Jyotish Sonowal and Peter Jones
The healthcare sector in the Western world is in the midst of a significant change. The majority of healthcare expenses are incurred through major tertiary care, performed in hospitals, which are generally structured and function in much the same way as 100 years ago. Care organizations are undertaking a gruelling process of having to maintain clinical continuity and yet advance as businesses in a world where funding policies, clinical and information technology, patient demographics and relationships between other healthcare systems are constantly changing (Cohen et al., 2004). Besides, governments throughout the developed world are under pressure from the goals of the (IHI) Triple Aim, to reduce healthcare costs, while improving the quality of care (Howie & Erickson, 2002; McCue, 1997; Segesten, Lundgren & Lindström, 1998) and satisfy the patient experience.
In such an environment, healthcare providers are finding it difficult to innovate business models or to understand the far-reaching social and environmental impacts of their services. Our OCADU research project investigated the adoption of designing business cases as systems for flourishing, to help clinicians and administrators in a hospital to reconceive and analyze their current clinical services, discover gaps and barriers to flourishing, and define recommendations. We take Ehrenfeld’s (2002) concept of flourishing as the aim of sustainability, nothing short of sustaining all life on earth forever. Keyes (1998, 2002) defined social flourishing as the sum of qualities that would ensure a healthy sense of well-being and social integration, which holds significance for healthcare activities. We employ a social ecosystem model to help identify functions and measures of flourishing across nested, multi final social systems. Using the Flourishing Business Canvas (Upward and Jones, 2016), this research project explores ways of impact definition and evaluation and also measures social and environmental benefits which will help decision-makers in a healthcare setting.
The study resolves a base of relevant literature in business models, business sustainability, lean process, and flourishing, in the healthcare context. A design action research methodology was employed, with expert and practitioner interviews and a business model design workshop. The participatory design workshop introduced the Flourishing Business canvas to clinical decision-makers (director and managers) in Toronto’s North York General Hospital in a generative session. The participants were engaged to collaborate and articulate their service lines as businesses, mapping their proposals using the FB canvas in the form of a model. Observations, verbal data, and canvas results were recorded. This and data from interviews with other clinical directors are tallied and analyzed to look for common challenges faced by the hospital and areas of opportunities. This analysis also leads to rich insights into the Flourishing Business modelling process, especially in a hospital setting.
The unique contribution is the design of a process and method for representing conditions and elements of flourishing within healthcare service lines: a business process that is currently desired but unavailable to organizations (Jones, 2016, personal conversation). The recommended process is an attempt at changing the mindset of planners in a hospital from traditional capital planning to systemic design-based planning and resource decision making. The culmination of the research insights led to service design proposals embodied in a blueprint for “soft services”, based on the 4C journey model (Jones, 2017) and adapted for this research.