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December 17, 2006

News from the Cutting Edge

Catalytic social innovations can change the world.

Having arrived at A&E ...waited for nearly 11 minutes before anyone arrived at the reception desk.This was at approx 6 O'Clock in the morning on a Saturday.The whole place looked deserted and like the aftermath of a football match with litter every where in the waiting area. The room that we were put in ...still had traces of blood on the floor and the bed frame.the ladies toilets were filthy with soiled paper blood etc...The nurse that came to check blood pressure etc. was very off hand and abrupt...

“Why should we pay you to provide a website where patients can just slag us off in public?” Director of Nursing, Acute Hospital

An understandable reaction perhaps given the nature of comments like the one above. But the real point here is the potential learning that such feedback creates for the organisation - not to mention future patients and commissioners.
Some change is incremental and can be accommodated easily with existing business practices. Other innovations are disruptive and make players uncomfortable.
Patient Opinion – and many other web 2.0 businesses – clearly has the potential to be disruptive. Managing this and ensuring that the overall impact is positive for society, patients and the NHS, whilst surviving as a business makes for an exciting ride.
Which makes an article in this months Harvard Business review by Clayton Christensen (who wrote the definitive book about Disruptive Innovations)particularly relevant. This time he is not talking about the effects of disruptive innovation in business but the ability of to generate better ways of solving social problems through social enterprises. What is it about The Big Issue, or micro-lending, or the Fair trade movement that makes them capable of changing society where welfare state interventions fail and businesses see no commercial opportunity?
Classically there have been two kinds of innovation: sustaining innovations (a better way to make widgets) and disruptive innovations (something that makes widgets obsolete). To this he adds catalytic innovations – innovations that put widgets to completely new uses in order to meet a social need.
Catalytic Innovations have five qualities:
• They create systemic social change through scaling and replication. This means they are not just one-off projects but that the mechanisms and resources to solve very large-scale problems are hard wired into them.
• They meet a need that is over served (because the service offered is more complex than people want) or not served at all.
• They typically offer ‘good enough’ services that are often of lower quality but which are more accessible and replicable.
• They generate resources in ways that are unavailable or unattractive to incumbents
• They are ignored or disparaged by existing players who find the new business model unprofitable or unattractive.
Interestingly Patient Opinion fits all these criteria. Our web-based structure meant that we always knew that we could scale. Indeed it is hard to think of any reasons why we would not want to be a national platform. And our subscription model creates the resources to support rapid growth.
Current systems for involving the public are both more complex and less effective than a web based system like Patient Opinion. Traditional ways of measuring feedback have their uses but speed, cheapness and universal cover are not amongst them.
By the same token Patient opinion offers data that is less ‘objective’ than surveys but which is never the less perceived as being ‘good enough’. Indeed in terms of demonstrating measurable service improvements quickly it out scores representative surveys every time.
The business model is also unattractive to incumbents: for-profits like Dr Foster find the risks of being sued unpalatable. And they are understandably uneasy about a product that sets out to make their core customers uncomfortable. It is hard for example to imagine a for-profit company publishing this kind of comment about one of its customers.
"...my father was treated appallingly in a local hospital last year ...he was left in a filthy ward, sitting in a plastic chair day and night for a month, suffered horrendous bed sores....not given adequate pain relief, not given clean drinking water,on one occasion he was left overnight in soiled pyjamas..."

All very comforting to know but does it help the business? Well yes. The article made it clearer to me that in many ways what we are selling to hospitals is a new and catalytic way of interacting with patients. As a provider you can choose not to reply to critical comments liek the ones above. Or you can see them as a learning opportunity. Our job at Patient Opinion is not to sell feedback but a service that enables hospitals to create fast, public, visible, measurable improvements in all those micro-aspects of service that are really important to patients.
Catalytic social innovations are important because they harness new opportunities and income streams that are largely invisible or unattractive to commercial or public sector incumbents and from them create new scalable solutions to social needs. It’s good to know that Patient Opinion fits the criteria exactly.

Posted by Paul at December 17, 2006 12:56 PM