Reflecting on #BIF2019

Our annual BIF Summit has always been magical for me – the planning, seeing the details come together, making sure everyone is checked in at registration and knowing I have played my part in making it happen.  This year it was time for something new – we needed to make a change, a pivot, a transformation. Mid-summer I got a call that the summit was back on – but needed to be different. I was lucky enough to be part of the team to see BIF2019: Wellbeing come together from start to well, I don’t want to say finish because it is an ongoing experience for me.  It has stayed with me not only because the videos are just coming out and we are releasing them, but also because it truly struck a chord with me on multiple layers. This was a focused event on wellbeing – an issue important to all and all that we do.

BIF2019: Wellbeing was a smaller, more interactive event which combined storytelling, networking and co-creation spaces.  This year was a truly unique experience – I left with an action plan on several fronts; I have communicated with a homeless man and formed a connection that was truly personal, shared the wonders of telemedicine with my friends, thought about unwritten rules, reached out to my government leaders about change, thought about struggling well and what that means to different people at different times, and I have turned on quiet music in our home again as it brings a sense of wellness ever present in the background.  I do not claim to be a creative person, but as a family we have created 30-minute blocks of time painting or dancing before dinner as a way to let go of the day. It has been hilarious.

With all of the running around, behind-the-scenes things to take care of during the event, I didn’t get to see every storyteller in real time, but I guarantee I will watch all of the videos and be rejuvenated throughout the year.  I am grateful for everyone’s participation and bringing their best selves to BIF2019: Wellbeing. While still digesting the incredible moments, I am putting together a living document where we can share our reflections and inspirations.  Let’s keep the connections and conversation going! I’d love to hear from you: what was most memorable to you, what was your big take-away? Any photos, graphic notes, or napkin sketches you’d like to share? You can reach me at Let’s keep wellbeing on the forefront of our minds!

Reimagining Maternal Health

“To prevent women from dying in childbirth, first stop blaming them. Two-thirds of all U.S. maternal deaths are considered preventable. Racism – not race – is a critical factor.”
-Monica R. McLemore, RN, MPH, PhD

Women in the U.S. are more likely to die in childbirth than any other high income nation This is a social issue, a racial issue, and an economic issue.

BIF has designed a new personalized wellbeing model to improve maternal health and wellbeing outcomes. We believe that if we personalize the experience for the woman, equipping her with the trusted information, support, and tools she needs to lead a healthy pregnancy, her maternal health outcomes will improve.


Learn More   ·   get in Touch

Introducing the PMxD Maternal Health Prototype

In the last few months since we shared our Personalized Medicine by Design (PMxD) conceptual business model, we’ve been hard at work evaluating initial health and wellbeing challenges for the Prototype phase of the PMxD design process. One challenge had particular urgency and that is why we have chosen to launch the PMxD Maternal Health Prototype.

PMxD is a transformational business model designed by our founder and Chief Catalyst, Saul Kaplan, that puts individuals at the core of a personalized health and wellbeing experience leading to improved healthcare outcomes. At the heart of the PMxD model, individuals are enabled by four core capabilities: Unleashing Personal Agency, Understanding Patterns of Wellness, Activating Personal Networks of Wellbeing, and Integrating Diversity, Equity, and Inclusion (DEI). The PMxD model has been informed by 70 BIF business model design projects over 14 years in healthcare, education, and social services.

Today we are proud and excited to introduce the PMxD Maternal Health Prototype: A Personalized Wellbeing Model to Improve Maternal Health Outcomes for Black and Brown Women



We are mobilizing the PMxD Maternal Health Prototype, starting in our home state of Rhode Island, to co-create opportunities with Black and brown pregnant women (25 in the initial prototype cohort) to access the information, practices, and support needed to help them achieve better maternal health outcomes for themselves and their babies. We believe that maternal health outcomes will improve if we center women in the model and focus on wellbeing, provide seamless integration of care when needed, and equip women with what they need for more successful maternal health. In the PMxD Maternal Health Prototype women will be empowered to trust their instincts, and seek help earlier if they experience heart health or mental health warning signs. Ultimately, women will have increased personal agency and confidence to positively influence outcomes within the prototype, and increased equity in care will reduce racial disparities in maternal health outcomes.

We welcome you to follow, engage in, and support our PMxD journey, it’s a collaborative process, and together we can start by improving maternal health outcomes in the U.S. 

Learn More About the PMxD Maternal Health Prototype

Personalized Medicine by Design: Story Cure

Since beginning work on our Personalized Medicine by Design (PMxD) project six months ago, I have been revisiting many of the projects we have completed over the last 14 years. We have seen the same themes emerge time and time again when we explore health and wellbeing for individuals and families. Distrust in the current healthcare system, lack of empathy from providers (ie. not truly being heard), lack of mental health resources, struggling with basic needs (eg. job security, education, access to healthcare, food, and housing), and on the flip side, the power of community to help one another.

In every project we undertake, co-designing with the community is a core principle, PMxD is no different. Our first community visit was in West Philadelphia with host Yolanda Wisher the Curator of Spoken Word at Philadelphia Contemporary. Yolanda created an incredible program called Story Cure, which took place at at the Community Education Center in West Philadelphia. Story Cure featured poetry by Trapeta B. Mayson, story circles for sharing experiences with health care and self-care, and a tea making workshop to nourish the soul.

Nothing prepared me for listening back to the audio of the stories shared. With headphones on (it’s true what they say, that audio is an intimate medium), I heard stories of frustration, pain, self actualization, and healing. The stories were haunting, so raw, and personal. As Trapeta B. Mayson later commented, “it was the work of courageous people”. But, one thing was abundantly clear, the system was not designed for the community it was serving.

Capturing the beauty of the experience, poet Trapeta B. Mayson, who listened as people shared, magically turned prose into poetry and performed “Stories Cure” at the end of the event. Listen in with us, hear for yourself, and honor those who choose to share their voices.

This is Story Cure.

#BIF2019: Wellbeing

Reports of the BIF Summit dying are exaggerated!

In January 2019, we announced that after 14 years of helping institutional leaders make transformation safer and easier to manage, we planned to leverage what we’ve learned, and the transformation tools we’ve created, to pivot toward directly launching new, human-centered personalized business models with patients, students and citizens at their core. We want to increase our impact by directly designing, prototyping and commercializing transformative business models in healthcare, education and public services.

Our BIF pivot is well underway starting in health and wellbeing with the launch of Personalized Medicine by Design #PMxD and our initial prototype focused on an important and urgent design challenge: transforming maternal health outcomes for Black and brown women in our home state of Rhode Island.

As much as we’ve loved hosting every one of our 14 inspiring Collaborative Innovation Summits over the years, we know in our hearts that the BIF Summit has to transform too.

At BIF, we share a core belief that transformation of our most important social systems is about catalyzing the organic emergence of self-organized purposeful networks. Our Summits have always received high grades on the self-organized part as thousands of us over the years have experienced first-hand the strategic importance and inspirational power of storytelling, and enabling random collisions of unusual suspects (making a #RCUS). But in order to increase our collective impact we must add new elements to our Summit experience and community tool kit, we need to get better at making our self-organized networks more purposeful.

Since announcing our BIF pivot we have heard and received an outpouring of encouragement from our community and past Summit attendees. We’re both inspired and amazed by the responses we received since announcing that we’re reimagining the BIF Summit. We clearly hit a nerve! So many of you shared stories with us about the personal impact that engaging in the BIF community and attending our annual Summits have had on you, your organizations and your communities. You made clear to us your hope and expectation that BIF would be back soon with a new improved Summit experience.

We heard you and agree.  The BIF Summit is back!

BIF is proud to present:
#BIF2019: Wellbeing
October 22-24 in Providence, Rhode Island

#BIF2019: Wellbeing combines two BIF superpowers, storytelling and making a #RCUS, with an immersive opportunity for all of us to roll up our sleeves to help design the next practices and new business models that enable individuals and families to take charge of improving their own health and wellbeing. We will not be admiring the challenges of today’s institutionally driven healthcare system, they are well known. Together we will bring BIF-style optimism to imagining a better, more personalized, future. A more inclusive and equitable future that unleashes personal agency, with the information, tools, practices and access to the expertise and resources necessary to improve our own wellbeing.

#BIF2019: Wellbeing will combine an intimate in-person convening at BIF in Providence for 100 participants with an open access platform to engage a larger motivated community remotely and directly in the Summit’s storytelling, conversation and design process. The Summit experience will include a mixture of storytelling, design sprints, share-outs, and networking. Our collective output will help unleash new system solutions to be prototyped in the real world. Summit storytellers and participants will represent a diversity of perspectives, views, identities and experiences across industries, sectors and disciplines. A focus on wellbeing pushes us all to go beyond the usual healthcare suspects and silos to open up new transformative solution horizons and approaches.

Learn More: Schedule, Logistics, and Sign-Up 

Saul Kaplan named Founding Member of The IEEE Fair Trade Data Initiative

The Business Innovation Factory (BIF) is pleased to announce that Founder and Chief Catalyst, Saul Kaplan has been named a Founding Member of The IEEE Fair Trade Data Initiative, a collaboration to develop a standards framework governing the fair trade of human and personal data.

IEEE is the world’s largest technical professional organization dedicated to advancing technology for the benefit of humanity. The Fair Trade Data Initiative is a working group of diverse stakeholders collaborating to create a recommendation for a standard to the IEEE Standards Association intending to help guide consumers, corporations and countries engage in the fair trade of inherent human data.

“It’s an honor and privilege to serve as a Founding Member of the IEEE Fair Trade Data Initiative. In developing global standards for the fair trade of human and personal data, we have the unique opportunity to ensure that the voice of the consumer is at the center of the framework.”  

Initiative Founding Team*:

  • Fahd Beg, Chief Investment Officer at Naspers
  • Dr. Christopher Boone, PhD, Vice President, Global Medical Epidemiology and Big Data Analysis Lead at Pfizer, Inc.
  • Krishna Cheriath, Chief Data Officer at Bristol-Myers Squibb
  • Richie Etwaru, Chief Executive Officer at
  • Saul Kaplan, Founder and Chief Catalyst at Business Innovation Factory
  • Dr. Jennifer Miller, PhD, Assistant Professor at the Yale School of Medicine and Founder, Bioethics International
  • Keerthika M. Subramanian, Esq., Corporate and Securities Attorney at Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

*All founding team members are acting strictly as individuals and not as representatives of their respective organizations

IEEE Standards Association (IEEE-SA) is a leading consensus building organization that nurtures, develops and advances global technologies, through IEEE. Bringing together a broad range of individuals and organizations from a wide range of technical and geographic points of origin to facilitate standards development and standards related collaboration.

To learn more about the initiative, including how to participate, visit:  Fair Trade Data Initiative


Update From the Field: National Association of Community Health Centers April 2019

The Business Innovation Factory (BIF) team just recently visited Castle Family Health Center in Atwater, California and Lawndale Christian Health Center in Chicago, Illinois where we conducted interviews with the health centers’ leaders, staff, and patients. Our work with the National Association of Community Health Centers (NACHC) is focused on creating more opportunities for transformation within their network. As we began to analyze and synthesize our findings, a few emerging curiosities came to the surface:

How do you create the conditions where people are able to advocate for their own health and wellness – both physical and mental?

What practices, processes, and mindsets are central to creating a culture of trust in a health center?

How are community health centers uniquely situated to be transformative players in the changing landscape of healthcare?  Beyond providing health care services, what roles do community health centers play in their ecosystem?

Throughout our travels to Florida, California, and Illinois we had rich discussions with patients that offered insights into their perspectives around these questions. Combined with over 14 years and 70 BIF projects seeking to understand customer (patient, student, and citizen) experience particularly in underserved communities we have a solid design foundation to explore opportunities with NACHC to accelerate patient-centered transformation in the communities it’s Members serve.


Prioritizing Personal Health, Wellness, and Self Advocacy


When individuals have the mindsets, time, resources, and/or support to invest in themselves, they can better advocate and have greater ownership over their healthcare and wellbeing experience beyond their visit to the doctor’s office. Patients will be better agents of their own health and wellbeing when their life experiences are understood in a full context. Health and wellness start by unleashing patient agency to take advantage of the right knowledge, tools, expertise, and resources when and where patients need them.

A patient from Castle Family Health Center explained,  “An important decision for me is to take care of myself because I was always worried about other people, what they were feeling, and making them happy….but getting to the point where I had allowed myself to be a little selfish, and take the time for me, that was a big decision. ”

The healthcare system today relies on the expertise of the doctor to provide knowledge or tell a patient what they need to change to improve their health and assumes people will take this advice and act on it. People need to feel empowered and enabled to make these changes in the face of other life stressors, and feel supported by their doctor. Providing the opportunities for patients to be engaged in their healthcare journey, rather than passively being told what they need to do by a doctor, will enable patients to actively sustain the steps towards improved health and wellness.


Cultivating a Culture of Trust


Individuals make important decisions based on the people, places, and information that they trust, which can lead to positive, negative, or neutral health and wellness outcomes in their life. When patients feel that both the staff and doctors truly listen and understand them, it helps build their trust and relationship with the health center they are utilizing. A patient at Castle Family Health Center described, “Right here is where my entire self-care comes from… They listen to what I’m feeling, you know?” This patient has entrusted the health center to help her on a path to taking better care of herself due to the positive experience she has had over time.

When trust is developed, patients are more open and comfortable sharing their experiences and problems, allowing health centers to better help them in reaching their health and wellness goals. In this day and age, there are many different options of providers and services available to individuals that it can be difficult to know who to trust. When health care centers are able to meet the needs of individuals and value them as more than patient X of the day, this moves from a transactional experience to one based on relationships.

This was demonstrated when another patient from Castle Family Health Center explained,  “They were kind. They were caring, attentive, and quick. If I came early, they called the doctor to see if there were any slots open or if someone didn’t show….I had two appointments today, and I checked in and they communicated with me and made me feel like I wasn’t just going to be brushed aside until my appointment time.”

Overcoming barriers of distrust within healthcare institutions requires creating a culture of trust where patients know their care is personalized for their life, resulting in a healthcare journey that has their best interests at heart.


Reflecting Community Values and Catalyzing Patients’ Narratives


People want to share their stories and contribute their knowledge and passion to their wider community. As noted before, the healthcare experience is often a one-way transfer of information, knowledge, and values. However, we heard from patients that it is just as important that they are able to see their values and knowledge reflected in the health center. They noted that generosity and collective support kept them engaged in spaces both in the health center and beyond.

A patient at Lawndale Christian Health Center shared that values of the health center help her have trust in the staff and services provided. Those values also made her more likely to share her story with members of her community and support them in living healthier lives.  

She shared: “If a testimony was ever required of me I’ll be sure to make some space for it to make people aware that this [depression and other mental health struggles] is a real thing and that there’s help out there and there is proper medication for this… Whenever you guys want to call me to initiate a conversation for me to express my own story, to share with others I’ll make time for it for sure.”

A patient from Bond Community Health Center shared a story where he saw himself reflected in the community. “Today a lady came in and she didn’t have her copayment. Another lady sitting in the waiting room walked up and said ‘I will pay her copayment. If she has any problems I’ll pay it for her.’ These are the people who touch you. She said the copay was $25 and she only had $20. And I looked at the receptionist and she already knew that I had it, but before I could reach to get the five dollars the other lady came up and said ‘I’ll do it.’ So you know, it’s people like me that are here with open hearts and they will do for others. So I feel really comfortable with the people here.”

When patients see a health center emulating the same values and beliefs that they adhere to, it creates a sense of trust and commitment as they are aligned together through a common purpose. Health centers have an opportunity to lift up patients’ narratives and create pathways for patients to become core to their recruitment, retention, and reform efforts.

As we continue our exploration, we look forward to more storytelling and actionable insights from the field to put patient experience at the core of our design and innovation process.


Read Part 1: Emerging Insights from the Leadership Perspective

Are you ready to transform healthcare? Email us at

Update From the Field: National Association of Community Health Centers March 2019

Last week, the BIF team visited Bond Community Health Center in Tallahassee, Florida and Eau Claire Cooperative Health in Columbia, South Carolina to conduct interviews with leaders, staff, and patients as we continue our work with the National Association of Community Health Centers (NACHC). BIF and NACHC leadership are joining forces to explore the questions:

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?

How might we continue to promote equality in the healthcare system?

We learned a lot in our four day trip down South, and a few insights emerged as we look toward the next phase of the project.


Key Insights we Learned from their Healthcare Leaders:


The role of Technology in healthcare systems

When speaking with leadership teams at the sites, we learned that technology is helpful but not the long term solution to fix the healthcare system. According to Donnell Durden, Coordinator of Community Relations and Outreach at Bond Community Health Center:

“All of the technology works, it helps, it helps us amplify our message. But nothing is more important than getting outside, touching the people, shaking hands… reaching out to them; letting them know that we are here for them, we want their business, but more so, we’re here.”

Emerging technologies help deliver value in the real world, but are not at the core of creating healthier communities. Technology can be utilized as a component to support larger system changes that focus on the human experience first. If they’re constrained by today’s business model, technologies will only deliver tweaks, not transformation. It is crucial that we consider technology to be a supplementary aspect of innovation, rather than innovation itself.


Medical services are only 20% of the health centers job-to-be-done

Keeping in mind the increased importance of the social determinants of health when considering the actual services needed to successfully run a community health center, medical services only cover about 20% of all patient needs. The remaining patient’s jobs-to-be-done are met through enabling wraparound services like transportation, having access to childcare, caseworkers, insurance specialists, social workers, and nutrition education outreach, among others. While none of these wraparound services are actually separate from a comprehensive care model, often these services are unacknowledged in traditional healthcare experiences. The wraparound enabling services compose the majority of what community health centers do for people, but these services are often non-billable and intangible in healthcare. By adopting a more evolved definition of what health and wellness look like for individuals, we gain a better understanding of service gaps and experiences, realizing that wraparound services provide a more holistic and comprehensive solution to their pain points.

What innovation means to healthcare leaders

When speaking with community health center leadership teams, we gathered that innovation means changing the way care is provided to better serve patients and families, leading to healthier, wholesome outcomes. It also means not accepting the status quo. But what does innovation look like within community health centers? Dr. Robinson, CEO of Bond Community Health Center posed the question:

“When we consider innovation, we need to ask ourselves- Is it a good fit in the community? Does it fit the mission? Is it feasible and sustainable? Can you see passion and excitement among your team and will that lead to lasting partnerships?”


Innovation means staying true to your core values while also not allowing the way systems work today to dictate what’s possible for a better future. Eau Claire Cooperative Health Center’s leadership team focuses on how their founder instilled in them the mindset and perspective that there isn’t anything they can’t do. Innovation isn’t easy in this context, but core business models need to change if we strive to continue breaking down the barriers of inequality in healthcare.


Looking Forward

Look out for the next update from the field highlighting the patient perspective as we continue to make discoveries in our research with NACHC.


For more on our work, visit our case study here: National Association of Community Health Centers Case Study

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.

Join BIF

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.


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.

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.

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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

Voices of the Innovative Learning Network (ILN)

On May 8-10, the Innovative Learning Network (ILN) met in Charlotte, North Carolina to discuss and explore business model innovation in the healthcare industry. I found it amazing to see such a diverse group of innovators – senior leaders, doctors, nurses, and directors of innovation just to name a few. With everyone’s different backgrounds, we were able to tackle the looming question of business model innovation in healthcare from all angles and perspectives in a safe space where thinking outside the box was encouraged.

Business Innovation Factory (BIF) hosted the meeting to lead a 3-day workshop with Atrium Health. The workshop was designed to take the ILNers through our Design Methodology and Playbook for Next Practices and New Business Models process using a case study from our past work with Children’s Health in Dallas. In groups, we started by shifting our lens to understand the pains, gains, and job-to-be-done from the customer’s perspective. Then, we took the customer’s current experience as a foundation for imagining a new customer experience that relieves the customer’s pain points, maximize the gains, and completes the job-to-be-done. Finally, we tested a low fidelity prototype and put it up to the constructive criticism of the other groups.

We met with a few top healthcare trailblazers from a variety of different organizations and backgrounds who aren’t afraid to operate in the ‘scary’ space of business model innovation to ask them a few questions. We asked them about their personal take on innovation, the obstacles they must circumnavigate to innovate within their company, what innovative questions they want to explore in their company, how they prepare for future business models, and how they differentiate between transformational and incremental change.

While healthcare leaders understand the imperative of business model innovation, it is often scary to disrupt a large system that has been in place for years. When the motto of healthcare is “do no harm,” it is hard to be the guinea pig to test out new business models and next practices. Our goal was to help them make the business model innovation process safer and easier to manage.

I found it fascinating how unique, yet similar each person’s response was to these questions. The ILN is such a great catalyst for future business models because it provides a place for members to discuss and explore business model innovation in a safe way. Tim Rawson from ILN said that the event was a meeting, not a conference because in a meeting, things can go wrong. It was clear that everybody, no matter who they were felt confident sharing their perspective and wasn’t afraid of failure, rather they embraced it.

From the ILN In-Person meeting and the interviews, I learned how there is a clear imperative for business model innovation in the healthcare industry. Leaders are ready and willing to make that next step to transform their business models, but they just need a clear path forward. At BIF, we make the step towards next practices transformation safer and easier to manage. It is no question that patient’s values have changed; they want to feel empowered to take control over their health and overall wellness. They want to understand their health in normal terms and have a clear path to achieving their wellness goals. By transforming business models to align with customer values, not only will the customer be happier and healthier, but the business itself will perform better under new metrics of success.

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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

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.

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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What’s Your From…To Story?

A fellow pharmacy school graduate and colleague from early in my career, George Zorich, is writing a book advocating for pharmacy schools to integrate entrepreneurship education into their standard curriculum. A section of the book will contain stories of pharmacy school graduates who leveraged their education in surprising ways, catalyzing non-traditional and interesting career paths. George asked me to share my story. I’m honored to be asked and I found it invaluable to reflect on my own convoluted career path. Are you doing what you originally set out to do in college? If you’re like most people you’ve had to reinvent yourself multiple times over your career. The world of work is changing faster than ever. What’s your from….to story? Here’s mine.

My thought process coming out of high school was no more complicated than, I love science and it would be nice if a college diploma resulted in a job! Pharmacy fit the bill. I wasn’t signing up for a career, just looking for a start. I wanted something I could build on without a clue where it might lead. A pharmacy degree from the University of Rhode Island School of Pharmacy in the 1970’s was the perfect prescription. I knew by my sophomore year I wouldn’t spend my career filling prescriptions but I have always valued the foundation I received at URI. While I couldn’t tell you then how I planned to leverage a pharmacy degree I had confidence it would set me up for a successful career. I have been grateful for my pharmacy education every day since.

I went on to launch a career with many twists and turns as an innovation junkie and strategist. I believe there is always a better way. I have dedicated my career and life to enable those around me to make what’s next easier and safer to manage. My career has followed the simple principle of always staying on a steep learning curve. I have always done my best work when I stretch myself to learn and do something new. I never cared about job titles, how many people reported to me, or how much money I made. I knew those things would come if I kept myself on a steep learning curve, always willing to tackle new challenges.

After pharmacy school, I wanted to learn how business and large organizations work and how emerging technologies change markets. I combined my analytical foundation from pharmacy school with an MBA from Rensselaer Polytechnic Institute (RPI) in the Strategic Management of Technology. From there I leveraged both degrees to work in the pharmaceutical industry for, Eli Lilly & Co, first in sales and then in the home office as a marketing manager. I had the incredible opportunity to work on the US introduction of Prozac. It was a young marketing manager’s dream job. I learned the difference between market making and share taking. Most people and organizations are share takers, competing for market share in a defined industry with known competitors. I became obsessed with market makers, people and organizations that redefine markets. My career has been defined by enabling market makers.

From Lilly I became a road warrior consultant first with Arthur D. Little and then as a Senior Partner at what became Accenture. I’m still learning what I learned during those halcyon days traveling around the world working with pharmaceutical and medical products companies, enabling and leading consulting practices and teams focused on innovation. I became interested in the difference between the innovation rhetoric coming out of the CEO suite and the real work being done at mid-levels in most of the companies I consulted with. The rhetoric was about transformation but the reality was more focused on incremental improvements to the way the companies worked at the time. Nothing wrong with tweaks but it seemed to me that a different approach to innovation was needed if transformation is the goal. Institutions are much better at share taking than market making.

I was fortunate to retire at an early age from Accenture, a few years after its IPO, and my wife wasn’t in the market for an innovation strategist at home to advise on household operations. I made the mistake of raising my hand to the new elected Governor in my home state of Rhode Island and the next thing I knew I was working as the number two at the state’s economic development agency. Soon after I joined the agency its Director went back to Wall Street and I found myself leading the agency. I had become an accidental bureaucrat! It completely changed my world- view and approach to innovation. Instead of seeing innovation through the lens of large institutions I learned to see it through the lens of the citizens, students, and patients they served. In developing the state’s economic development strategy I began to see the state as a real-world sandbox to develop transformational models in government, education, and healthcare.

I created the Business Innovation Factory (BIF) at first as a local program in Rhode Island, and when I left state government, to now serve government, healthcare, and education leaders across the country to explore and test next practices and new business models to help make transformation safer and easier to manage. We live in a time that screams for transformation and the best we seem capable of is tweaking what works today. BIF is trying to change that.

I am proud of my pharmacy background and how I’ve been able to combine and recombine what I’ve learned along the way to take on and create new roles that didn’t exist or that I could never imagine when I was in college. The truth is that none of us can predict what we will be doing in the future. All we can do is learn how to confidently reinvent ourselves, building on our capabilities and experiences. Reinvention is the most important life skill in a rapidly changing world. Any college degree or post-secondary credential, including pharmacy, is a wonderful foundation to open up many new career and life paths if we let it.

What’s your from…to story?

Our Health Imperative: A Methodology to Get From ‘Now’ to ‘Next’

Our health system has the ability to accelerate society’s path to what’s ‘next’ — a next that holds the promise of focusing on health rather than health care or, better yet, sick care.

What’s getting in the way?

The system is locked in its ‘mental valley’ of the now chasing incremental change in hopes that it will ‘fix’ what has been broken for decades.

Transformation itself needs to be embraced and practiced as a core leadership skill because we are all frustrated in the now, and transformation is the constant that will move institutions and organizations to the ‘next’.

Which is why I am excited to share BIF’s methodology for making the transformation journey safer and easier for health leaders.

We know it’s a natural tendency for institutions and organizations in the health space to focus on existing practices and models that have had past success rather than investing in responding to changes in the market with new capabilities. That’s understandable because it feels safe and manageable; the truth is, that yields only small ‘tweaks’ of change.

But a growing number of health leaders have told us that their current approach to change isn’t working; incremental inertia and mindset are keeping them stuck on a ‘healthcare-hamster wheel’.

This is why it is our priority in the BIF Patient Experience Lab (PXL) to provide a methodology that makes transformational work less risky, more manageable, and, well, safer.

BIF’s PXL is a platform where health leaders define and test vital next practices and new business that offer different health models to our population that extend beyond clinical walls to where we live, work, play and all of the virtual spaces in between.

Our BIF methodology offers a clear path for how an organization can make transformational change by starting with the essential first step of shifting its lens to reframe opportunities through the experience of individuals and families.


BIF's Design Methodology

Seeing Beyond the Boundaries of “What Is” to “What Could Be”

The process begins by helping leaders shift their current lens to understand the gaps that their customers currently face, or, in other words, the job that they need to be done. By engaging patients, families and organizational leaders in thoughtful and provocative conversations, an empathetic reframe of the customer experience happens and new opportunities for adding value emerge.

Some new value propositions we have been exploring with leaders in our PXL include ‘how might we’…

…get back to extraordinary basics of health and wellness.Download Your Copy Now!

…recognize that most of what impacts our health happens outside clinical walls.

…extend health beyond clinical walls to where we live, work, play, and all virtual spaces in between.

…acknowledge the medical model as only one piece of the health journey

…respond to the effects of social, economic and environmental factors on health

…take advantage of intersections across medical, social and economic aspects of a person’s health so, new solutions emerge by thinking about them together instead of each in their own “lane”.

…act as a health ecosystem.

…secure real capital– financial, political, and social to be invested in ways that explore and nurture new ways of working; it’s bigger than funded programs, pilots, or studies.

…invest time and money to establish and foster authentic relationships across health driven sectors

…establish mutually accountable partnerships in and out of healthcare industry that goes ‘beyond handshakes’

…implement new ways to understand, measure and communicate the value of ‘health’ beyond biological measures

…include evidence for agency; how it can underpin health and why it matters of its own accord.

…show that organizations with transformation as a key driver of their strategy will succeed and lead.

…stop ‘thinking and talking’ and start ‘designing and trying’ next practices and new models

Once new value propositions are defined, we work with leaders to combine, recombine or reimagine new capabilities to prototype and test. Prototyping capabilities enable organizations to learn quickly if they have added value for individuals, families and key stakeholders and creates the conditions to capture both successes and failures or make real-time adjustments in the moment.

When a minimally viable set of new capabilities has been prototyped and tested for value, with real people in their real world, we help organizations create a path to commercialize them.

At its core, BIF’s methodology embeds ongoing risk mitigation to decrease time spent on undesirable and ineffective new capabilities and increase time spent on developing sustainable new organizational capabilities to serve as next practices for new business models; getting us on a path to what’s ‘next’ for health.

What Next Looks Like

Creating the ‘next’ in health has never been easy, in fact, it has only gotten harder over time.

With highly regulated environments, increasing system and operational complexity, disruptive competing stakeholders, and a hefty responsibility to do no harm, transforming next practices and new business models that can cure, heal or help is hard.

But it’s happening- with institutional leaders in our Patient Experience Lab and across the globe.

Notable points of lights are emerging from the United States, Netherlands and Canada, moving from the now to the next by enlisting a full gamut of cross-sector, cross-industry ‘unusual suspects’ to change the game.

Above all, it is dynamic and what is ‘next’ today will change in one, three and five years from now.

‘Next’ will continue to evolve and be undefined, yet ready to be shaped by institutional and organizational leaders who know how vital it is to stay nimble with heightened awareness aware of what ‘next’ will be.

The goal is to ensure that transformation is a skill and muscle flexed regularly by leaders — in order to stay relevant to our changing health needs.

What ‘Next’ Now?

Because the low hanging fruit is gone we have incrementally changed or are in the process of incrementally changing all of existing technical problems in our health system — leaving us with complex, human-centered challenges that require new mindsets and capabilities beyond the status quo.

These challenges are rooted in the need to meet our population at the complex intersections of their medical, economic and social needs — which as a direct result, render most of the existing practices and models no longer viable, valuable, or sustainable for institutions, consumers or the bottom line, no matter how much we keep ‘tweaking’ them.

We’ve run out of band-aids and the Frankenstein monster we built is on the loose and scaring society.

It’s time to help get institutional leaders off of the whiteboard and into the real world, to move from ‘thinking and talking’ to ‘trying and learning’ our way to the ‘next.’

Our Health Imperative: Leading the Transformational Change

The conditions are ripe for transformational change that is intentional, safe and repeatable, adding new value for the health of our population.

It’s going to take cross-sector, cross-industry superpowers coming together to truly transform health and wellness models for our population because the ‘next’ is still out there undefined.

We share our BIF Methodology today to describe how we help institutional leaders explore and test what’s ‘next’. We also share it because, at BIF, we believe that social system transformation becomes possible when we all open source our approaches, platforms, and experience.

That’s how we get better and faster together.

This is not only our internal process for how we work but also what we believe will make the titanic shifts needed to move the entire health industry forward into next practices and new business models that transform society’s future health and wellness models.

We know we are still early in our journey, so at BIF, we will continue to partner with health leaders to move from the now to the next, leading transformational change together as an ecosystem of health, not a silo of healthcare.

BIF's Design Methodology

Whether you have just started your journey to transform the path to health and wellness or have been on it for a while, we want to learn with you:

·       What are you trying as your ‘next’?

·       What advice do you have for others wanting to go from chasing incremental change to leading transformational change?

I’ll pause there and look to you all to fuel this urgent conversation.


PXL Shares Family Well-Being Experimentation Stories

Patient Experience Lab partnered with Children’s Health and Dallas families and communities to prototype, test, and iterate on two new approaches to improving family well-being.

These experiments were intended to help us learn: how can we begin to understand the conditions that encourage positive behavior change, and improve well-being for the whole family?

We are excited to present video stories that highlight families’ experiences with each, as well as key elements of the family-centered designs:

1. What’s Cookin’ Dallas

A healthy cooking and eating experience in the Lake Highlands community, co-created and run by families. Multiple iterations of the model allowed families to continually address their community’s needs: transportation to increase access to healthy foods, tangible, affordable, and relevant nutrition information, and cooking experiences created and facilitated by trusted community members.

2. Your Best You

A three-week youth leadership program to facilitate creative expression and reflection, enable self-awareness, and harness change-making power. A curricular fusion of design thinking and Roberto Rivera’s Fullfill the Dream, a creative pathway to self-discovery, provided teens with tools to identify and apply their personal skills and superpowers to address challenges – both those they face as individuals, and those their communities confront.

One of the many important insights gleaned from experimenting alongside Children’s Health and local families is that enabling agency (putting families in charge of well-being initiatives and catalyzing purposeful networks among them) is crucial to ensuring that families can continually strive to live healthy and well lives. To move from a model that provides sick care to a model that keeps populations healthy, we need to reframe the roles that families and institutions play.

Partner, don’t prescribe.

By engaging families in the design and delivery of models, we’ve learned that families know the challenges they face in striving to be well and what the needs of their communities are. Giving families access to the institutional resources to address those needs creates the conditions in which hope can grow: specifically, the hope that self-directed changes will pave the road to healthier futures.

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Hot Off the Presses: Healthcare Narrative Playbook!

“After nourishment, shelter, and companionship, stories are the thing we need most in the world.” – Phillip Pullman

BIF PXL is so excited and proud to announce that our Healthcare Narrative Playbook is finally complete!

Check out the video story to learn more:

Special thanks to Rob Ranney for his beautiful video storytelling. 

The narrative playbook is a practical guide for patients, providers, and caregivers – it provides strategies for using narrative methods in healthcare, in ways that have real impact. The methods included have been vetted by our thought leaders, are backed by research, and can be used cost-effectively and time-efficiently.

Click through below to view the Playbook:

Sincere and heartfelt thanks to our participants and supporters, from all of us on the BIF PXL team! As is true of all great stories, the story of the Healthcare Narrative Playbook was a co-created one: informed by your knowledge of our healthcare system and inspired by your passion for the potential impact of narrative on health and outcomes.

The Power of the Narrative

What happens when you bring together 30+ doctors, nurses, patient advocates, researchers, professors, artists, performers, entrepreneurs, hospital administrators, consultants, and more who believe the power of story can improve care, healing, and health outcomes?

Random Collisions of Unusual Suspects (or for those who know BIF, #RCUS).

Our mission over two days — February 5th and 6th  was to bring these thought leaders together to help define and co-create a narrative “playbook” that will demonstrate the value of narrative methods in the context of healthcare, codify best practices, and engage people in its adoption & implementation. As an Experience Designer, it was important to me to provide the right mix of inspiration, collaboration, and productivity that would allow for people to design their emerging experiences (both online with the #hcnarrative hashtag and offline during the workshop). That’s when beautiful things happen.

Here are some of the big questions we tackled and started to unpack. Over the next few weeks, we will continue to synthesize the ideas, insights, and content that came out of the participatory design studio in order to publicly share the Narrative Healthcare Playbook in March.


How do we define “narrative” (and is that even the right term)?

In planning this event, we expected that defining “narrative” would be an easy task. But the power of nuance and language brought in some messiness to the process  doesn’t it always? We did land on some common elements of the definition, such as the continual and iterative process it takes to build and form, the sense- and meaning-making it provides, and different roles it creates space for. But it also highlighted some differences of opinion (Is it really about empathy for understanding? Or improving care?) including using the term, “narrative”.

What is a narrative “playbook”?

We use the metaphor of a playbook to explain how we envision people using the output. In football, a playbook is a notebook with techniques and strategies relating to game plays. Different situations require different strategies, which take the context (the team formation, skills of the players, how far the goal line is, etc.) into account. This is how we want the playbook to be structured and used  we are building it to provide strategic guidance about how different users can use narrative methods during specific scenarios.

Who are the users and what value does it provide?

As for the users of the playbook, we had originally named three user groups  patients, providers, caregivers, and the fourth group of general “others” (hospital admins/policymakers/payors/etc.). We included the last bucket to see if there were, in fact, other potential users for which narrative could have value. To further develop the user groups and the use case scenarios in which they could use narrative methods, we assigned teams to each group. Starting with a brainstorm about their general needs, teams developed common scenarios (As a patient, “I’ve been diagnosed with a chronic condition”), the challenges within the scenario (“I don’t know how to tell my family”, “I want a second opinion”), and the potential impact the playbook could have (“Linking experience/emotions to language, fostering hope, creating connection”).

What are the barriers to adoption?

We know there are a lot of barriers  emotional, cognitive, cultural, ethical, and systemic  that stand in the way of exploring, adopting, and implementing narrative methods. By writing them all down, it felt overwhelming but also a challenge that we, as a collective group, can undertake.

While we have much work ahead of us  synthesizing scenarios, codifying methods, developing language and tone, and building the deliverable itself  we hope to continue to bring people into the process to co-create the narrative of the power of narrative in healthcare. Check back in to learn about our process and opportunities to participate!

Patients and Families and Doctors, Oh My!

Wow.  ‘Hair on Fire Moments’ and all, the Patient Experience Lab was smokin’ this week (actually, literally, because my hair caught on fire last night from a poorly placed dinner candle, giving me the tapered look I was searching for at my last haircut but didn’t get, making it the perfect metaphorical ending to a crazy but productive week).

The more context, depth, empathy, and honesty that the story has, the better chance we have at using those stories to inspire new relationships, design more relevant experience — and transform social systems.   

The BIF studio was all abuzz this week with brilliant minds from the across the US and UK, collaborating on strategies to catalyze the inculcation of more systematic use of ‘the narrative’ in our healthcare systems.  And our “Family Well-Being” team was down in Dallas exploring the concept of what it means to be “well” with families from all socioeconomic classes, experiencing the role that Texas pride takes on for the born and bred, the incredible resilience found in some of Dallas’ poorest neighborhoods, and the hopes and fears of the first generation change-makers trying to forge a different path than the ones their parents and grandparents took.

The theme: stories, stories, and more stories.  From patients who told us of the day they decided to speak out about failed, intractable systems, to physicians who saved patients from life-altering treatments by avoiding a contextual error discovered through conversation, not data. And of course, families who spoke of the importance of trusted relationships — not only in your inner circle but in your community support system  as a key element of well-being.

I was saddened, inspired, touched, motivated, and challenged by the many stories I heard this week from patients, families, doctors, educators, researchers, and business leaders. It reaffirms my belief that storytelling is one of the most powerful tools for transformation…and the more context, depth, empathy, and honesty that the story has, the better chance we have at using those stories to inspire new relationships, design more relevant experience — and transform social systems.   

A New Story from the Patient Experience Lab

Those who know us well know that at BIF, we believe a great story can change the world. So we’re happy to say that we have just kicked off an exciting new project with funding from The Robert Wood Johnson Foundation, all about the power of story in healthcare.

As the Director of the Patient Experience Lab, I have often been heard saying “Our System is Showing” when referring to the challenges in our healthcare system in America. I am obsessed with changing the entire narrative from one where our “system” is the first thing we think about when the topic of healthcare comes up, to one where the path to health and wellness is most visible and top of mind, with a system underneath it, simply supporting it.  An aggressive goal, yes, but every great story has a little tension and a beginning.

Beginning this week, we are inviting thought leaders from around the country to participate in a convening around the notion of how we might capitalize on the power of the narrative to help us better support the care and healing process — both from a patient and provider standpoint. There are so many instances of the use of narrative resulting in positive outcomes, but the efforts are disparate and fragmented. To harness the many uses, practices and narrative forms — from oral and written to artistic — BIF will be hosting a two-day Participatory Design Studio, which is a roll-up-your-sleeves, facilitated session to stimulate point-of-view experience and inspire new thinking based on shared value. We will then codify the results and produce an interactive publication, with a goal of stimulating discussion and implementing some of the methods and tools generated.

Included in the participant list are educators, researchers, physicians, authors, advocates, artists, and patients themselves. We have signed on celebrated professionals from institutions such as Tufts, UCSF, UIC, Kaiser Permanente, Georgetown, and more. We have only just begun the invitation process and are already more than halfway toward our goal of recruiting about 30 individuals who will gather together to share, collaborate, and co-design a comprehensive playbook on the potential for more widespread use of the narrative in healthcare.

This should be a good story, so be sure to follow along as each chapter unfolds. We will be blogging and tweeting about it throughout.

The MinuteClinic Disruption

The Boston Herald ran a story over the weekend about Rhode Island-based CVS’s plans to locate low-cost health care clinics in retail stores in Boston. I’m sure CVS knew they were in for a fight considering the lengths many Rhode Island primary-care physicians have taken to block their efforts to do the same here in our state.

From the article Competition won’t ail you:

“Boston Mayor Thomas Menino is concerned about CVS’s plans to locate low-cost health care clinics in retail stores in his city. Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene, he has said.”

The idea of the MinuteClinic is as much a mindset problem as it is a financial threat. The model runs counter to everything a physician has been trained for. Another problem – most physicians don’t want to be businesspeople and this is a real business conundrum. Following a disruptive strategy involves fear, risk and potential cannibalization—the mindset being that current customers (or patients as the case may be) are the lifeblood of the company (physician practices) and they must be protected at all costs. Of course in the end, these fears usually become self-fulfilling prophecies.

Clay Christensen is one of our research advisors here at the Business Innovation Factory. He would emphatically say don’t bother fighting the disruption. But he’ll also tell you that if you answer the disruptive threat, you shouldn’t invest your dollars in trying to advance your existing business model to please your existing customers in your existing value network. In so doing, you force the disruptive technology to compete on a sustaining basis, and will nearly always fail.

Clay suggests shifting responsibility for answering the disruptive threat to an autonomous organization that can then frame it as an opportunity. A new organization can pursue alternative channels, utilize different suppliers, and employ different services. Most importantly, they can do this without hindering their current, and most likely profitable value network while also giving their new growth ventures a solid foundation for success.

What does that mean for a primary-care physician’s practice? Here’s what Innosight (the consulting firm founded by Clay Christensen) has to say:

“In reality, these clinic’s present a good growth opportunity, but it will require significant change in one that requires a significant change in business practices vs. operating the sort of doctor’s office to which they are accustomed. Predictably, rather than seeing local doctors seize the opportunity, we are witnessing new specialists such as CHD Meridian and Whole Health Management ride the disruptive wave.”

Without a doubt, this story will be one for the record books. It’ll be fascinating to watch it play out. (Even though we all know the ending.)