market Maker, will be co-facilitating with the team at Atrium to introduce BIF’s Design Methodology for exploring testing, and prototyping new business models. The methodology was formed to help leaders identify current pain points within their organizations by shifting perspective to the lens of the customer experience. Once the customer’s pain points are recognized, a job-to-be-done is formed based off of the fundamental problem a customer is trying to solve. The job-to-be-done will then be designed and prototyped, eventually leading to how the new transformative strategy can be tested, implemented and commercialized in the real world.

Do you have an innovation challenge but are not quite sure where to start? BIF membership enabled business leaders to start small and scale fast based on our proven methodology. Members get the unique opportunity to get involved with our network of leaders and big thinkers to transform fast. To learn more about membership opportunities, click here.

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We’re Hiring: Experience Designer

BIF makes business model transformation safer and easier to manage for institutional leaders. We do this for businesses and in complex social systems in healthcare, education, and public sectors.

As an Experience Designer at BIF, you will work as part of a multi-disciplinary team that focuses on understanding real user problems & business opportunities, designing, building, prototyping, testing, and iterating to create scalable solutions that address our clients’ most pressing problems. Members of the BIF Experience Design team will be focused on driving impact and creating genuine value for clients and internal users.

As an Experience Designer you will:

  • Work in multi-disciplinary teams to create user-centered experiences and solutions, while balancing business goals and technical implications
  • Use design-led thinking to communicate how a solution can satisfy user needs, business goals, technical constraints, and other project requirements
  • Lead secondary research efforts to build foundational knowledge in lab domain areas
  • Contribute to and/or lead ethnographic fieldwork efforts (start to finish) which generate powerful observations and insights
  • Help synthesize data and translate observations and insights into transformational ideas for new solutions and approaches
  • Create interactive prototypes at various levels of fidelity to showcase user experience and solutions
  • Craft and articulate a compelling story that helps people connect with the work
  • Have exposure to a broad array of client needs and industries

As an Experience Designer you will be expected to:

  • Activate user insights and opportunities through a lens of business strategy
  • Combine fluency in qualitative research methods and data analysis with an ability to move beyond research as outcome, to research as input to real-world solutions
  • Explore new and novel approaches to research and its application in BIF’s lab work
  • Have experience with or be open to working within the human-centered design process
  • Be prepared to lead conversations having to do with “what to do and why” as well as the “how” of implementation
  • Possess an entrepreneurial mindset and work comfortably with ambiguous problems in a dynamic environment
  • Work collaboratively or independently as needed
  • Have excellent writing and communication skills
  • Be willing to travel

This is a full-time position in Providence, R.I., salary range starts at $40,000 for Experience Designer, $55,000 for Senior Experience Designer, based on your skill and experience. If this sounds like you, please send a resume, cover letter, and writing sample. All materials should be sent to

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

We are a lean team, which will provide you opportunities to present directly to our senior leaders. Your impact will be felt immediately!



BIF Welcomes the Joe Andruzzi Foundation

We’re pleased to announce our newest BIF Member, the Joe Andruzzi Foundation. JAF inspires us all by helping to alleviate the financial burden for cancer patients and their families throughout New England.

“As the Joe Andruzzi Foundation enters its tenth year, we are thrilled to become members of the extended BIF community,” said Joe Andruzzi, President and Co-Founder of the Joe Andruzzi Foundation. “Our entire organization is looking forward to tapping into the extensive resources offered within a BIF membership as we strengthen a strategy and business model that will help carry the Foundation’s mission into its next decade of operation.”

As a Member, JAF will gain access to BIF’s innovation experience, community, and unique approach to developing next practices and new business models through BIF’s Design Methodology. With a growing financial burden placed upon patients, JAF and BIF will work together to explore and test new ways of addressing rising and oftentimes unexpected medical costs to alleviate the burden facing patients and their families, building on the organizations 10 years of experience.

“We’re thrilled to partner with the Joe Andruzzi Foundation. JAF shares BIF’s core human-centered values and strategic focus on transforming healthcare” said BIF Founder and Chief Catalyst Saul Kaplan. “The financial toxicity of cancer is increasing and is as important to manage as the toxicity of cancer treatments. BIF is excited to help JAF explore new transformational models that rise to the level of the financial problem that families impacted by cancer face.”

Founded by former New England Patriots offensive guard Joe Andruzzi and his wife Jen in 2008, the Joe Andruzzi Foundation grew from Joe’s own successful battle with cancer and serves as a means to provide financial assistance to cancer patients and their families so they can focus on recovery – not bills. It also funds research at Boston Children’s Hospital, building on the Andruzzis’ longstanding commitment to cutting-edge pediatric brain cancer research.

If you’d like to get involved or lend your support to the organization, please visit:

You can hear more on Joe’s story from the #BIF2017 Summit below:

When Transformation Feels Intimidating, Membership Can Help

Membership is the first step in shifting the conversation towards what is safe, practical, and possible. It’s a low-threshold way to catalyze your innovation agenda and an easy initial engagement with BIF.

Start Your BIF Membership Today

Congrats to #BIF2017 Storyteller Alan Webber!

BIF is overjoyed to share in the news of longtime supporter and BIF storyteller Alan Webber’s election as Mayor of Santa Fe!

Since the start of the BIF summit, we’ve heard from over 500 innovators across every sector and discipline who have inspired both audience and fellow storytellers alike to shift their lens, to think differently, and to take action in order to transform the world. Alan Webber’s story is no exception.

Taking to the #BIF2017 stage, Webber shared his journey from the co-founder of Fast Company magazine, to the rise of entrepreneurship, to where we are now in a  politically driven climate – and a hint of where he might be heading.

Encouraging the audience to create meaningful change through civic engagement, his ask of the audience? To run for office. To step up and make a show of support and show of voice to make a difference. The answer-back? “Run Alan, Run!”

At BIF, we believe in the power of storytelling. The power to create change. To connect, inspire, and transform. We’re thrilled to share a part in Alan’s story and be witnessing the next chapter in his, truly exemplifying what it means to inspire us all and be a changemaker.

“Once in a while you encounter a gathering that says it’s about ideas, and, well, it’s about ideas and more. It’s about a way of sharing ideas that are friendly. Honest. Comfortable. Unassuming. It’s about a way of bringing people together so they actually get to engage with each other. It’s about a mindset that is genuine. Which only happens because the people who stand behind the conference are genuine. And honestly interested in the right stuff, the real stuff, the stuff that matters. And that’s what makes BIF matter for me.”

Alan Webber, Founding Editor at Fast Company and Mayor-Elect of Santa Fe

The Equity Opportunity in Healthcare

In 2015, BIF was working in Dallas, TX – a racially segregated city – with Children’s Health System of Texas. As part of that work, we were building Children’s design thinking capability – and nothing was getting designed without customer feedback.

At the end of a particularly grueling design sprint, we brought in a group of teenagers – for whom the staff had been designing and asked them to critique the concepts. We could see the staff sweating – getting critiqued by customers is hard; getting critiqued by teenagers is harder. And, not for nothing, race was on our minds:

How open and honest a conversation would we have, with a primarily black teenager customer group and a primarily white staff group?

Privilege and power were the two elephants in the room.

But something amazing happened. After a fabulous critique, the teenagers were invited to ask questions of the staff. One of the teenage boys turned to the staff and said:

“Was that hard for you? Because it was incredibly uncomfortable for us.”

That question began a courageous conversation that openly and honestly explored and addressed our two elephants.

It is a well-established that racial inequity in the United States generates poor health outcomes. Countless studies, programs, and initiatives have been launched to attempt to close this racial gap in health outcomes, yet disparities persist. Why?

Part of it has to do with implicit (and sometimes explicit) biases. White doctors will often dominate the conversation when seeing a black patient and spend less time listening to the personal experiences of the patient. They will often discredit their patient’s abilities to comply with medical instruction and undervalue perceptions of pain. Often, all done without conscious intent.

These biases affect how healthcare is delivered and also how it is received. When a patient feels belittled by their physician or if their experiences and feelings are discredited, trust in the medical community erodes. As it is, distrust exists writ large, stemming from deep historical roots of unethical and racially motivated practices, from slavery and sterilization to Tuskegee and syphilis in the 1970’s.

This distrust that is not easily abdicated by a well-intentioned institution. Trust is even harder to establish when diversity, equity, and inclusion is treated as a bolt-on, which it so often is. For example, while designing a community health center in a primarily Latino community, we heard first hand how families often screened for Spanish speaking physicians only to discover that Spanish speaking meant the ability to say, and only say: “Hola, como estas?”

The institution is trying of course, but the result is often insulting.

The challenge is that bolt-on’s like this is what we know how to do.

Begging the question:

How might we design healthcare business models that generate better outcomes by recognizing the importance of diversity, equity, and inclusion?

First, we must understand the job that people want done. We hear often from patients that this is as simple as being treated as a human being. This requires that we practice inquiry – instead of creating a story about someone based on the color of their skin or the language they speak, we invite them to tell their stories. In this sense, storytelling is a critical organizational capability  – and the reason why BIF has worked with innovating organizations, such as Mass General Hospital and the Robert Wood Johnson Foundation, to build storytelling muscle within the medical industry.

Second, we must begin to recognize what white privilege means and the implications of that from a customer’s point of view. Our privilege means that we can buy band-aids in “flesh” color and they will likely match the color of our skin. Our privilege means that we recognize and know how to use the food that is sold in our supermarkets. Our privilege means that we can comfortably avoid, ignore, and minimize the impact that racism has on our lives.

This just isn’t true for Americans of color, and it’s incumbent on the healthcare industry to acknowledge that the lived experiences of inequity play a pivotal role in the health and well-being of marginalized communities.  Gaps in income, housing, and education are all significant factors when addressing the underlying disparities in both physical and mental health outcomes. To the extent that upwards of 70 percent of health outcomes are from social determinants, not medical determines. And while we know this, our approaches have been insufficient bolt-ons. We have created and funded collective impact efforts around housing or asthma; we have created care management programs. But rarely have we considered if we needed to fundamentally reimagine the business that we’re in. This is why the business model BIF designed for Children’s Health System of Texas moved it out of the business of delivering health programming and into the business of brokering relationships with social service agencies. This is why we authored the blueprint for creating sustainable new business models for moving Health Care Upstream.

Thirdly, we have to recognize that some aspects and assumptions of white culture in healthcare make it unattractive and irrelevant to many. Our white culture assumes a future orientation with delayed gratification. When we invert this, we’re able to recognize that people just want to feel well now, and that inspired a model for family well-being. Our white culture emphasizes creating divides between the personal and professional, which prevents the empathy, trust, and context that is essential between patient and caregiver.  Our white culture emphasizes rugged individualism which is not aligned with how many people live and thrive. This is why, when addressing preterm births in Cincinnati, we considered “what if we changed our care delivery model and approached medical appointments more like community gatherings” where patients share experiences that affect their overall health and well-being with a community of people who live and look like them?

When care becomes personalized, instead of medicalized, health outcomes improve.

As part of BIF’s early design work in Dallas, we created a small prototype called Your Best You to determine if improving well-being was actually possible. Our hypothesis was that if we activated kids’ sense of personal power, we could improve their sense of well-being. Your Best You was a 2-week curriculum that married aspects of Hip-Hop culture with design thinking, heightening kids’ sense of agency, creativity, and personal impact. One of our participants, an 11-year-old girl, spoke specifically about how awesome and important it was to be in an environment that let her be herself versus asking her to conform to a different set of norms. As it turns out, the ability to be yourself does wonders for your well-being and health.

Our healthcare system, however, still prioritizes quantity over quality. It also remains true that our healthcare workforce is not taught to address societal inequities or community norms. Addressing the social differences of patients would require a different set of skills that is not currently imparted in our medical education. Which leads us to address the question: how might we begin to re-imagine medical education so that group facilitation, bias recognition, and empathetic listening are core skills taught in line with clinical practice?

This is hard work and it all requires new capabilities, like storytelling. This is why efforts to address diversity, equity, and inclusion have been treated as bolt-ons. And herein lies the opportunity:

When healthcare business models are created with equity at their core, they have the ability to move beyond the bolt-ons that have sustained the structural norms of bias and discrimination, both known and unknown and seize the opportunity to fight against insidious structural racism, the implicit biases of practitioners and patients, and even overt external discrimination.

They also have the ability to finally include and pull people into a system which otherwise feels intimidating and hostile.

At the Business Innovation Factory, we know that when our social systems treat diversity, equity, and inclusion as mere bolt-ons to the current models, our systems become fragile and unsustainable. As new business models emerge, we believe that those that put and maintain DEI at their core are best positioned to transform and improve the experiences and lives of their consumers.

Join the conversation and explore how putting DEI at the core of your business model could identify opportunities for transformation.

Part 1: The Diversity, Equity, Inclusion Imperative

Part 2: Finding Our Equity Why

Why DEI? Join The Conversation

Finding our Equity Why

Twice recently I’ve been asked to reflect on “my why.” The first time, at a student-led professional development on unconscious bias from Diversity Talks and the second, at a meet-up of EduLeaders of Color RI. I am grateful for these two gatherings because I’ve been putting a lot of pressure on myself to find words to describe my investment in equity and justice in education (and broadly). Additionally, I’ve been trying to think of ways to bring others on that journey — both friends and opponents.

In short, I’ve been searching for a point of view to ground me and provide direction as I imagine the future of education. As the conversation around diversity, equity, and inclusion (DEI) picks up steam, I have felt even more pressure. It is one thing to talk about these topics with folks that “get it”, are increasing their consciousness, and are actively building equity into their practice. It is another to be in conversations and settings where equity is just a casual topic or bolt-on.

My why: I am angry that students and educators (especially those who are Black and brown, LGBTQ, lower-income, English language learners etc.) are flattened by a system that doesn’t allow them to be their full selves. I love my communities and want to be in the business of co-designing and building an education system where they can thrive—one where equity is at the core.

Most of the conversations and actions in the education sector are not structured with the same ‘why’ in mind. Equity is often a bolt-on added to existing conversations, practices, or programs. This has produced inconsistent, narrow-focused point solutions or top-down mandates across schools, organizations, and policy.

These efforts do not:

  • Combat the root causes of inequity and oppression that are stitched into the fabric of the education system (and our society)
  • Raise the achievement of all students, while narrowing the gaps between the highest and lowest performing students or eliminate the racial predictability and disproportionality of which student groups occupy the highest and lowest achievement categories [Glenn Singleton, 2015]
  • Transform experiences for students, educators, and families

To do that, we need something more. We all need personal and institutional ‘whys’ around equity. And our why has to be stronger than our why not.

Luckily over the past year, the Student Experience Lab has had a project that has helped me imagine what an education system with equity at the core might look like. Throughout the Teachers For Equity project, we developed and tested a model that used a system-focused, teacher-driven approach to advancing racial equity. I have previously written about the conditions that make this model powerful: educators were close to their communities, focused on equity, and were designing with NOT for other educators and students.

Our prototype’s why: We want to transform the values, norms, and practice of the classroom and activate teachers to change not only what is taught, but how it is taught, how teachers and students engage, and how school communities learn and grow together.

Download Our DEI Toolkits

Transforming values, norms, and practices that are rooted in systemic racism is not work that happens easily. It is work that put equity at the core and required every educator to have a strong personal ‘why’. They needed something that rooted them in the work when facing pushback from colleagues or when they did not immediately see results in student achievement.  

As they uncovered, explored, and modified their whys we were able to move from a lens where equity was merely a bolt-on. We were then able to surface other key conditions of an equity-centered education system:

A commitment to building racial consciousness. There is no such thing as achieving complete cultural competence, this work requires being actively adaptive and responsive. In Teachers For Equity that required two things: content and reflection. The content was the “easy” part. There are plentiful resources to get educated on racial dynamics and histories—what’s harder to uncover is what is stopping us from engaging with these histories or conversations about race. Deep reflection on our own racial identity and experience is essential for understanding structures and mental models that perpetuate racial disparities. By creating opportunities for courageous conversations, our racial consciousness grew from a deeply personal place—and I believe our lives and work will be impacted forever because of it.

A transformational point of view. Transformation often feels intimidating. When we are challenged, it is more natural to go to what is comfortable, technical, or measurable. However, just like getting to the core of our personal racial narratives changes the work, so does getting to the core of the system. Combining a strong ‘why’ with a systems focused lens made educators more confident providing leadership to address root issues of educational equity.

An acceptance of losing competence. All of us like to be (or to be seen as) smart, capable, and competent. Throughout this process we had to work through losing competence— discovering all that we didn’t know about race, having vulnerable conversations, and redesigning a system founded on oppression. When facing uncertainty, we had to avoid disengaging or pivoting the work so that we can speak and act with more authority. Spoiler alert: we were not always successful.

A human-centered culture. Teachers are the closest to students and their needs, yet they are often the last to be considered when designing new, equity-centered models. The goal to advance equity must be supported at every level, but most importantly, teachers must be supported in building equitable practices in order for significant impact to take place. This requires institutions to build in time, space, and a culture of design that allows teachers to create and reflect on equitable values, norms, curriculums, and practice. It can also be aided by intentionally pushing the boundaries of professional-personal divides that hinder vulnerable, courageous conversations. Vulnerable sharing doesn’t mean sharing every detail of your life, but wanting and giving permission to bring in your authentic personal experiences to the table as we work to solve some of the toughest issues facing classrooms and education.

Throughout this project, we saw powerful glimpses of these conditions in action. They enabled us to go beyond surface level solutions to think more holistically about how school and communities could better learn and grow together.

Transformation is comprised of actions taken to change the core of how things are done. The conditions above may seem small/intuitive, but because they target the core of the challenges we face around racial equity (mindsets, feelings, and actions), we saw them enable powerful actions. On a large scale, actions like these can make significant changes in student outcomes. They can help us fulfill our “why” and transform how we deliver more value. For me that looks like using these conditions to create more opportunities for students, educators and leaders to be their authentic selves. It is a commitment to have an explicit focus on equity in my work in education.

At BIF, this experience provides guidance as we continue to design with equity at the core. This prototype imagines the future of education. One that is more equitable. One that our students and educators deserve. One that we hope to collectively work towards.

Tell us your equity why! How does it impact how you create and deliver value? And if you don’t have one, how are you going to find it?

Part 1: The Diversity, Equity, Inclusion Imperative

Part 3: The Equity Opportunity in Healthcare


Download Our DEI Toolkits

BIF Collaborating with Mass General Hospital Healthcare Transformation Lab

The Business Innovation Factory (BIF) Patient Experience Lab is pleased to announce that it will be collaborating with the Massachusetts General Hospital Healthcare Transformation Lab (MGH HTL) and Lab of Computer Science (MGH LCS) to build up the teams’ internal innovation capacity through human-centered design and storytelling.

The Healthcare Transformation Lab was founded on a mission to improve the experience and value of healthcare through collaborative innovation. The Lab of Computer Science was founded in 1964 and has enhanced the lives of clinicians, researchers, and patients with innovative healthcare technology for half a century. Both located in Boston, Massachusetts and situated within the Massachusetts General Hospital, the HTL and LCS work to connect, inspire, and support a diverse group of people as they collaborate on ways to improve healthcare.

Working with both teams and core leadership from the MGH HTL/LCS, BIF will structure, design, and facilitate a series of design sprints in a “learning by doing approach.” Through these design sessions, BIF will help to create the conditions necessary for innovation to thrive.  

Through this collaboration, the MGH team will learn to leverage internal conditions, develop human-centered design and storytelling capabilities, and catalyze innovation throughout the organization.

BIF is excited and honored to support the MGH team on their journey to build internal storytelling, human-centered design, and innovation capacity.

The Diversity, Equity, and Inclusion Imperative

A few years ago, while working on a project for Cincinnati Children’s Hospital, I faced one of the more challenging experiences in my professional work — and, even now, reflecting on it gives me goosebumps.

Here’s the context:

BIF had been asked by Cincinnati Children’s to help them explore and design next practices that would reduce infant mortality in the surrounding community — Avondale. Avondale, at the time, was ranked highest in the country for infant mortality, largely stemming from (a) preterm births and (b) a majority population that was at high-risk for preterm births. Sadly, the reason why stems from race — black women experience more preterm births and infant deaths than any other population. I will come back to the role that race (or racism more specifically) plays in preterm births later.

Our team had spent months immersed in so many powerful, wonderful, and often sad stories. We interviewed pregnant teenagers (and non-pregnant teenagers). We interviewed formerly incarcerated women. We interviewed moms and pregnant women, whose abusive husbands had landed them in shelters. We interviewed pregnant moms and their pregnant daughters. We interviewed non-pregnant women. And we interviewed dads.

We synthesized all of the findings from these interviews, landing on a handful of opportunity spaces and brought diverse community stakeholders together into a participatory design studio. And that’s when it happened.

I had just wrapped up a presentation of our findings, including a podcast of women talking about their experiences (note: listening without visual cues is so core to empathizing without judgment), and had opened up the room to observations and questions. One community stakeholder raised her hand and said:

“You’re white. I’m sure it goes without saying. But if you had knocked on my door, my family and I wouldn’t have told you sh*t.”

There are many things that flew through my mind in the nanosecond I had before I needed to respond.

  • She just questioned the credibility of our findings, at a moment when I need buy-in in order to move forward
  • She’s not wrong; I’m sure there are definitely things we didn’t hear
  • What if we didn’t just not hear things, but what if, given our white privilege (and the biases that come with it) we weren’t able to truly witness their experiences?
  • Holy crap, are we about to talk about race, for real, in public?

I remember my voice shaking in my response, and (having played this scene over and over again in my head), I know I said something along the lines of:

“Yes, I am white, and as such, I can never fully understand what it means to be a black woman. We’re trained to listen, and we do our best to listen with open hearts. And I’d like to honor these women and their time by considering what they did tell us.”

The conversation continued, but I never forgot that interchange.

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Here’s why it matters.

I’ve been working in innovation long enough to see trends cycle through the social sector. Diversity, equity, and inclusion (DEI) has been and might continue to be, one of those trends. It has been on everyone’s radar at one time or another in every decade since, well, before I started working. For example, in 1992, I did my field training in Kenya and required reading was Moving the Centre, a book that invited researchers to consider moving their own race and class privileges out the center of their mental models, in order to explore new ways of working that would leverage diversity. Why do I feel that the invitation didn’t get much traction?

I believe the answer lies in the traditional approach. In BIF speak, institutions approach DEI as a “bolt-on.” This is what we know how to do. We take our existing culture and bolt-on a DEI committee. We take our existing marketing strategy and bolt-on specific activities to reach “underserved communities.” We take our existing products or services and we tweak them to serve “new” audiences.

I think there are perils with this approach:

  1. People are truly hurt, and injustices are created, when we don’t truly shift our lens, mental models, or our behaviors to address DEI systemically.
  2. We miss huge opportunities to serve everyone better.
  3. Bolt-ons aren’t sustainable and will continue to perpetuate trends.

I think the real invitation is to consider how our institutions move from bolt-ons to next practices and new business models. Here’s how.

Shifting our Lens

At the beginning of the Cincinnati research, one phrase kept getting me hung up: Baby Daddy. Women had baby daddies and not husbands. Women had multiple baby daddies. As a white girl from Connecticut, it was hard to say baby daddy comfortably. But here’s the thing that I was comfortable doing:

Asking myself why.

And what surfaces is a bias. Aren’t we supposed to grow up, get married, and have one father for our children? Isn’t nuclear family the right kind of family? The irony, of course, is that I am divorced with two kids. I will never have a nuclear family, and I have learned it takes a village. I host Sunday Dinner — supper with my family, my partner’s family, random teenagers, lonely neighbors, good friends. Why? Because I understand that we don’t get by on a nuclear family. But nuclear family is stuck in my mind — it is part of the whiteness culture that is prevalent in this country – as the universally accepted right way.

Cincinnati Children’s Hospital won a Mayo Transform Award for Neighborhood Feasts, a concept that forged communal relationships between physicians and community women.

Once I acknowledged and moved beyond the notion that there is a right or wrong way, I grew a sense of wonder. Communal families are more expansive; there are more people to play so many roles — regardless of age, gender, or relationship. They are inclusive and accepting. They are more adaptive and responsive; less fragile. There are so many implications for this and how these strengths could be used; it inspired my thinking about how we can re-image support systems; and also, it inspired a key opportunity area:

How might inclusive relationships and communal events change the power structure between patients and doctors (a power structure that often dissuades women from engaging in their care)?

Designing for Diversity, Equity, and Inclusion

The second opportunity is to not just seek inspiration from – but to also design business models for –  diversity, equity, and inclusion. In a forthcoming blog, you’ll hear about our friends at Trinity Rep who came to BIF because they were facing an inflection point in their very identity. As a community repertory theatre, it is charged with reflecting the challenges and issues that exist in the community around it. But a racially charged scene on the stage catalyzed a racially charged response from the community; causing them to question what it would mean to not just have a DEI initiative or do DEI programming, but to transform their business model and put DEI at the core? They asked themselves if this could transform their community.

It’s a compelling question and one that is important for all institutions. If public service put DEI at its core, how would communities look different? How would public services look different? For example, the immigrant debate rages so loudly in this country, through a mindset of who stays and who goes; it is a conversation about exclusion. Through this lens, we are failing to recognize the opportunities found through inclusion. This could mean many things, but my mind goes immediately to the power of entrepreneurship. As entrepreneurs, immigrants ground and fuel our small businesses, and through it, our economy. When we design for inclusion and equity, we’re creating institutions that unleash, rather than limit, people’s potential.

The opportunities in education are also enormous. If higher education designed for diversity, it would have a system that was more flexible and affordable. In short, we would have higher education models that are better for everyone. If K-12 education designed for diversity, we would have classrooms that taught us how to collaborate with “unusual suspects” for critical problem solving (hello – major skill requirement of the 21st century), higher graduation rates, and more people actually engaged in developing the skills, competencies, and capabilities that can move this country forward. In our next post in this series, we’ll share findings from our SXL Teachers for Equity project, which points to the fact that racially conscious classrooms forced teachers and students alike to be more authentic and open — the very conditions for learning and evolving.

In healthcare, I have seen first hand (and designed) opportunities for putting DEI at the core of what we do. DEI forced us to question the 9–5 schedule of primary care. It forced us to consider the importance of “connected knowledge,” given how many people are part of raising a child. It forced us to consider the power and importance of first-generation changemakers, for creating and spreading new habits and values related to good health. It forced us to consider how we move from sick care to family well being. And new business models emerged as a result that could better serve everyone.

In short, when we design for DEI, we create more opportunities to be true and worthy market makers.

Sustaining the DEI Shift

The Cincinnati project was one of BIF’s first forays into the use of a community critique. Early on in our research and synthesis, we invited a handful of “experts” in infant/maternal health and community health to hear our findings. I discussed the role that race was playing in women’s experience. One of our critiquers, a white male physician from Brown University, asked me point blank:

“It sounds like you want to address racism.”

The way I heard it, it sounded less like a question, and more like an observation of the preposterous.

“I think we need to,” I said.

I felt small, then. But I’m not feeling small anymore.

Since then, studies have proven conclusively that infant mortality is a direct result of racism in this country. When I say that people are hurt regularly by racism, this is what I mean. We lose babies. And we don’t just lose them as babies, we lose them as children, young adults, adults. We lose the potential they can offer the world. Can you imagine how our communities, cities, country might be different if that creative potential was unleashed and tapped rather than lost? Can you imagine how your institution might be different? More creative? More innovative?

If we fail to create a sustaining shift, if we continue to treat DEI as a bolt-on, we’ll fail to prevent that hurt and injustice. We’ll fail to seize opportunities to make things better. For everyone. We’ll miss opportunities for innovation, and market making.

This is why BIF has taken on a series of DEI efforts — both in the projects that we take on and how we embrace it internally.

This is the first in a series of blog posts focused on how our real-world experience labs are using diversity, equity, and inclusion to design innovative new business models. Coming up next, you’ll see how we’re transforming classrooms and learning by activating teacher leaders in order to design more equitable and diverse experiences. From our Patient Experience Lab, we’ll share how “witnessing our patients,” establishes trust, and fundamentally improves health and well-being. Our Citizen Experience Lab will share how communities become stronger and more resilient through inclusion. Finally, we’ll share the courageous conversations we’re tackling internally, to ensure that our own culture and values are a reflection of sustaining the shift to DEI, knowing that what we design will be better the more diverse our designers are and our culture is.

We invite you to join these conversations, and to explore how putting DEI at the core of your business model exploration can surface opportunities for transformation.

Part 2: Finding Our Equity Why

Part 3: The Equity Opportunity in Healthcare

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Transforming the Loneliness Epidemic

Earlier this month, I kicked off our new work with Mass General Hospital’s Transformation Lab. On behalf of BIF, I couldn’t be more excited to work with such a landmark and important health care system, helping build core human-centered innovation capabilities.

With the opportunity to spend the day in Boston, I hopped on an early (early, early) train to join Design Mornings — creative morning conversations hosted by the Design Museum. The nomadic conversations are hosted by and for the design community, and topics fluctuate. The last conversation I joined focused on the design of relationships (which is killer subject if you’re designing innovative business models in health care, public service, and education).

The most recent talk was titled:

Play for All: A Boston Story

And it is a very Boston Story. The story begins with the Boston Marathon Bombing in April 2013. Martin Richards, an eight-year-old boy, was one of five who lost their lives that day. Martin’s Park is an inclusive playground, currently in development, nested outside that the Boston Children’s Museum. It will celebrate a message of peace, the mantra of a young boy — taken too soon, too needlessly, and to traumatically — by creating space for all children to play. It is a beautiful legacy.

Martin’s Park is designed as an urban playground to inspire our curiosity and exploration. What if we designed for adult’s curiosity and exploration as well? 

As I was taken through the design elements (at a high-level, at a model level, and at the site level), I was struck by the divide between children and adults. I was struck by the placement of benches (far away from the playspaces), the locus of activity (specific for children), and the opportunities for interaction (limited to play spaces). This is a space designed for children to interact, explore, and be curious, but not the adults who come with them. It invited me to consider how I use play spaces — my kids play, while I sit on a bench; I enjoy the outside but I typically devote more time to my phone than I do to my surroundings.

We answer to many masters and interests when we design, so this is not a critique of Martin’s Park, only a curiosity that the conversation inspired:

Our society is feeling so incredibly isolated and excluded that it is considered a public health issue. It is having staggering consequences on our communities, which are both fatigued and traumatized by the impact of individual disassociation and loneliness. Begging the question:

How might play spaces — which by nature are multi-generational and community placed — be designed to inspire exploration, curiosity, and interaction, and in doing so, cure the loneliness that plagues children and adult alike?


First, let’s examine the problem through two different lenses:

(1) Loneliness as a national epidemic; (2) The importance of play at all age levels.

First, attention to loneliness has been a growing area of study. Kavita Patel, in her 2016 BIF talk, points to the health care risks of loneliness — and the degree to which it is a growing epidemic. In their 2010 Loneliness Study, the AARP reports that 42.6 million American adults over the age of 45 suffered from chronic loneliness — making them at greater risk for heart attacks and making them less able to manage and cope with everyday illnesses. By 2012, that number was estimated to be between 25–45% of the US population. Further, increasingly people are becoming more isolated — marriage rates are down, children per household rates are down, 25% of the American population lives alone, and as our population ages, it becomes increasingly more isolated. In Britain, the epidemic is growing so systemic that they’ve appointed a Minister of Loneliness within the government.

Many studies point to the impact:

  • Infants in custodial care with little human contact fail to thrive and will often die
  • People who feel socially connected are 50% less likely than their lonely counterparts to suffer from premature death
  • Recent studies of middle-aged men point to loneliness as the leading cause of death — greater than heart failure or smoking.

In short, the body of a lonely person is emotionally and physically different than that of a non-lonely person.

Earlier this fall, I stumbled upon this blog post by Charlie Hoehn which connected the dots between the loneliness, play, and mass violence happening in the US. This really stood out to me:

The irony is that loneliness would not be a problem if we all got ample time to play. Not only would we have deeper friendships, we’d also have better relationships with ourselves. Play allows us to enjoy our own company.

There is a strong correlation with play deprivation and mental illness.

When you deprive mammals of play, it leads to chronic depression. When you deprive a human child of play, their mental and emotional health deteriorate. Play suppression has enormous health consequences.


Not surprisingly, play is a regular act and theme at BIF’s Collaborative Innovation Summit.

I had become interested in play when my partner — who designs play spaces — introduced me to some fascinating documentaries and books on the subject. Play then became an area of study as I worked on my thesis, and I explored how the tenets of play contributed to collaborative innovation. One those tenets underscored the difference between play and games.

In games, there are rules and an outcome. Play is more open-ended — driven by curiosity, exploration, and possibility. It is the difference between kids meeting in the street and figuring out how to make use of a random material (empty cans come to mind), and kids meeting for a pick-up game of basketball. Both are important, but the outcome is different. The outcome of play is invariably innovation. The outcome of a game is a winner and a loser. They serve different purposes, but play offers us the opportunity to co-create something new. In his BIF-9 talk, Carl Stormer talked about improvisation through play as the peaceful passing of power in service of creation and transformation.

I can’t imagine a more valuable process for EVERYONE to participate in.


Playspaces are inherently multi-generational. Kids don’t bring themselves to play spaces. They come with caregivers. Parents. Grandparents. Aunties. Nannies. Friends. I love that we design play spaces, and Martin’s park included, for inclusion. We’re designing for most of the right things: social/emotional, physical, sensory, cognitive, and communication needs of diverse children. And in doing so, we’re bringing diverse kids together.


I do believe we’ve missed an opportunity to design for these needs across generations. Playspaces are as ubiquitous as the humans who occupy them.

Why not use this capacity to meet the same unmet needs of our increasingly lonely adult population?

How might play spaces become the civic spaces that bring diverse people together, encourage connection, and shared experiences? What might this mean for healing the loneliness epidemic that alienates us from ourselves?

At BIF, we see firsthand how innovation comes from #RCUS — the random collisions of unusual suspects. We know that magic happens when we get out of our swim lanes and bump into others. Stories are shared, dots are connected, innovation is inspired. We feel braver because we realize we’re not alone, that there are others out there who are hungry for the same things we are.

This is as true for our citizens as it is for our corporate leaders. For corporate leaders, BIF create spaces (i.e. Labs) for next practices and new model development. By design, they bring diverse people together to play with capabilities in new and different ways. How might play spaces become the equivalent for communities? How might conversations on the playground serve as a catalyst for transformation — at the individual, family, and community level?

I, for one, would like to explore what this looks like in the real world. Who is up to a play date?

Is Your CEO Serious About Innovation?

I used to think that if I just yakked long and loud enough, I could convince CEOs to embrace transformational innovation.

It took me 25 years as a road warrior consultant, author, and accidental government bureaucrat to realize that proselytizing doesn’t work. If leaders don’t want to change, all the consulting jargon and fancy PowerPoints in the world won’t convince them to.

In those situations, no matter what lofty rhetoric the CEO uses in public or at company retreats about “creating an innovation culture” and encouraging everyone to think outside of the box, the best result you can hope for are incremental innovations to improve the performance of today’s business model. You never get transformational new business models — and you always get frustrated if you were hoping for bolder change. If you want transformational innovation, you have to find leaders who want transformational change and are receptive to organizing differently for tweaks than for transformation. After learning this lesson the hard way over many years, I no longer try to convince CEOs who don’t want to change and instead try to find those CEO’s who do.

Here’s my list of 10 questions you can ask a CEO to tell if they are really serious about transformational innovation:

  1. Do you agree transformational innovation goes beyond breakthrough products to include business model innovation — entirely new ways to create, deliver and capture value?
  2. Will your employees tell me that failure is a career-limiting move, or that the company celebrates experimentation?
  3. How much time do you spend strengthening and protecting the current business model, versus designing the next one?
  4. Do you have clear and discrete objectives for both incremental and transformational innovation? Do you organize differently for each?
  5. Does your organization invest in R&D for new business models as it does for new products, services, and technologies?
  6. Are you prepared to have your organization disrupt itself? How do you see that playing out?
  7. Do internal ideas and projects that threaten to cannibalize the current business model get squashed — or nurtured?
  8. Do you have a process for allocating resources for transformational innovation projects that lie outside of the control of business units?
  9. Do executives with responsibility for exploring transformational business models report to you, or to another line executive responsible for today’s business?
  10. Are you willing to create a sandbox to explore transformational business models? Would you carve out a part of your current business/market to serve as an ongoing real-world innovation lab?

A few words of advice about using these questions in the real world: tread lightly, since no CEO likes to be put on the spot and drilled with a laundry list of questions. Pick a few of the ten to put into your own words to help you discern whether the company you work for or are thinking about working for (or with), has a leader who shares your appetite for transformational innovation. Better to know what kind of environment you’re going into in advance than to learn painful lessons later.

Community Supported Health

With the growing demand and availability of digital and telehealth services and the proliferation of holistic medicine, much of what we used to define as medicine occurs outside of the medical environment.

The points and models of care must change. No longer is health confined to the doctor’s office or the hospital emergency room.  As the industry moves away from medicalized care and towards personalized care, we are asking people to take increased ownership of their own health, but are we giving them the necessary tools to do this?

Addressing the upstream social determinants that undermine and affect personal and community health such as environment, access, and income is essential, yet it overlooks a fundamental truth about many health conditions: they are driven and sustained by personal behaviors.

Eating healthier, being more active, and reducing your stress are all often ‘prescribed’ behaviors, but these prescriptions don’t come in a bottle or from a pharmacy. They must be personally directed and pursued. How do we ensure that individuals and families are supported and empowered to make the necessary changes to their own behaviors? A few months ago, I was given the opportunity to visit an organization eagerly tackling that question.

Open Source Wellness, based in Oakland, CA, combines an overwhelmingly welcoming space with the behavioral coaching and support needed to improve overall health and wellbeing. They term themselves a ‘behavioral pharmacy,’ a place that enables individuals to easily and joyfully comply with the often vague ‘behavioral prescriptions’ given by their doctors.

The program works by creating a culture where health is powered by connection and community support. They focus on four discrete yet uniquely connected areas:

Move (physical activity), Nourish (healthy eating), Connect (social support), Be (stress reduction)

A members group is decided based on a one-to-one personal assessment of needs and goals. The participants and coaches take part in fun and enjoyable moments of activity and play, share a healthy meal and then move into smaller cohorts focused on individual goals and priorities.

Open Source Wellness is redefining the model of how we engage with and deliver whole-person, holistic, behavior-centric care. They are leveraging the powers of community and belonging to create a sense of agency for their members. Members leave with the tools they need to embark on their own wellness journeys and return week after week feeling supported, powerful, and healthy.

As new models of care emerge, we are reminded that while access and quality will always be at the forefront of healthcare, they are not the only things that matter for a person’s health. At the Business Innovation Factory, we believe in models that are human (patient, student, or citizen) centered, and in models that create and capture value from the whole person.

Open Source Wellness is one of those models; an organization determined to see every patient as a whole person, and address individual needs in a human-centered way. Every meeting starts and ends with a moment of energized connection; a tangible sense of support and community (oh, and there’s chocolate!).

Learn more about Open Source Wellness by clicking here.

BIF Welcomes, CVS Health, and URI College of Business Administration as Members!, CVS Health, and the University of Rhode Island College of Business Administration will be able to engage with a vast network of institutional business model innovators, taking advantage of opportunities to connect leaders to a steady flow of business model design idea, practices, and tools.


If your company isn’t quite ready to take on a new business model strategy or design project, consider becoming a BIF Member or Partner. Both options offer opportunities to connect your leadership team with peers and big thinkers and introduce them to a steady flow of business model design ideas, practices, and tools.

Visit our Membership page for more information. We’d love to chat.



Stories Are Old Fashioned

The future of healthcare has to be all about technical evolution, right? Electronic medical records, predictive analytics, telehealth, blockchain — those are the driving forces of traditional innovation in the health space, and while the improvements that these advances make are unquestionable, they are also cold, unfeeling, non-human centered tweaks.

Healthcare is intrinsically human and ultimately and consistently reliant on a direct person to person contact. That absolute need for human interaction leaves even the best technological solutions lacking a certain discrete ability, namely, empathy.

In healthcare, empathy is essential. It can generate a deeper understanding of the needs of the individual and family, establish and sustain a connection between patients and providers facilitating a greater quality of care, and empower leaders and organizations to learn from their communities and work towards continuous improvement.

Here at the BIF, we believe that storytelling can be an incredibly powerful tool for building empathy. It can open people to new perspectives, create shared experiences, and promote insights and learnings. Through our work, we have seen storytelling used in three distinct ways:

  • Storytelling helps us understand.
  • Storytelling that helps us improve.
  • Storytelling that helps us inspire and engage.

Storytelling helps us understand the job to be done.

Every business model is designed to create, deliver, and capture value for the customer. Healthcare is no different, with the slight exception that each customer, each individual, each patient is seeking their own unique value. When we start with a patient story, we can gain a deeper understanding of the needs of that patient, and a better understanding of a patient’s needs allows an organization to serve them better.

When HopeLab, a Social Innovation Company based in San Francisco, CA was searching for ways to improve the experience of children with cancer, they chose to listen to their patient’s stories. What they found was that the patients feared the treatment just as much as they feared the disease. This enabled HopeLab to focus on a gamified treatment that removed the fear. By devoting time to listen to their patient’s stories, HopeLab was able to increase treatment compliance, produce better clinical outcomes and improve the patient experience.

Storytelling helps us to continually improve patient care

Traditional healthcare can be impersonal, to put it lightly; twenty minutes in the waiting room followed by a few deep breaths, a cold stethoscope, a barrage of ubiquitous questions, and you’re done. When we allow a provider or caregiver a glimpse into the life of the patient and their family, you create a shared experience that fosters empathy and makes healthcare personal again.

At Yale-New Haven Hospital, patients and families are encouraged to create a communication board inside the patient’s room. These boards depict the lives of the patient outside of the hospital; their likes, dislikes, and interests. This information may seem trivial but it could provide clues to environmental conditions, lifestyle factors, socioeconomic status or behaviors that can affect patient health.

Storytelling helps us learn and change.

In an age where everything is measured and metrics reign supreme, it is important to remain that context is still king. So much of our healthcare system is reliant on data that we have come to believe that that same data will drive us to improve and innovate. However, data is more powerful when it is presented with a story (i.e. 200 unique admissions to the zoo vs. the story of Fiona at the Cincinnati Zoo). Persuasion based on data will lead organizations toward incremental quality improvement tweaks. Inspiration to transform relies on story.

Throughout Adventist Health System, storytelling is used to promote cases of exceptional care as examples of what patient care should look like at all levels of the organization. These stories are highlighted by leadership through a series of ‘mission moments’. The organizations have adopted storytelling as a strategic practice that propels the mission forward.

Storytelling can help us answer the questions:

How might we gain a deeper understanding of the pain points experienced by my patients so that we can treat the whole person?

How might we help a caregiver see the patient as a person, distinct and separate from their medical condition?

How might we engage leaders in our efforts to transform healthcare and improve the patient experience?

Organizations could have this incredible tool that will capture, create, and deliver new value to their customers. Patients could feel understood at the onset of care, important during the course of their treatment, and empowered to help others with their story.

When used in harmony, organizations can explore, employ, and exploit the incredible power of narrative to create dynamic value for their consumer and improve their user experience.


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Conditions for Collaborative Innovation

In Part One of this series, I defined collaborative innovation as an imperative for the 21st Century, and yet, also a poorly understood and utilized tool. In part Two, I wanted to dig further into what it looks like, how it happens, and the conditions that support it.

The day after Christmas 2004, a 9.1 magnitude earthquake in the Indian Ocean catalyzed a tsunami that killed nearly 250,000 in 14 countries. The tsunami knocked out central infrastructure — roads, electricity, and banks. Those of us at GlobalGiving were keen to respond and started raising money quickly to help relief efforts. The challenge, however, was distribution. The logical recipient — the Red Cross — was delayed in reaching remote villages most in need. It felt inhumane to ask unknown individuals to go through the typical vetting procedures associated disbursing philanthropic dollars to nonprofits. Instead, we activated a network of entrepreneurs on the ground and turned to an underused grantmaking tool called fiscal reporting. Instead of having to find and fund only nonprofits, we were able to fund any efforts — executed by any type of organization, individual, or network — that were in the service of relief. We simply had to document fiscal expenditures; a significantly less cumbersome task. In this way, we were able to more quickly bankroll relief efforts — providing water, emergency supplies, and human resources to where they were needed most.

It is understood that 70% of health determinants are non-medical; meaning, they are the output of where we live, our education, and how we make our livings. While this has been known and understood for decades, our health care system has been unable, or unwilling, to move upstream and address the social, or non-medical determinants of health; they have continued to focus on sick care while our population gets unhealthier. Enter Children’s Health System of Texas, and Peter Roberts. Peter hired BIF to help understand what it would take to keep families healthy. The answer could be summed up by helping them improve their wellbeing. Doing this required networking with “unlikely partners” — moving Children’s Health out of the business of program delivery and into the business of brokering relationships. It required working with community organizations to change their cost and revenue structures, to be able to serve an n of 1, when they were in the business of costing services by programs. It required unleashing capabilities from their current business model in service of a new one, not for just one organization but for the many required to catalyze the prototype of a new system.

Just how many fish are there in the sea? The perspective changes based on whether you are a New England fisherman regularly catching fish in the sea or whether you are NOAA scientist worried about data pointing to dwindling supplies. The lack of shared reality makes it difficult to created shared motivation for monitoring and accounting for fish supplies. It also leads to significant tension and distrust. A tension that is only heightened when the financial and time burden of monitoring is hoisted onto the fishermen. The better way? What if we created a new value chain, using fishing vessels as platforms for shared data collection? What if we empowered and rewarded fishermen who take a greater ownership role in monitoring and accounting by collecting and owning fish and other environmental data (such as temperature, current, pollution) that can begin to build a base of knowledge about the overall health of fisheries? In this shift, we imagine a common value chain for all that can engender cooperation. A unified approach, common language, and cooperative platform with new value streams can enhance trust and foster collective action — in effect, giving separate business models a reason to cooperate as a system. This was the concept co-created by government, scientists, fishermen, and entrepreneurs.

Two successful entrepreneurs walk into a makeshift recording studio in New Haven, CT. They both have an emphasis on place-making. Barry Svigals is an architect who relies heavily on participatory design to engage people in imagining and co-creating future structures; he recently completed the design of the new Sandyhook elementary school. Ben Berkowitz is the founder of the revolutionary #civtech ‘See.Click.Fix.’ I had invited them together, to prototype a new podcast series, #RCUS, an exploration into the mechanics of Random Collisions of Unusual Suspects. Barry and Ben work 50 feet from each other; they have spoken at the same conferences; they have friends in common. They buy their coffee from the same shop. But they had never met. When they came together in a facilitated conversation, they immediately started riffing off each other — co-creating play spaces for “Make Haven,” a down space for creative construction and innovation and imagining networked community projects, combining employees and spaces to create public installations to signal the meaning and purpose of community.

Whether it is epic disasters or everyday disasters, whether it is random collisions of unusual suspects, or it is the creative resolution of fierce tensions, the answer is collaborative innovation, because it can create unparalleled opportunities to tackle complicated and complex problems at a new scale. Rather than trying to parse out the issue, tackling it piece by piece and creating point solutions, collaborative innovation enables us to think and act more systemically and imagine bigger bolder solutions.

But it is significantly harder than coming together to talk and share. Coming together to actively create and/or make requires that we have a good methodology and the right conditions. If we understand these things, we can accelerate the incidences, and therefore the impact of collaborative innovation.

It won’t come as a surprise that two of the cases described above are examples from BIF’s portfolio of projects demonstrating the power and potential of transformative innovation; nor that we understand that the same methodology that helps leaders explore and test new business models is the same methodology that helps leaders collaboratively explore and test new business models.

If a business model is a network of capabilities woven together into a sustainable delivery model, a system is a network of business models that have learned how to cooperate.

Value chains create incentives for cooperation. But what does it take to get people and institutions to explore and innovate together?

This is significantly harder. First, most leaders are so focused on scaling the existing business model that allocating time and resources to exploring new ones — and collaborative business models to boot — is best described as a distraction. Second, collaborative innovation requires a “play” mindset — one which many leaders have outgrown. A play mindset is one in which the outcome is unknown, and the purpose of engaging is curiosity and the pure joy of unbridled exploration. Third, collaborative innovation requires revealing a vulnerability in both your point of view and your position. It requires saying that our existing business model isn’t the only “right” answer, or that it isn’t “totally sufficient” for the job to be done. It requires admitting that we have a blind spot or that we need others to get to scale or deliver a value chain. This is a vulnerability that individuals and organizations hate to reveal to the public, and certainly don’t want to reveal to investors or funders. Fourth, if we’re able to get past these issues, there is the technical complexity of working together. Most importantly, we lack shared information, language, and metrics which enable us to actually play together.

When combined, these factors collude to kill collaborative innovation; leaders lack both the incentives and will for unbundling capabilities from their current delivery model in service of something new. This is why in addition to the “how” and a methodology, we need the conditions.

These conditions are infrastructure — tools, language, and techniques- that together create the alchemy of trust, play, and collaboration. And from projects like the ones above, as well as a host of others, I’ve come to understand that there are five specific elements:

Conditions for collaborative innovation

Understanding the mechanics of collaborative innovation enables us to catalyze and accelerate its emergence. What might this mean for individuals and institutions? First, and I’ll talk more about this in the third segment of this series, individuals are taking advantage of new collaborative platforms to leverage excess capacity (Gig Platforms), share knowledge and resources (Sharing Platform), leverage crowds (Crowdsourcing Platforms), and make stuff (Maker Spaces). Organizations have an unprecedented opportunity to catalyze new markets and systems, leverage their own underutilized assets (including thought capital, as well as technological and physical assets) for new revenue streams, and deploy innovation resources in entirely new ways.

In short, by creating the conditions for collaborative innovation, we are changing the innovation equation from linear to exponential.

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Introduction to Collaborative Innovation

It took me two decades of work, a marriage, a divorce, and a masters thesis to understand that I have spent much of my life curious about and actively exploring a series of interconnected and related questions, which I have adopted as my personal design challenge:

How do people self-organize in purposeful ways? How do they network their gifts and talents together to solve problems, create value, find joy, and make meaning? How do they grow and transform over time creating the evolutionary transitions that we understand as progress?

More importantly, I have come to understand that we have a new imperative to understand the mechanics of these processes, such that we can mimic them to accelerate the pace of change.

I call this the collaborative innovation imperative.

And it is the imperative of the 21st century.

This is a story in three parts. Here, I explore why the innovation of the 21st century must be collaborative. I’ll explore how we understand, and fail to understand collaboration and innovation. In Part II, I’ll share the findings over years of exploration — what are the conditions that enable people to come together and strive together. Beyond colliding with unusual suspects, how do you organize together? How do you find new ways to create value together? What is the supporting infrastructure that can mimic and accelerate this process? I’ll share finding from years of learning and doing — academic exploration and real-world prototypes. Finally, in Part III, I’ll talk about platforms for collaborative innovation — what exists today and what is missing in the market.

There is a simple reason that collaborative innovation is the 21st century imperative:

Our world is increasingly complex and interconnected. The world’s problems follow suit. Accordingly, our approach to solution designs needs to be as well. It is that simple. But we keep trying incremental approaches and point solutions, and we keep being disappointed.

Let’s take any issue — starting with health. I don’t want to start with “health care” because “health care” has become the industrial solution to “health.” Health is made up of our physical and mental well-being. It can be managed and nurtured in a variety of ways that work across daily habits and routines, surrounding environments, relationships, spiritual practice, etc. But that’s not what the industrial solution looks like — it looks like sick care, a point solution that treats the physical ailments of the body. The system that supports it is organized around the goal of sick care.

If we can do that, we can also organize around the concept of “health” — a concept that BIF’s Patient Experience Lab has proven in the market a couple of times. Yet for some reason, that approach is often touted as “too complicated.”

Unfortunately, while collaborative innovation is the imperative of the 21st century, the phrase also contains two words central to a game of Buzz Word Bingo in almost any environment. Both are so overused that many audiences have demanded that we create new words. We want collaborative work environments, collaborative learning, and even collaborative consumption. Everything is innovative — from chairs to the new lunch menu at Applebees.

So then, what is collaborative innovation?
Collaborative innovation is the answer to a job to be done. But more often then not, it’s the answer to the wrong job. When people say they want collaboration, what they are really saying is that they don’t want to go it alone; they want to think out loud, or they want validation of an idea to lower the cost of failure. Collaborative innovation then becomes a pacifier to the lonely innovator — the person on the bleeding, painful, crazy edge of what is possible.

I think this is important — we all get better faster by thinking together — but it limits the real frontier and potential of collaboration, and doesn’t necessarily lead to innovation, which we define as actually creating value for people in new ways.

The real frontier is when we start acting together — by making and creating. Here, we can collaborate to design concepts, to prototype concepts, and to scale/commercialize concepts. We work collaboratively because we can’t get there alone.

Here’s why.
We all have our own blind spots. We operate through lenses and models that create efficiencies, but they also serve as constraints or blinders. The value of random collisions is that when we combine our collective lenses, we can see the opportunities in our blind spots. We can find opportunities at the edge of our own visibility. We can create wholly new opportunities in our opposing viewpoints and models through the creative resolution of our tensions. In this sense, our perspectives, experiences, and lenses are ingredients that we can combine in new and different ways to collaboratively innovate together.

Second, we collaborate to prototype together because just like the ideation phase — we need to combine and recombine capabilities in order to create a tangible concept that people can experience. It is unlikely that we have all the capabilities we need, and we need to borrow them from others. In my experience, organizations have 65–70% of the capabilities in-house for prototyping new models, and everything else needs to be cobbled together in other ways.

Finally, similar to the prototyping phase, commercialization requires new value chains at scale. Collaborative innovation in the commercialization phase enables us to create gravity, organize the supply chain, and catalyze the network effect to go to market successfully.

All of this is easy to explain on the whiteboard.

In the real world, the challenge, and opportunity, for all of this, is that it requires more than coming together — it requires trust, alchemy, and infrastructure.

It requires the “right” conditions.


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Escape Boring Learning

You are trapped in a room and you have only two ways to get free: solve a series of problems or wait until the bell rings signaling your freedom leave. Am I talking about a traditional classroom or an escape room?

Many students feel trapped in classrooms where boredom persists — they are being lectured at, asked to memorize information, and to regurgitate it on standardized assessments. Sixty percent of students who consider dropping out report that it is because they don’t see the value in the work they are doing. Student motivation has been a topic of studies and school reform efforts for decades, yet there have been little disruptive system-wide changes in instruction or assessment to increase student engagement.

According to a study done in 2003 by the Center on Education Policy at George Washington University, students are more motivated when one to all of these conditions are met:

  • They feel competent and able to complete an assignment or challenge
  • They understand the relevance of their work
  • They are rewarded for completing the task either socially or academically
  • They understand the cause and effect nature of the work — their actions contribute to an outcome that is predictable.

Here in the Student Experience Lab, we have been on a mission to escape from standard curriculum and assessments and escape into Deeper Learning (DL). Deeper Learning can be a solution for student and educator disengagement. It is defined by the Hewlett Foundation as a set of six interrelated competencies: mastering rigorous academic content, learning how to think critically and solve problems, working collaboratively, communicating effectively, directing one’s own learning, and developing an academic mindset — a belief in one’s ability to grow. Walk into any school committed to deeper learning and you will likely see students excitedly working together on projects, collaborating with their communities, igniting their passions, and guiding their own learning.

Why Escape Rooms?

Escape rooms are an immersive entertainment phenomenon that has sparked a booming new industry all across the country. Escape rooms are live-action adventure games where players solve a set of puzzles, problems, and tasks in order to find a way out. Players have to race against the clock to find hidden clues and uncover the story of the room. Good escape rooms:

  • have a compelling narrative — like searching for a gold prospector’s stash.
  • engage multiple senses — like smelling different ‘wines’ to know which bottle has the right clue or listening to different notes to create a musical masterpiece.
  • are filled with delightful surprises — like trap doors that lead to extra rooms, or secret messages revealed under a blacklight.
  • tap into individual abilities and group collaboration — such as having one person call out instructions and that others execute, or having a puzzle that taps into math, science, or music skills.

Since we are always looking to find exciting, relevant connections from ‘non-school experiences’ we have been exploring how escape rooms offer an opportunity to dive into Deeper Learning and explore its competencies. In the classroom, engaging escape room experiences have everything listed above plus content specific elements that bring learning to life.

Our team went to Austin to challenge SXSWedu participants to escape boring learning with us. In a jam-packed day, we took a trip to an escape room with 25 teachers who all had to escape by solving puzzles within 60 minutes. We then took a trip to a collaborative working space to debrief the experience and assess our learning. After debriefing what made the escape room so engaging, and analyzing how we might hack it for educational purposes. Then it was time to try those ideas out and create puzzle rooms for the rest of the SXSWedu attendees in hopes that it would inspire them to recreate similar experiences in their classrooms. At the end of the day, more than 100 teachers went through the three escape rooms that participants created and debriefed their experiences using a Deeper Learning rubric that helps assess which Deeper Learning competencies participants were using while in the escape room.

So how can you continue to escape boring learning?

  • Take advantage of our open source Deeper Learning Escape Room toolkit — co-created with teachers and students this document contains analysis, insights, and ideas for the creation and implementation of an escape room at your school.
  • Get a window into our experience at SXSWedu by watching the video below
  • If you like what you see, vote for the next stage of our work — DeeperLearning Escape Pods — to be showcased at SXSWedu.

Let us know how you plan to escape boring learning at your school, email me at!

The Fourth Pillar of Transforming our Health System

Traditional models of reform have focused on the three conventional pillars of health care: cost, access, and efficiency. Though these pillars functioned as the foundation of the ACA, we still have yet to resolve the underlying pain points that continue to resonant across the country, seven years’ post-ACA implementation.

A study commissioned by the Robert Wood Johnson Foundation, National Public Radio, and the Harvard T.H. Chan School of Public Health tells us:

  • 61% of adults would rate the nation’s healthcare system fair or poor
  • 45% of adults have seen the cost of their health insurance premium rise over the last two years

Just over two weeks ago, a resounding thumb down from Senior Arizona Senator John McCain spelled the latest failed attempt at the repeal and replacement of Obamacare (The Affordable Care Act, or ACA).

Much like our health system, our political system acts more stubborn than transformational, clinging to the comfort of the familiar, rather than forging toward the true change of disruptive innovation and there is no telling what leaders of either system are going to do next.

As uncertainty around current market stabilization continues, political leaders in Washington are moving on and healthcare leaders across the country are hedging their bets and limiting their risk — all to the detriments of the individuals and families that rely on the American health system.

When marooned in a sea of uncertainty, our health and political leaders struggle to explore, prototype, and test new models that yield significant and lasting change and resign themselves to conventional, albeit broken models.

Today, we have a health system that is not valuable to individuals and families. Their needs are not prioritized or solved for, often leaving many unable to access, obtain, or afford needed medical care. This oversight sustains the current model, overlooking the necessary addition of a fourth pillar to transform our health system; the experience and needs of individuals and families.

We need a new way of delivering a valuable health experience in this country.


This new way requires that we design a health system (inclusive of wellness and care models in addition to insurance and payment models) that delivers on two different value propositions: one that offers equity, access, and affordability to consumers, and one that offers efficiency, cost-reductions, and predictability to payers and providers.

What do we do when our healthcare system is overshadowed by our health insurance system? We design for the one thing they have in common: the patient. This requires leaders to step away from the conventional mindset, and get out of the mental valley that accepts the present system as gospel and attempts only to make tweaks around the edges.

Here in the Patient Experience Lab (PXL) at Business Innovation Factory (BIF), we believe that by placing individuals and families at the center of their own experience, we transform the health system in a more inclusive way. We use a human-centered design-driven methodology, making it easier and safer for institutions and organizations across the health system to transform the ways that they create, capture, and deliver value to the individuals, families, and communities they serve.

We start by shifting the focus of institutional leaders away from the traditional three pillars of healthcare (cost, access, and efficiency) to design a system informed by the experience and needs of individuals and families: the fourth pillar of our health system. With this fourth pillar, a new set of questions and challenges emerge loud and clear; questions that we have been asking throughout our work here at BIF.


How might we shift the current experience of health and wellness to be one that is understood and claimed by families and children, rather than simply available to them?

How might we better understand what contributes to poor health outcomes and lack of engagement in a personal health and wellness journey?

How might we promote effective cross-sector partnerships and models between clinical and nonclinical entities in service of whole person health?

When we co-design the care and cost models that make up our health system using insights from institutional leaders, politicians, clinicians, insurance companies and patients, we create a holistic system that adds value and improves the health and wellness experience for individuals and families. Using a human-centered design approach ensures that the fourth pillar of care is first understood and then built-in as a central component. By designing with the consumer and not for them, we can create a more stable system that delivers new and sustainable value.

To do this, institutions and leaders across the health ecosystem must be willing to prototype and test new models and next practices that incorporate this fourth pillar of care. When the voice of individuals and families is incorporated from the start, meaningful models and strategies for health will be formed to create, capture and deliver new value across all pillars at scale.

At the core, BIF’s methodology serves as a roadmap for leaders who are ready to integrate the fourth pillar to transform our health system; challenging not only themselves but the entire health ecosystem to co-design a better way to deliver health across this country by leveraging the experiences of those it serves.

The Affordable Housing Crisis

The United States is facing an affordable housing crisis in almost every county, and it is only getting worse. Attempts to remedy the problem are proving too narrow, which means it may be time to re-frame the issue. We believe it is critical that we seek more comprehensive solutions based on a systematic analysis of citizen experience, and to create new models for addressing this crisis better aligned to the realities and needs of those facing it.

As a recent CityLab article reports, “nationwide, only 21 units are available per 100 extremely low-income renter households (those earning below 30 percent of the area median income) without government assistance. With assistance, it’s 46.” The US Department of Housing and Urban Development (HUD) reports that “families who pay more than 30 percent of their income for housing are considered cost burdened and may have difficulty affording necessities such as food, clothing, transportation and medical care.” Prioritizing any of these other necessities over housing could then leave them at imminent risk for homelessness.

Currently, there are:

·       An estimated 12 million renter and homeowner households who spend more than 50% of their annual incomes on housing.

·       Over 1 million people served by HUD through emergency, transitional, and permanent housing programs a year.

·       About half a million citizens who experience homelessness in the US on any given night; a number that could rise as high as 2 million over the course of a year.

This is a crisis that directly impacts millions of US citizens, and indirectly affects millions more. But what is causing it?

A recent Urban Institute report attributes the affordable housing crisis to two factors — rising rent prices and rising demand for affordable housing since 2000, as a greater number of people seek to rent. The struggle to find an affordable place to live is gravest in urban areas, where levels of homelessness are consequently highest. In some cities, buildings offering affordable housing have waiting lists in the hundreds before construction is even complete.

There is a crisis to be found here, for sure, but are we framing its solution all wrong?

Many reports would lead us to believe that the housing crisis is merely a supply-side issue — that there is simply not enough affordable housing to go around. However, other statistics like rising rates of inequality and stagnant wages in the US suggest that there might be other factors at play. In forging solutions, it is vital to ask the individuals, couples and families affected by the crisis more about their experiences, as there is always more to their stories than siloed numbers and isolated stats. What institutional leaders aspiring to holistically address this crisis really need to do is to shift their perspectives for solving the problem, to view it not only through segmented data and reports, but across sectors and from the lens of those actually struggling to make ends meet and tasked with the ever-growing challenge of finding and maintaining a sustainably affordable place to live.

Here at the BIF, we work towards systems-level change because we know that point solutions, such as increasing the supply of housing, are not enough. Throwing more housing options at a low-income community facing an affordable housing shortage might seem like an easy fix, but it doesn’t get at the complexity of the problem — such as deeper-seeded factors that may limit income, to begin with, or pose barriers to access. It won’t tackle the root causes of the problem.

BIF's Design Methodology

In order to effect systems-level change, we need next practices and agile new business models that we can network together across silos and sectors in a way that can shift and adapt to ever-changing contexts. In our messy, volatile world, the conditions that lead to pressures on housing and other basic needs are ever evolving and we need networks of public service models that can also evolve and shift to continue meeting the changing needs of citizens, and the myriad challenges they face, over time.

We need flexibleadaptable, and agile public services, truly designed to meet citizens where they are and when they need them — whether confronting homelessness or any other calamity, ideally well before a crisis takes hold in a way similar to how the affordable housing shortage has imperiled American citizens nationwide.

Citizens in need are waiting, and we can surely do better if we take the time to co-create new models, based on human experience, together!

Before Social Impact Bonds: Build A Next Practice Lab

It is funny to feel old enough to say I am a veteran of anything. But in this case, it just might be true:

I am a veteran of the rise, growth, and scale of creative social finance tools. 

And I can say with good confidence that public service leaders shouldn’t be talking about social impact bonds unless they have a Next Practice Lab to (1) explore holistic solutions to issues, and (2) keep funded solutions current, desirable, and viable.  

First, A little History

Social finance refers to the tools that have been applied to how we finance the development, scale, and spread of business models that address social needs, e.g. food scarcity, electricity for the rural poor, early childhood development.

Social finance began with the early days of organized philanthropy and the emergence of foundations. This was just post-World War II, and funding from foundations served as the R&D arm for social services. Those services that proved successful would be adopted and scaled by the government.

Over time, this value chain got diluted. Foundations started generating their own theories of change; funded more than R&D — including organizational capacity and going to scale. Government funding for social services changed as well, often driven by changes in political power and support for public welfare. And of course, social services changed — both becoming more independent from government and often more systemic in nature — seeking to address the root of the issue in addition to presenting symptoms.

Fast forward to the 1980s and the emergence of social entrepreneurship. Social entrepreneurship catalyzed three changes to the landscape:

  1. A bias for transformative innovation — the belief, mindset, and entrepreneurial drive to solve problems in wholly different ways; and
  2. An emphasis on creative revenue models — primarily earned income — to enable flexibility, independence, and sustainability of this “innovation.”
  3. An imperative to “invest” in social change, and the corresponding emergence of a social financial ecosystem.

Firms, like Ashoka, grew to support early-stage ventures. Impact investors, like Acumen Fund, started putting “patient” capital into later stage ventures to help them scale. Social investors started divesting from traditional investments with a straightforward financial return, into portfolios, like State Street, that could measure/report on double, triple, and quadruple bottom lines. Crowdfunding platforms, like GlobalGiving, cropped up, creating new purposeful and lucrative relationships of donors and social change agents.

As the ecosystem developed, social impact bonds — or “pay for success” — emerged on the horizon, promising to replace antiquated models with less expensive, higher impact solutions; these new models would be financed by the savings realized by making the transition to a faster better model, i.e. the “bond.”

But before public service leaders go gaga over the promise of social impact bonds, it is important that they first establish a Next Practice Lab.

Here is why:

We Need Better Models

If you take any expensive, messy issue in the United States — from incarceration to affordable housing, you will find this commonality:

They are complex and interconnected.

Public service leaders struggle to work in this complexity. In their struggle, they silo and narrow problems, shrinking them into manageable “point” solutions or “tweaks.”

Hence, when we consider issuing a social impact bond to finance the scale of a less expensive solution to the status quo, we get scaled solutions that are only relative to how we currently understand the problem. Meaning, if you frame the problem as incarceration, you get a less expensive, more effective solution to dealing with people in the prison system.

However, there are opportunities when we work in the messiness of an issue, and when we can frame it in new and different ways.

For example, what if we had a framework for understanding the supply AND demand side of incarceration? What if we had a framework that helped us explore next practices for addressing systemic racism amongst police ranks or the impact of chronically homeless youth (forces of supply)? What if we had a framework that helped us explore next practices for addressing the “pull” of poverty that creates demand for prison systems in communities? What if we have a framework for exploring next practices that span both sides of the equation?

Human-centered design, the core of BIF’s methodology, helps leaders shift how they understand a problem, see interconnections, and better frame wholistic solutions. That is one benefit to a Next Practice Lab; it can generate more holistic models that can be scaled by social impact bonds, getting more bang for the taxpayer buck.

The Half-Life of Scalable Models is Getting Shorter

The other thing to consider is the problem with long-term financing of long-term solutions. Does this really work anymore?

The truth is that models don’t stay relevant for very long. The needs of the market (or the job that consumers, citizens, etc., need us to do) change regularly. Public services that are committed to a single model fail to keep up with the changing needs of users, in fact, because they are too focused on executing their existing model. Further, they are at risk of being disrupted by organizations who can more nimbly and more flexibly address the dynamic needs of customers.

Solutions become antiquated very quickly. This is the challenge with “best” practices versus “next” practices. Because of the changing needs of users, we will always need a “next” model to implement and scale. Is issuing a bond to finance the scale of a solution that might be outdated in a few years worth it?

What if there was an “and”? Meaning, what if public leaders could scale a model, and allow it to get better on an ongoing basis? This is the second benefit of a Next Practice Lab; it can help inform models, develop learnings that kept them relevant and evolving, generating a better, longer-term ROI.

It’s not that I believe problems are too complex or too much of a moving target to address. It is that I believe public service leaders would have a better impact if they nest a Next Practice Lab alongside social impact bonds in order to inform, instruct, and adjust the portfolio of investments funded by social impact bonds.

Next Practice Lab

Human-centered design helps leaders shift how they see and frame a problem — helping them design more holistic models for creating and delivering value while capturing better returns for the taxpayer. These are next practices, and a lab delivers the capacity to manage a portfolio of next practices on an ongoing basis. These next practices can help leaders identify new business models to scale through social impact bonds or they can be in service of a funded model — helping it develop new capabilities and adjust to changing environments.

The benefits to public service leaders are that (1) it reduces the risk of issuing a social impact bond and (2) it extends the shelf life and ROI of funded models.

The benefits to citizens? More holistic solutions to the problems we actually experience, at a lower cost, and longer timeframe. I’d sign up for that.


Transforming Communities from the Ground Up

“Everything grows from the ground up,” said Angela Blanchard, President and CEO of BakerRipley, in a recent Business Model Sandbox Podcast with our Chief Catalyst, Saul Kaplan.

As one of the largest community development corporations in Houston and the US, BakerRipley employs a human-centered approach to community transformation that today serves over half a million people. Angela emphasizes the need for “appreciative inquiry” and the holistic integration of services when it comes to community work, and isn’t going to wait until government figures out how to provide for communities before identifying what neighborhoods and their residents already have to work with.

BIF is delighted to welcome Angela to our Board of Directors, and thankful for the following insights shared during her recent interview with Saul. They resonate particularly well with us here in BIF’s Citizen Experience Lab, as they are truly demonstrative of what it means to be “citizen-centered” in the work that we do.

Everything Grows from the Ground Up

In the podcast, Angela revealed that she is an avid gardener and enjoys working in the soil. Like the plants she spends time cultivating, community work, she recognizes, won’t take off unless you start on the ground. You have to get to know the community with which you are working, the people that live there, and what their aspirations are before you can begin any sort of sustainable work in community transformation, and we feel similarly here at the BIF. That’s why the first stage of any human-centered work is the participatory analysis element, in which our designers, working with our clients, take some quality time to really get to know the users of the systems we seek to re-create. “Everything grows from the ground up” functions as an excellent reminder that our work must always be grounded in a strong intimacy with the community members, patients, students, and in the CXL, citizens that we seek to serve if we can reasonably expect those systems to grow and thrive.

Work with What You’ve Got – And Build

Angela recognizes that approaches to community development typically fixate on problems. Practitioners attempt to offer technical solutions to ‘broken neighborhoods,’ ‘broken communities,’ and ‘broken families’ that fall short of affecting any holistic change. This deficits approach to community development, she claims, is not working. Rather, BakerRipley engages communities through the lens of “appreciative inquiry” and “appreciative community building,” which draws upon existing community assets and provides for self-determined change. Here at BIF, we know it is important to consider and leverage the existing capabilities of any organization when seeking transformation through business model innovation — to identify and work with what you already have. Recognizing what you have to work with and moving forward with that is the first step towards change, and Angela is a person who doesn’t like to waste any time waiting around for government or “someone somewhere else to figure things out” to start making a difference. Like us, she operates with a bias for action.

Another good reminder from Angela is that you can’t help those who haven’t asked for help; this most often results in agenda-pushing, amounting to what she referred to as appropriation or even “colonization.” This is especially important when working with communities that have been marginalized or disenfranchised because otherwise, you’re just another group forcing your own agenda onto them. Angela recognizes that BakerRipley’s role in these neighborhoods is one of an ‘enabler.’ They enable change and transformation founded on the goals and aspirations they hear on the ground, using the strengths and assets of the community to build upon, and thus facilitate change by enabling the agency of the folks who have asked BakerRipley to assist them.

This is hugely important for not only community buy-in of projects, but to work on projects identified and driven by the very community they seek to help — because you can’t help people if you’re not giving them what they need or want. Only in this way can their work be truly community-centered, and the same is true of any work that aims to transform and improve the citizen experience in a genuinely human and user-centered way. The point could even be taken to considering our own BIF CXL clients — you can’t help a public service transform if its leaders aren’t open to trying a more human-centered approach. You can’t force innovation onto someone unless they’re already open to it.

Community First

By being rooted in the community experience, open to trying a variety of new and different models, and committed to community transformation that works for community members, BakerRipley is an example for what government social services could be. With a holistic, un-siloed approach to integrated services based upon what the communities in the neighborhoods where they work really want and need, BakerRipley delivers tremendous value to hundreds of thousands of people — succeeding at great scale. The work of the organization that Angela leads is rooted in the assets and aspirations of community members, which has proven extraordinarily effective. And its agile and bold ability to test, try, fail, and try again makes for ample learning and quicker success. The work of BakerRipley is truly a model for effective, human-centered transformation, and the organization has hundreds of thousands of success stories to share to back that up.

Cooking with Heat

I watch a lot of competition cooking shows — to the point where I feel like I have an intimate understanding of knife cuts, reductions, and how to confit duck. Without any formal education and very little dedicated practice, I yell at my computer screen and judge contestants from afar knowing that I would be able to handle the pressure if I were in the kitchen. You see many folks like me appearing on these shows and getting hit with a strong dose of reality when they did not have the skills they needed to create beautiful, thoughtful, and — most importantly — delicious meals in that environment. And those with experience, judges and other contestants, will usually call them out for it or will pointedly glance.

What happens when the stakes are higher than a cooking show? What happens when power and responsibility are put into the hands of those without experience or knowledge of an environment?

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Teachers and students are at the heart of our education system but are often overlooked when brainstorming how education should be transformed. Most are never asked their opinions on how to improve different environments — from their classroom to district to national oversight. Similar to my yelling at chefs through my screen, decisions and priorities within education are decided by those who are watching, rather than those who are closest to it. Even more disconcerting is that individuals watching often have the power to set standards and judge progress.

You can not create successful, equitable solutions unless you are proximate. You can not cook without heat.

The work to be done is both complex and simple: let educators and students design and lead the future models of education. The Student Experience Lab (SXL) operates from a lens informed by what educators and students care about. We are excited that the folks at Teacher2Teacher have also been researching and mobilizing around similar themes. Recently they hosted a webinar entitled “What Teachers Care About” that explored which narratives matter to teachers (measured through online platforms) and how those of us who design with educators can leverage different topics to foster connection and learning for all.

The presenters talked about both positive narratives that reflect optimism and confidence and negative narratives that reflect concern about future direction. In 2014, teacher narratives were 54% negative, with top concerns being that teachers deserve professional respect, need opportunities to learn, and must focus on teaching the whole child.

Since then, narratives have shifted towards a more positive, hopeful language. Integral to this shift has been the presence of social justice focused narratives — specifically those surrounding racial and socioeconomic equity. Educators have explicitly named poverty, racial biases, structural influences, representative staff, and many more examples, as influential issues that need to be tackled. They have also been telling us that education is a right and that all students deserve both access and success within the education system.

So how do we get the experienced cooks in the kitchen to design thoughtful and lasting solutions? How do we make sure that educators and students close to issues surrounding equity have the power to create change?

Unlike a fancy competition kitchen, we have all had access to education from some angle — student, teacher, parent, etc. Unfortunately, a lot of folks in education are cooking without heat: they are not close to the environment, they aren’t focused on equity, and they are not listening to what students and teachers need.

Right now, and hopefully forever, many educators are hungry for resources that bring equity out of a solely learning space and into their practice. We believe that the work we are doing with our Teachers For Equity (T4E) Fellowship will begin to bridge those worlds in a meaningful way.

On an unseasonably warm weekend in February, BIF hosted 20 teacher leaders, one district leader, and our partner Pacific Educational Group. We took a deep dive into exploring racial equity, ourselves, PEG’s courageous conversations protocol, design thinking, and building communities of practice. The T4E Fellows will lead communities of practice that can include students, teachers, community members, administrators, and anyone else with a stake in creating equitable educational environments in their regions.

“Everything we need is in the room” -Leidene, PEG Equity Transformation Specialist, validating how much knowledge and experience we have to share with one another.

In the first few months of the fellowship, not only have these educators told us what they care about, but they have also shown us. These fellows have the will to engage topics of racial equity, understand their environments, and are prepared to cultivate communities that can create stronger, more supportive educational spaces. They have also shared stories with one another about successes and missteps as they build up equitable practices. The range of experience, both in teaching and life, has created a community where we all are empowered to teach and learn from one another.

Although they are experts in their experiences, the T4E Fellows have started by expanding their understanding of others in their environments. They have initiated conversations with both those who will inform their communities of practice work and those who will be active participants in it. They have already taken what they have learned and found ways to apply it to their leadership. One fellow has proposed that a good way to kick off their community would be by sharing those research conversation findings so that the group is informed by more than just one opinion of what matters. Others have recognized the powerful role students play in the communities, but also in emphasizing why this work is so important. In stepping back, the T4E Fellowship is modeling how to value student agency and strength. In short, the T4E Fellows are cooking with heat and I am excited to see what ideas and inspiration come out of their communities.

Next Practices Vs. Best Practices

Everyone bows down to the all, important benchmark. How many times have you heard someone say, “You only get what you measure”? Most organizations commit to identifying and measuring performance against industry best practice. Many have recognized the value of looking outside of their industry for practices that might provide a source of competitive advantage.

Adopting existing best practice makes sense if you want to improve the performance of your current business model. Going beyond the limits of your current business model requires a network-enabled capability to do R&D for new business models. The imperative is to build on best practices to explore and develop next practices.

Understanding best practices and applying them to increase business model productivity is an essential capability for all organizations. No surprise most companies benchmark their performance adopting practices ranging from accessing benchmarking data to sourcing (internal and external) process improvement capabilities. Like all learned behaviors the earlier it is adopted the easier it is to scale and to apply in other markets. Entrepreneurs and small business leaders should start with a back of the napkin approach. Be specific about goals and take the napkin out a lot.

It doesn’t take long to exhaust the library of best practices in any given industry. Field organizations have seen most of what the competition is doing and can report their observations. In addition, your customers and networks have an important perspective that should be tapped. Social network platforms, like Twitter, Facebook, and Linked-in make real-time information interaction possible across networks. Leverage these new tools and platforms. It is worth it.

Your Vision. Our Approach. BIF's Design Methodology Playbook for Download

Only exploring your own industry for best practices is limiting. New sources of competitive advantage are far more likely to come from observing and adopting best practices in completely unrelated industries. All leaders should spend more discretionary time outside of their industry, discipline, and sector. There is more to learn from unusual suspects who bring fresh and different perspectives than from the ideas circulated and re-circulated among the usual suspects. The big and important value creating opportunities will most likely be found in the gray areas between the silos we inhabit. Get out more.

Best practices are necessary but not sufficient. Business models don’t last as long as they used to. Leaders must identify and experiment with next practices. Next practices enable new ways to deliver customer value. Next practices are better ways to combine and network capabilities that change the value equation of your organization. Organizations should always be developing a portfolio of next practices that recombine capabilities to find new ways to deliver value. Leaders should design and test new business models unconstrained by the current business or industry model.

It is easy to sketch out business model innovation scenarios on the whiteboard. It is far more difficult to take the idea off the whiteboard for a spin in the real world. We need safe and manageable platforms for real-world experimentation of new business models and systems. Since most leaders in the 21st century will likely have to change their business models several times over their careers it makes sense to do R&D for new business models the same way R&D is done for new products and technologies today. Create the space for exploration.

It is not best practices, but next practices that will sustain your organization on a strong growth trajectory. While you continue to pedal the bicycle of today’s business model make sure that no less than 10% of your time and resources is dedicated to exploring new business models and developing next practices.