“Luke, use the Force”…but Obi, “We have the technology”

Okay, so I apologise for the awful mishmash of 1970s-era Hollywood quotes but the opportunity was simply too hard to resist – there is a point to this title!

In my last post, I talked about disruptive and sustaining research endeavours, and how disruptive research projects could align a researcher to a) be in a position to recognise serendipitous discoveries and b) for performing work in an area that is likely to have a large impact not just a publication level, but may possibly directly impact the recipient.

In this post, I’d like to talk about how a well defined value proposition in a particular field of research and the design structure matrix simulation tool can be used to push an idea through a “needs-first” ideation pipeline to maximise the impact of the research conducted.

“Errrr wha?” I hear you say. Let me take a few steps back….

So what is a value proposition, and how does it come about? Although there are many definitions, I like the definition that Wikipedia (yes, I know…) gives:

A value proposition is a promise of value to be delivered and a belief from the customer that value will be experienced.

Value depends on an individual’s perception what is being offered. For example, you decide that you would like to purchase a new mobile phone. You decide to visit your local mobile phone dealership where you are provided with a number of options in terms of brand and model of mobile phone, as well as various usage plans. Eventually, you decide to choose a particular mobile phone brand and model, bundled with a certain amount of service inclusions, and you enter into an agreement between yourself and the service provider that you will financially remunerate the service provider in return for the ability to use your new mobile phone on their communication network.

Using this example, value can be expressed in more tangible terms:

Value = Benefit / Cost

Benefit to the recipient is the ability to send text messages, make phone calls, and find information from the Internet. The costs incurred by the recipient is the fee he or she pays to the communications service provider. Value can be perceived by the recipient in different ways, but in this case, it is easy to argue that the ability to communicate is valuable, more so than the financial costs incurred. Ultimately, the mobile phone and a service contract gets a particular job done for the customer.

In the case of medical research, a value proposition can be quite difficult to define. How do you justify a large cost (human resources, money, and time) for benefits that may be quite incremental in the management of a particular disease, or results in only a benefit to a small population or group of people suffering from a rare disease? Worse still, how do you justify the costs incurred by the taxpayer to invest in a scientific research project that is considered to be “fundamental work” and may not have true impact for many years to come, well after the political ebb and flow of research funding has swept out into the sea where you drown?

It’s any wonder why funding bodies don’t just simply walk away from it all!

Compound a poor value proposition with the Catch-22 situation an early career medical researcher is faced with (few publications, inexperience in grant writing, overwhelming choice in research direction) and you have the perfect conditions early stage career failure.

There is however, a way to get around a poor value proposition, as well as a way to direct a career down certain path. It starts with gaining unconscious consciousness about the field that an early stage researcher is interested in.

A postgraduate student is taught that the literature review years a good way to discover knowledge in a particular field. I contend that the review of literature is only one component of research when it comes to discovering the core issues that will drive a particular research endeavour. Patent searches in the areas where research translation success is measured in terms of commercial output is a well described ” alternative path” to discovering the competitive research and commercial landscape, but it’s not relevant for researchers in public health research. In many medical research organisations, commercialisation activities (esp. drugs and medical devices) are considered to be “innovation”, because tangible value can be delivered to the customer in exchange for financial return.

In public health research, value to the customer are not always tangible, and does not always return financial benefits to those that instigated ideas, solutions and background research needed to solve a particular public health problem. This is where the typical commercialisation pathway breaks down; the model just doesn’t work in this particular domain as commercialisation activities can be considered as being a specific case of entrepreneurial endeavour.

If one considers entrepreneurial endeavours to be a general case of linking together available resources in a creative way to solve unsolved problems, then entrepreneurial principles can be applied in the area of public health research – I don’t have a name for the entrepreneurial activities in healthcare research, but it would be the sibling to commercialisation in the pharmaceutical/medical technology context.

So how do you define a good value proposition in public health research? In pharmaceuticals, serendipitous discoveries will often define the value proposition – just take the discovery of Viagra as a potent vasodilatator as well-known example. Well, public health researchers could take a leaf out of the Medtech entrepreneur’s handbook. In the medical technology space, a technology can be made to work given the right amount of money, resources and time. However, the most breakthrough medical devices are the ones that specifically solve well-defined, well-characterised problems. Many start-up medical technology companies go through the process of clearly identifying a clinical, surgical or another problem that needs to be solved, and then designs the technology around the problem so that a solution can be effectively implemented compared to existing solutions.

Effectively, a small company developing a medical technology needs to have full insight into not just the medical problem, but also the environment in which the medical problems are addressed, the patient’s experience, the healthcare providers’ economic burden, the framework in which a government may subsidise such a treatment/technology and most importantly, whether healthcare professionals closest to the patients believe that such a technology could revolutionise the way the medical problem is treated or managed. The company needs to have an unconscious consciousness and global overview of the medical problem they are trying to solve with technology. Unconscious consciousness is a state where you know and understand the problems so well that you can articulate every relevant aspect that needs to be addressed in order for the problem to be solved.

The best example of unconscious consciousness can be highlighted with an elite sportsperson. The years of training combined with natural ability allows an individual to understand how their body performs under extremely stressful situations. The sportsperson understands their body so well that when they compete, to the average observer, their actions seem flawless and effortless. However, the trained observer will realise that it is natural ability, years of training and a complete understanding of the environment and the operator’s actions within that environment that leads to the amazing performances that are showcased.

So let’s relate this concept back to medical research, in particular public health research. How does one gain unconscious consciousness about a particular problem that medical research aims to solve? Certainly the literature review is a first step, but it doesn’t allow a larger picture of the problem to be painted – literature is just that, literature. It tells little or nothing about the voice of the customer and the experience that someone suffering from a particular disease may be experiencing.

To gain unconscious consciousness, one needs to walk as close as possible a path that a disease suffer/patient walks. To do this, a researcher must engage with people actually experiencing the disease, the carers that care for them, the NGO’s that provide care and financial support for the families and patients when there are gaps, patient support groups, local healthcare networks as well as policy-makers in government that dictate how people with particular disease can have their medical expenses subsidised/re-imbursed through government agencies and programs.

By experiencing the problems, challenges and hardship that someone with a chronic disease has to endure, the researcher becomes much closer to gaining unconscious consciousness (aka enlightenment) of the issues the patient must deal with on a day-to-day basis. The researcher is exposed to the global picture of the problem, the stakeholders involved and where current treatments, interventions and programs fail. Networking is absolutely critical here, as often, word-of-mouth discussions can spawn new collaborations, or expose a researcher to serendipitous opportunities.

Armed with this new knowledge, a good value proposition for the research endeavour can be well-defined and well-argued. This makes the perceived benefits (and therefore perceived value) of the research project higher, thus making it a higher priority project in the eyes of a funding body compared to other, less well-thought-out research proposals. This is absolutely critical for the early career researcher as they are poorly funded and have a short track record in publications – they need a big break to get their careers started so the “first impression” has to be good.

Unconscious consciousness can be gained by biomedical science / science graduates when they work as a research assistant before they decide to embark on postgraduate research. A young researcher being immersed in a laboratory or research environment gets to understand not only the research being performed, but also gets to see the politics of the organisation, how research is performed (well, or otherwise) in the “real world” and make connections with potential supervisors. This knowledge hopefully allows the potential postgraduate student to make an informed decision about which project to embark on and what lab to perform the work in, rather than picking a project “because it sounds interesting”.

So where does outcome-driven innovation, the Minimum Viable Solution (MVS) and the Design Structure Matrix simulation tool come into play?

Well, going back to my post’s title – if you can consider unconscious consciousness as “The Force”, then you can consider such tools as the Design Structure Matrix simulator as “The Technology”

In my previous blog post, I talked about how outcome-driven innovation using the “needs-first” approach is superior to the “ideas-first” approach. By developing a well-defined, highly beneficial value proposition to solve a well-characterised, well-understood problem, an investigator has effectively undertaken the “ideas-first” approach to solving a problem in medicine. By defining the scope of the problem and understanding it inside-out, often, the general concept about a solution can be ideated. The solution can be large or small, but with an early career researcher, a small solution is more suitable as it is the first step in establishing funding and opportunities to publish. Pilot studies to quickly validate new solutions are extremely beneficial – I consider pilot studies to be the Minimum Viable Solution (MVS). If the final solution is global, the MVS might be a program that can be implemented at a single hospital site, a solution that can be easily replicated at other sites, or on a regional scale. Because the solution has been well-ideated with a global perspective of the problem in mind, it should then be easier to translate the MVS on to a much larger stage where it can have maximal impact. If a particular MVS is not suitable and fails, at least it fails when it is small when the resource expenditure is minimal. Resources that would normally be used to implement one large solution can be used to greater effect by fuelling multiple MVS’ until the most suitable MVS emerges.

Once an MVS has been defined, work needs to be undertaken to develop the solution for point where it can be delivered to the recipient. Often, this process can be quite confusing, or decisions about how the program or solution is structured relies on the investigators knowing information that they don’t currently have. It may be difficult to judge where limited resources need to be allocated in order to make the MVS work.

Enter the Design Structure Matrix (DSM) simulation tool. Originally created in the United States to aid the development of the Apollo program to get humans onto the moon.

DSM is one of the many types of project management tools that are used in technology development. The design structure matrix tool a particularly excels in the management of codependent tasks, or tasks that need to be performed concurrently in order for key information and knowledge to be generated. For example, the design of a new health-care programme may need to suit a particular region, but without discussions with local hospital networks, the proposed design may not work. Here, a project simulated using a design structure matrix tool may highlight this obstacle, and possibly indicate that the design of the program may need to occur simultaneously with key people in the local hospital network so that the interdependent activities can generate all the relevant information that is needed.

I won’t go into the full details of how DSM tools work (perhaps in another blog post if people request), except to say that in the planning stages of research projects, they are superior to standard project management tools that only allow for linear processes (i.e, one tasks follows another, and tasks are no co-dependant). They can highlight potential roadblocks in your project, map out your career, help you decide where resources need to be allocated and flag potential risks well before you get to them. DSM tools are technical innovation programs used by innovators and entrepreneurs that are exceptionally useful in helping develop MVP’s based on good value propositions. You can read more about DSM tools at DSMweb.org.

Well, this post has been a long one, but these ideas have been on my mind for a while so I had to get them out! As always, thoughts and comments are welcome.

@ayftan

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