This interdisciplinary course focuses on sustainable innovation, introducing entrepreneurial students to the realities of problem identification and solution design within the complex world of healthcare.
Prioritizing Needs: Seeing the Full Cycle of Care Part A
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Do curso por Duke University
Healthcare Innovation and Entrepreneurship
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Prioritizing Needs
What is the full cycle of care? How do you prioritize needs? How do you specify needs? How do you prepare a Need Statement?
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Marilyn M. Lombardi, Ph.D.Associate Clinical Professor
School of Nursing
Bob Barnes, PhDInstructor
Biomedical Engineering
Hey everyone, it's Marilyn Lombardi again.
And welcome to this third week of our course on healthcare innovation and
entrepreneurship. So we come to the point where we're going
to be talking about how to get that long list of needs that you may be developing,
into a manageable shorter list. And that means prioritizing those needs.
How do you go about this? Well, the first thing that we're going to
advise that you do, is return to those participants that you've been observing
all along. And others within the healthcare arena,
and use them as key informants to give you sort of themes and patterns you can
hold onto. In assessing what needs are most
significant to these people, what needs are addressable at this moment.
And what, where do I want to sort of separate the wheat from the chaff.
How do I get a sense of what are the top one, two, three needs that really need to
be addressed at this moment given this market.
This is when you turn to the participants.
Now this may be a, a piece of advice that seems to run counter to what we've been
telling you thus far. And it's true that in the first phase of
the innovation process, which was the observation phase.
We told you to be quite cautious, wary about what participants said in terms of
what they're, what they're doing, how they assess what they're doing, what they
think they're doing, what they think the problems are in the environment.
We said transcribe those, bring them into your notebook, keep them as part of the
impressions that you have of the general environment.
But take them with a grain of salt is an idiom that we have in English which means
essentially be wary, stay aloof from that position.
Now we're going to ask you to go in the opposite direction at this point.
Once you've observed the environment for yourself and you've got a long list of
unmet clinical needs as you determined them to be.
Now it is really time to get kind of validation, reinforcement a sense of, I'm
I really making sense here? And now you return to these participants,
having appreciated the difference between what they say they're doing and what
they're actually doing, what they say they want and what they might really
want. And it is time for you to use a very
determined interview protocol to get at as many insights as you can.
With regard to the significance of the needs that you have identified and
highlighted. So in Part A, which is this part of our
prioritizing need lecture, we're going to be talking primarily about what is a
stakeholder, how do you identify one, how do you recruit one.
In the second part, Part B, we'll show you ways of creating a protocol, an
interview protocol, planning that interview, recruiting key stakeholders.
And actually documenting what you've learned out of this entire interview
process. So the stake holder defined, the stake
holder is essentially anyone who is going to be affected or is affected by the
issue at hand. That can be someone who is in a position
of authority, who really has a decision making role when it comes to that issue.
And can say yeah or nay, yes or no, about whether an issue gets actually addressed
or whether it's tabled or whether a solution is needed or not.
On the other hand, there are people that are heavily affected by an issue and yet
have no decision-making authority. These too are categories of key
informants that you need to interview that you need to engage with.
So people who have, and people who do not have the authority to to push the green
light and say, let's go and let's hit this issue and let's address it.
Then on the the other cluster of people involved are those that lay outside of
any given organization. They may be policy makers, they may be
payers, they may be care advocates. They may be anyone who has the ability to
evaluate a healthcare organization and say whether that health care organization
has achieved or not achieved it's mission.
These two are key stakeholders in anything that you design to improve or to
innovate within the healthcare framework. Now this slide achieves two goals as far
as I'm concerned. First, it reminds you and asks you to
review where those needs that you've identified fall within the general cycle
of care as we have described it here. Bob Barnes has already presented you with
the eight healthcare components and this slide also you'll have it as a handout.
You'll read it at, at, at your leisure and you'll see that there are various
examples, descriptive examples, of each of these categories in the healthcare,
the overall healthcare process. I want to, however, get two things out of
this. First, I want you to be able to take all
of those needs that you've already sort of preliminarily noticed and, and
identified. And plug them into the various categories
that they primarily reside within. Right.
That'll give you a good sense of your bearings.
Where does this need really impact the health care environment in general.
So make sure that you categorize them under these healthcare components.
Secondarily I want to talk for a moment to those of you who are contemplating.
Is it possible for me to actually complete the requirements in this course
demanded of me in order to follow the distinction track?
Now, as you recall, the distinction track was all about applying.
During this six week period, applying a bit of what you're learning in this
course to a real world situation. And I can imagine that there are many of
you who might be thinking I'm not a doctor, I'm not a nurse, I'm not a
physical therapist, I'm not daily immersed in a clinical environment.
And I have no access to people who will allow me to shadow them through that
environment. What I'm I going to do?
How I'm I going to actually observe an environment that counts, and glean from
that environment some impressions about what's needed?
And I say this slide is going to help you to do so.
First of all, let me draw your attention specifically to the first two categories,
assessment and prevention. Every one of us is engaged in these two
components of healthcare, and we don't need a healthcare professional in order
to engage with these components. In fact we do it every day exclusively of
any service provided by a healthcare professional.
We don't take an office, office visit with a doctor in order to sort of take
our own pulse, both literally and figuratively.
We're constantly assessing whether we are feeling good, whether there is a soreness
that needs to be considered. Whether there's a blemish that really
should be watched, whether we have the need for a change in our eating habits,
our lifestyle habits. Whatever it may be, we're in a constant
mode of self-assessment. And at the same time most of us are also
in a preventive mode. We're trying to prevent conditions as far
as we understand them, from developing. many of us are really, really adept, and,
and, and very very concentrated on looking at our environmental factors that
impinge on our own health. And the health of our family members.
So there might be questions of purity in terms of the water source that we have.
There might be the, the, the possibility that a mosquito infestation could bring
with it some kind of conditions that we want to prevent.
In any case whatever it is, whether it's wearing a helmet every time you get on a
motorcycle, you are engaged in preventive health care.
That being said, those of you who have no access to a clinical environment can
still come up with a long list of challenges and opportunities, and unmet
needs. Simply by observing yourself, your, the
behavior, and the concerns of your friends, your family, and people at large
in any setting, in any part of the world. So I, I encourage you to think about that
possibility, that opportunity for developing your own distinction track,
assignments, requirements for following that track.
And for succeeding and completing those requirementts in the course.
Now, for those of you who have more of a, a professional connection to the health
care realm. Perhaps it's easier for you to engage in
observing environments where the rest of the categories are explicitly
demonstrating themselves to take place. For instance it might be in diagnosis,
you might be seeing needs that hover around intervention, et cetera, et
cetera. The needs might come out in fact, in this
last component, which is probably the least understood.
Which is the integration, the better and smoother integration across the preceding
categories of patient information, patient knowledge that can be used to
treat. And to support the patient.
In other words, where in the healthcare environment as a whole do we cross over
the various components, the various categories we've laid out?
And often enough, information technologies play a role in either
attempting to overcome the silos, the diagnosis, intervention, recovery and the
like. And allowing those silos to communicate
with one another for the benefit of the patient and the provider.
So here we have the eight components. Find where you, find where you lie, where
your expertise is and where your problem areas and observed areas are within this
healthcare framework. Once you've done that, once you've
located precisely what area in the healthcare framework you've concentrated
on. Then out of that framework, out of that
area can emerge a sort of typology, a more nuance typology of, of stakeholders.
So who are the stakeholders most affiliated with that particular problem
area? That could be consumers, for example, and
consumers is a broad category. I don't simply mean patients and family
members of patients. I also mean care advocacy groups who have
taken it upon themselves to support the rights and, and to strengthen the care
provided to particular populations. So there's the consumers, there are
professionals, we've already talked at length about them, there are researchers.
And that means to extend the continuum of care all the way back to the bench
scientist, the one that is furthest removed from the point of care.
And yet whose discoveries will ultimately impact provider and patient possibly
years down the road and after a transition and translation process that
involves clinical trials. So the bench scientist may be absolutely
essential to understanding and improving a problem area.
Don't forget about researcher, they could be social scientists and environmental
health researchers as well. They're the policy makers and payers,
there is industry, those medical device manufacturers and pharmaceutical
companies, and the non-governmental organization.
The various venture philanthropists, charities, foundations, the trade and
labor unions who will be, all of whom will be impacted potentially by a change
in the system, by an improvement to the system, by addressing a need within the
system. And finally a little word of advice with
all of these stakeholders in play. In order to decide for yourself which
representative groups to pursue when you recruit your informants.
Think of it as a, as an environmental space that you can, that you can scan
more easily by creating a visualization. In this case I've thrown together a slide
that shows you the relationships among various clusters of key stakeholders.
You can see that I've put the diabetes patient at, as an example, at the heart
of the issue, and radiating out from the patient because this is patient-centered
care. Radiating out becomes is clustered these
groups of healthcare professionals. On the one hand healthcare ecosystems in
a larger sense in the other and the various therapists and educators and
online support and family networks. That form the real foundation of care for
this patient. Do something similar for your own set of
needs if it's helpful and and you'll be prepared at that point to recruit your
key stake holders. And move forward into Part D of this
lecture where as I said before, we'll be talking in far more sort of pragmatic
terms about how to recruit these people. How to get them to give you the
information that you need and how to share back with them that information in
order to allow them to fully embrace your vision, your project and you particular
initiative. So we come to the end of Part A, I
want to thank you again for listening, want to say good bye to you now.
And hope that you'll view Part B at you convenience and and I appreciate your
attention, I really do. Thank you very much.
Bye bye.
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