NESTA on “people powered public services” and beyond the poverty of imagination

In my mind one of the most innovative organizations in the area of service design, cooperation and public services is NESTA.  They recently published a fascinating report,“The Human Factor”, that examines how co-creation with the public and patients within the context of the NHS can save both money and lives. The co-creation, cooperation, commons themes that run throughout the report are central to the work I’ve been highlighting on this blog around what I’m calling “open health”. The report is a must read for anyone interested in innovation in the healthcare or public health arenas. We’re going to have to become experts in this way of working in the future but getting organizations to think beyond traditional partnerships and anemic forms of ‘engagement’ will be challenging. Below I’ll provide some of the key insights from the report.

  • Beyond Efficiencies:  Just thinking in terms of saving money without changing the nature of service design will only get you so far.  What we need is radical redesign.  Think about how to design for desired outcomes rather than purely on existing, often dysfunctional and inappropriate infrastructures
  • A good case study of redesign is NeuroResponse, a social enterprise incubated by the Young Foundation’s Launchpad that addresses the unmet needs of patients with neurological disorders through the use of existing telecommunications infrastructures so that more patients can receive treatment at home. That is, moving from an acute care model to community care. The cost of a diagnosis of MS currently costs the system £17,000 per person or a total of £400 million of which the majority is for in-patient, hospital-based care. Telemedicine has the potential to save millions.
  • The Expert Patient Programme is another example of how self-care is being used to improve outcomes and patient satisfaction.  Hospital admissions have been reduced by 50% and visits to GPs reduced by between 40-69%.
  • Community-based initiatives tend to be better for behavioral change than top-down approaches. The Knowsley Primary Care Trust created a partnership for Wellbeing that focuses on cardio-vascular disease prevention at the community level and works through pubs, bingo halls and shopping centers. The result has been a 28% reduction in cancer morbidity rates and 32% decrease in smoking.
  • Well London is a consortium of health, environmental, education and arts organizations that invests in community projects for health behavioral change.  This includes projects like Healthy Spaces that transforms open spaces into greener, more attractive places.  Community mental health is one of the focus areas.
  • Transforming Innovation: perhaps the most difficult challenge is changing the way organizations think about innovation.  The US public health sector is in dire need of this change in mindset.  Getting funders AND organizations to take risks, experiment, move beyond dated ways of thinking about technologies and community is a challenge.  One of the platforms they’ve used in the UK is Patient Opinion, a platform that enables users of the NHS to provide feedback and develop networks of user-citizens to provide the essential feedback that innovators within the system can use to improve services.
  • Open Innovation for behavioral change: The Big Green Challengeis another initiative designed by NESTA focusing on climate change and how communities can reduce their carbon emissions. The program is essentially a platform that crowdsources ideas for innovative strategies and provides awards for the best proposals. The concept has been extended into the obesity/diabetes space through the Healthy Community Challenge Fund to test and evaluate ideas that make activity and healthier food choices easier.

In the month or so since I posted the draft white paper on open health and platforms for public health 2.0 below I’ve receive quite a bit of positive feedback from most quarters. One of the criticisms I receive from many within mainstream public health programs is that the content is bit ahead of where funders are in the present, too much in the future. I strongly disagree, these tools are here now. We’re at the BEGINNING of a prolonged financial crisis and the old ways of ‘doing’ health and public health are failing too frequently. This is the time to innovate and think about how to design more innovative approaches, innovative institutional cultures and experiment. I was listening to a conversation on stimulus funding in public health and how organizations are being asked to collaborate as they compete for funding from the federal government. We’re still thinking in terms of partnerships rather than networks. We rarely think of new business models that we could use in public health and couple these with user-led innovation and co-creation paradigms. We may not be able to fix the poverty of resources in the short-term but we can address the poverty of imagination in health if we open up to new paradigms.