Can Value Proposition Design Save Lives?

"...  hospitals are not rewarded for saving lives, they're rewarded for doing more procedures. When we prevent a patient from getting septic, some hospitals lose money."

As a part of preparing for HIMSS 2023 next week, the Janea Systems team has been consuming content from speakers whose talks we want to attend.

The speaker, in this case, is AI healthcare trailblazer Suchi Saria and the heartbreaking quote is from her 2020 TEDMED talk on overcoming barriers to AI adoption in hospitals.

Watching her talk about these barriers - reluctant clinicians, cagey software vendors, and profit-aligned hospitals – I was struck by how much this was a business model and value proposition design challenge. (Starts at 14:40 in the video.)

People face behavioral and structural barriers to adopting new technologies. Clinicians are busy and optimize for difficult local conditions. Electronic Records Vendors want to preserve both patient privacy and their own competitive advantage. For-profit hospitals have conflicting financial incentives and ethical obligations. Combine this with an absence of authoritative guidance on an emerging complex topic, and every adoption discussion starts near zero.

The guidance part is now forthcoming. The "coalition of the willing" at the Coalition for Health AI has released a "Blueprint for Trustworthy AI Implementation Guidance and Assurance for Healthcare". Aligned with the US Blueprint for an AI Bill of Rights, the CHAI blueprint contains recommendations from experts across healthcare systems, academia, government, and industry for:

"... a framework focused on health impact, fairness, ethics, and equity principles to ensure that AI in healthcare benefits all populations, including groups from underserved and under-represented communities."

However, guidance alone doesn't close the adoption gap. The blueprint ends with the observation that:

"... to foster an environment where an assurance standards guide and tools are deployed, we must examine various incentive structures and policies surrounding these. Incentives shape behavior, sometimes implicitly. A compelling business case for putting in the effort to build and coalesce around a national standard is needed."

That brings us back to business models and value propositions. As a startup person, I'm intimidated by the byzantine nature of institutional healthcare environments. They have all the complexity of large enterprises, while being literally life and death, combined with complex regulations, perverse incentives, and strange contradictions.

I thought about how design approaches could help – wondering if there was a bat signal for Alexander Osterwalder – and then realized that there are at least three top one-percent US business schools affiliated with the universities participating in CHAI. They probably have it covered and I'm looking forward to seeing the progress they'll make.