Reflection – Visualization

Challenge

I was hired to lead the turn-around of a struggling Healthcare IT start-up that had been losing  money since its inception 5 years earlier.  The company aggregated unstructured data for all  Geriatric Care Providers from the licensing boards across all 50 states in over 24 categories of  care and provided tools to utilize that data in the form of custom portals for large Non-Profit  and Patient Advocacy Organizations. In most cases these custom portals are the centerpieces of  these organizations’ web-sites and one of the most significant resources that they provide to  their constituents. The portals are used to help care-seekers with serious age-related, chronic  medical conditions such as Alzheimer’s, Dementia, Kidney Failure or Arthritis identify  appropriate service providers in their areas.

Unfortunately, the cost of aggregating the data was much higher than the licensing revenue  was generating, and after 5 years of negative cashflow, the business was at risk of failing.  In  addition, the company’s biggest clients were complaining about the quality of the data and the  limited functionality of the portals we hosted for them. Providers were unhappy because we  charged a high annual fee for “featured listings” which put them at the top of search results  even when they weren’t the best fit for the clients. It took months to close a sale with a  provider and the renewal rate was less than 5%.  It was apparent that we were going to have to  come up with new ways to generate revenue while reducing operational costs.

Selection

It was difficult to fully comprehend the magnitude of the existing operational challenges much  less chart a path towards success just by interviewing the various stakeholders in the business. I  chose visualization for its usefulness in helping to facilitate a shared understanding of the core  issues facing the business and in building consensus around the best approaches for  overcoming those issues. Throughout the “What is” and “What if” phases, I relied heavily on a  variety of visualization techniques depending upon the problem domain and the stakeholders.  The tools used ranged initially from White Boards/Markers and Brown Paper/Sticky Notes to  software like Excel, Adobe Illustrator and Power point for UI mock-ups and process flow  illustration.

Application

I was able to make extensive use of visualization through all four phases of the Design Thinking  process, from What is and What if, to What wows and What works. To understand “what is” we  employed large 3’ x 10’ sheets of brown paper. We taped the paper to the wall and began  putting up post it notes representing the high-level steps required for existing processes.  Because of the ample space afforded we were able to add actual artifacts to the brown paper  exhibits such as responses from ethnographic interviews with clients as well as sample inputs  and outputs of our services. This enabled all the members of our team to have a comprehensive

and shared understanding of the serious issues and challenges we faced. To brainstorm and  gain consensus around “what If” approaches we discussed alternative ways to think about the  jobs we were doing and the problems we were solving for the different respective constituents  and we added sticky notes to the existing process flows. We then began to move the sticky  notes around on the papers in new or novel ways. To address the “What wows” and “What  works” questions we created several alternative UI mockups from new screen designs to  sample proposed process outputs and put them together in PowerPoint slide decks to help  others understand the company’s new vision. We included new proposed process flow designs  with animation in our slides to add clarity to how the proposed process would work and to  illustrate the improvements over existing processes so that we could share those ideas with our  existing and prospective stakeholders. The slides enabled us to engage in co-creation sessions  with each stakeholder, and were very valuable tools for soliciting their ideas, input and  feedback. It was almost like presenting them with a new product without having had to go  through the expense of developing it. They were excited about the progress we were making  and the fact that they were invited to help shape the product.

Insight

The primary insight we gained was that both Care-seekers and Providers had felt overwhelmed  with the high “noise to signal” ratio in our existing service.  Simply put, our search tool brought  back too many prospective providers for care-seekers to sift through and conversely providers  were being overwhelmed with calls from too many unqualified leads or prospective care- seekers and they were getting too few calls from qualified care-seekers. There was a clear need  for our service to do a better job of intelligently filtering and matching the unique needs of  specific care-seekers with the unique offerings of the different providers in a given service  category.

This key insight yielded a series of “what if” questions centering around the notion of a smarter  search engine and the production of a custom scoring system for how well each provider in a  specific geography matched a given care-seeker’s articulated unique needs.  This scoring system  would provide a rank ordered listing of customer-specific qualified providers to the care-seeker.   Feedback on this idea was overwhelmingly positive.  Both Care-seekers and the Service  Providers could see enormous benefits in having the system do the heavy lifting of matching  the needs of the care-seekers to the providers best suited to meet those needs and to provide a  short-list of those providers in a nicely formatted report. This could not only save several days’  worth of time for care-seekers while yielding better patient outcomes but it could also,  simultaneously, save massive amounts of time for Providers who could spend less time filtering  out unqualified leads.

The key innovative ideas or “napkin pitches” we developed using design thinking were:

• Implementing automated enrollment and a low recurring monthly subscription for

providers instead of manual enrollment and a high annual fee for a featured listing.

• Providing a care-seeker profile to capture their unique needs and using that to generate

a custom rank ordered listing of providers best matching their needs

• Providing master corporate accounts for providers with multiple locations  • Eliminating the “pay for placement” concept with a merit based placement on search

results based on the degree to which a provider matched a care-seekers articulated  needs rather than how much providers paid for a listing.

• Offering a $300 rebate to care-seekers who use the service paid for by providers whose

service they selected.

• Sharing the rebate revenue and provider profile revenue with Non-profit clients.

Some of the innovative ideas that we presented to our clients and prospects for feedback and  consideration that we thought would be the most popular unexpectedly turned out to be the  least. One was the notion of offering a provider-funded cash rebate to care-seekers who used  the service.  We had believed that this would be a great idea and that we would be the only  company in the country not only providing the highest quality search service to Care-seekers,  but also paying them several hundred dollars to use the service. While the providers gravitated  to the idea, the feedback from prospective care-seekers was that they would feel awkward  getting a cash rebate for choosing one provider over another for their parent.

Approach

For the sake of expediency, we presented our portfolio of “napkin pitches” as a single  comprehensive symphonic solution rather than rolling these out separately and atomically. As a  small company we simply did not have the resources to manage six separate campaigns. If we  had had more time and resources, perhaps we could have presented each concept individually,  but we felt the sum of the whole was greater than the parts and presented a more compelling  story in its entirety. Our learning launch was very successful. In the first few weeks of rolling out  the automated enrollment and monthly billing option for providers the number went from 50  to over 1,500 paying providers.

An alternative tool that would also have been highly effective for this exercise is Storytelling.  Our problem domain affects nearly every household in the country and storytelling would be a  great fit for the highly emotional and personal nature of the problems of caring for elderly  loved ones. During our ethnographic research we heard countless horror stories of the impact  of placing loved ones with the wrong providers and the terrible emotional and financial burdens  those decisions caused their families. The research we did on the provider side also revealed  the hardships providers experienced having to pay excessive referral fees to agencies like A  Place for Mom which caused them to have to sacrifice food quality for residents of Assisted  Living Facilities to make ends meet. Using real names and faces to relate these experiences as  stories instead of reducing them to statistics could have enabled us to create more emotionally  impactful presentations to our Non-Profit clients.


Reflection – Visualization Challenge I was hired to lead the turn - around of a struggling Healthcare IT start - up that had been losing money since its inception 5 years earlier . The company aggregated unstructured data for all Geriatric Care Providers from the licensing boards across all 50 states in over 24 categories of care and provided tools to utilize that data in the form of custom portals for large Non - Profit and Patient Advocacy Organizations . In most cases these custom portals are the centerpieces of these organizations ’ web - sites and one of the most significant resources that they provide to their constituents . The portals are used to help care - seekers with serious age - related , chronic medical conditions such as Alzheimer ’s , Dementia , Kidney Failure or Arthritis identify appropriate service providers in their areas . Unfortunately , the cost of aggregating the data was much higher than the licensing revenue was generating , and after 5 years of negative cashflow , the business was at risk of failing . In addition , the company ’s biggest clients were complaining about the quality of the data and the limited functionality of the portals we hosted for them . Providers were unhappy because we charged a high annual fee for “ featured listings ” which put them at the top of search results even when they were n’t the best fit for the clients . It took months to close a sale with a provider and the renewal rate was less than 5 % . It was apparent that we were going to have to come up with new ways to generate revenue while reducing operational costs . Selection It was difficult to fully comprehend the magnitude of the existing operational challenges much less chart a path towards success just by interviewing the various stakeholders in the business . I chose visualization for its usefulness in helping to facilitate a shared understanding of the core issues facing the business and in building consensus around the best approaches for overcoming those issues . Throughout the “ What is ” and “ What if ” phases , I relied heavily on a variety of visualization techniques depending upon the problem domain and the stakeholders . The tools used ranged initially from White Boards / Markers and Brown Paper / Sticky Notes to software like Excel , Adobe Illustrator and Power point for UI mock - ups and process flow illustration . Application I was able to make extensive use of visualization through all four phases of the Design Thinking process , from What is and What if , to What wows and What works . To understand “ what is ” we employed large 3 ’ x 10 ’ sheets of brown paper . We taped the paper to the wall and began putting up post it notes representing the high - level steps required for existing processes . Because of the ample space afforded we were able to add actual artifacts to the brown paper exhibits such as responses from ethnographic interviews with clients as well as sample inputs and outputs of our services . This enabled all the members of our team to have a comprehensive and shared understanding of the serious issues and challenges we faced . To brainstorm and gain consensus around “ what If ” approaches we discussed alternative ways to think about the jobs we were doing and the problems we were solving for the different respective constituents and we added sticky notes to the existing process flows . We then began to move the sticky notes around on the papers in new or novel ways . To address the “ What wows ” and “ What works ” questions we created several alternative UI mockups from new screen designs to sample proposed process outputs and put them together in PowerPoint slide decks to help others understand the company ’s new vision . We included new proposed process flow designs with animation in our slides to add clarity to how the proposed process would work and to illustrate the improvements over existing processes so that we could share those ideas with our existing and prospective stakeholders . The slides enabled us to engage in co - creation sessions with each stakeholder , and were very valuable tools for soliciting their ideas , input and feedback . It was almost like presenting them with a new product without having had to go through the expense of developing it . They were excited about the progress we were making and the fact that they were invited to help shape the product . Insight The primary insight we gained was that both Care - seekers and Providers had felt overwhelmed with the high “ noise to signal ” ratio in our existing service . Simply put , our search tool brought back too many prospective providers for care - seekers to sift through and conversely providers were being overwhelmed with calls from too many unqualified leads or prospective care- seekers and they were getting too few calls from qualified care - seekers . There was a clear need for our service to do a better job of intelligently filtering and matching the unique needs of specific care - seekers with the unique offerings of the different providers in a given service category . This key insight yielded a series of “ what if ” questions centering around the notion of a smarter search engine and the production of a custom scoring system for how well each provider in a specific geography matched a given care - seeker ’s articulated unique needs . This scoring system would provide a rank ordered listing of customer - specific qualified providers to the care - seeker . Feedback on this idea was overwhelmingly positive . Both Care - seekers and the Service Providers could see enormous benefits in having the system do the heavy lifting of matching the needs of the care - seekers to the providers best suited to meet those needs and to provide a short - list of those providers in a nicely formatted report . This could not only save several days ’ worth of time for care - seekers while yielding better patient outcomes but it could also , simultaneously , save massive amounts of time for Providers who could spend less time filtering out unqualified leads . The key innovative ideas or “ napkin pitches ” we developed using design thinking were : • Implementing automated enrollment and a low recurring monthly subscription for providers instead of manual enrollment and a high annual fee for a featured listing . • Providing a care - seeker profile to capture their unique needs and using that to generate a custom rank ordered listing of providers best matching their needs • Providing master corporate accounts for providers with multiple locations • Eliminating the “ pay for placement ” concept with a merit based placement on search results based on the degree to which a provider matched a care - seekers articulated needs rather than how much providers paid for a listing . • Offering a $ 300 rebate to care - seekers who use the service paid for by providers whose service they selected . • Sharing the rebate revenue and provider profile revenue with Non - profit clients . Some of the innovative ideas that we presented to our clients and prospects for feedback and consideration that we thought would be the most popular unexpectedly turned out to be the least . One was the notion of offering a provider - funded cash rebate to care - seekers who used the service . We had believed that this would be a great idea and that we would be the only company in the country not only providing the highest quality search service to Care - seekers , but also paying them several hundred dollars to use the service . While the providers gravitated to the idea , the feedback from prospective care - seekers was that they would feel awkward getting a cash rebate for choosing one provider over another for their parent . Approach For the sake of expediency , we presented our portfolio of “ napkin pitches ” as a single comprehensive symphonic solution rather than rolling these out separately and atomically . As a small company we simply did not have the resources to manage six separate campaigns . If we had had more time and resources , perhaps we could have presented each concept individually , but we felt the sum of the whole was greater than the parts and presented a more compelling story in its entirety . Our learning launch was very successful . In the first few weeks of rolling out the automated enrollment and monthly billing option for providers the number went from 50 to over 1,500 paying providers . An alternative tool that would also have been highly effective for this exercise is Storytelling . Our problem domain affects nearly every household in the country and storytelling would be a great fit for the highly emotional and personal nature of the problems of caring for elderly loved ones . During our ethnographic research we heard countless horror stories of the impact of placing loved ones with the wrong providers and the terrible emotional and financial burdens those decisions caused their families . The research we did on the provider side also revealed the hardships providers experienced having to pay excessive referral fees to agencies like A Place for Mom which caused them to have to sacrifice food quality for residents of Assisted Living Facilities to make ends meet . Using real names and faces to relate these experiences as stories instead of reducing them to statistics could have enabled us to create more emotionally impactful presentations to our Non - Profit clients .