Written by Lucy Fulford
Banking hadn’t changed in decades before disruptive, challenger banks like Monzo gained cult status among customers for their ease of use. These challengers fulfilled needs people didn’t even know they had, but soon came to rely on – individually relatively small benefits such as choosing PINs, blocking lost cards from an app or receiving geo-tagged purchase notifications – but collectively amounting to a very different experience.
What brings them together is the quality of thinking behind the consumer experience. Today, parts of pharma are adopting different user-centred design approaches to their products and services, each moving away from pill-first, top-down and enjoying better patient outcomes and better ROI as a result.
There are two related, but separate, modes of thought.
1. Design Thinking
Design thinking was introduced many years ago by organisations like Ideo, but made famous by high-profile examples like Apple and GE, who have profited from this approach, according to Gregory Miller, leader of Global Marketing and Innovation Excellence at UCB.
“Design thinking is a tried and tested methodology for new ways of working and we are just catching up. It starts and ends with the patient. You design solutions in a creative way and don’t fall in love with existing ones. You have a prototype mindset, so you are testing, failing and learning, and scaling up when you have something really viable.”
2. Human-centred design
Separate but not necessarily independent from design thinking, human-centred design focuses on inverting the traditional internal development processes which have tended to emphasise technical or chemical capability over the human experience, explains Laura Hammershoy, Director of Healthcare Research and Innovation at London and San Francisco design agency Native.
“We talk about human-centric design as being about inside-out innovation,” says Hammershoy. “You may have a great molecule that can do A, B and C, and work out how to put that into the world. The opposite would be to start with the patient experience and ask, ‘What do they need? How do our technical capabilities fit with what is valuable for them?’”
The Design Approach in Practice
Listening and observing both patients and clinicians helped identify important unmet needs that Native used to drive its design strategy for new intimate care solutions, for Coloplast. The results of a process, which covered the entire Ostomy, Woundcare and Continence portfolio of products, delivered vastly improved experiences, and products that felt like they were created with care and attention to the user. People felt like people, not patients. One particular colostomy bag had the materials changed for fabrics that looked and felt like clothing, did not conform to classic medically-looking flesh-tones and reduced friction between the skin. It went on to out sell its competitors by four to one.
There has been a clear financial benefit to these innovations: Over the seven year engagement with Native, Coloplast’s share price soared by 500%, they generated the best worldwide patient reputation among 28 leading medical companies for 3 years in a row, and Forbes ranked them as one of the world’s most innovative companies.
The shifts in the marketplace towards value-based healthcare, and the inexorably more patient-centric approach in healthcare, will only serve to drive pharma towards these ‘pull’ or outside-in innovation models, and away from the historic ‘push’ models, says Miller.
“The days where payers would pay for something coming out of the research lab, physicians would prescribe it and patients just swallowed it (literally) are over. If we don’t recognise these tectonic shifts in the market and continue to push, our solutions will become irrelevant. You need to define, in the market, what the needs are and then work backwards before we can say we’ve designed solutions.”
As a laggard in applying these kind of design principles, the healthcare sector has a sizeable opportunity, he adds. “Because the experiences are bad, and inefficiencies are high, if you apply design thinking, you’re going to improve things a lot. It’s the new El Dorado.”
There are two distinctive applications to human-centric design in the pharma industry, says Hammershoy. “It's definitely valuable when we're designing supportive services around the pharmaceutical product itself after launch, a sort of ‘pill plus’ solution. It’s also really helpful in rethinking an entire company’s approach to a therapeutic area, asking how it can be more meaningful to patients and HCPs, essentially refocusing R&D innovation activities on the human experience.”
This doesn’t mean reducing the validity and importance of scientific research, it’s fundamentally a reordering of the way we do things. With human-centric design, the first step is conducting an audit into a client’s organisational structure, the R&D pipeline, their patient populations and therapeutic areas, and their appetite for innovation, says Hammershoy. “What’s their ambition and at what level of the business is this grounded? Are they looking for a test project or are they ready for more transformative engagement?”
It’s rare to find foundational, real world patient insights to work with at this stage, says Hammershoy, because human-centric research generally sits with marketing, at a later stage in the pipeline. “That happens when there is a product in market, not in R&D, which creates a situation where there are no deep insights. That research is product-focused and more evaluative than exploratory.”
Deeper insights matter because patient insights at the research stage can signal the need to explore diverse disease mechanisms, says Niclas Nilsson, Head of R&D Open Innovation at LEO Pharma, citing a simple example in the company’s psoriasis work. It was discovered that ‘traditional targets’ such as inflammation and scaling must be targeted, but patient feedback indicated the itch factor was a primary problem, which can be treated with an entirely different chemical pathway.
The historical lack of such deep and early insights is something LEO is trying to combat through his pioneering pilots in Denmark to bring users into the R&D process. “Incorporating patient needs earlier in the R&D process is quite a challenge, but also greatly needed. Together with openness, it ensures a better fit when the product comes out and could be a very simple way to reduce attrition and increase product efficacy.”
Building on the success of LEO Pharma’s collaborative Open Innovation programme (which seeks to lower the barriers to entry in the skincare field by allowing biotechs, universities and other pharma companies to bring molecules to LEO’s labs for free, including providing anonymous analysis, without losing their IP or signing up to new business obligations), Nilsson has ambitions to bring patients wholly into the research stage by harnessing the unique subsector of patients with a scientific background.
“It's about democratisation of science,” says Nilsson. “We thought, ‘Why can’t we include patients in this possibility?’ So that’s something we’re trying to do on an exploratory basis. We don’t have to limit this collaboration to companies. If patients have a scientific interest, they could participate in this programme and we now have the platform to make that happen.”
Catalysts for change
When it comes to flagship examples of Design Thinking in healthcare, Miller points to the Mayo Clinic, the Cleveland Clinic and the work of the Helix Centre innovation lab, which is embedded within St Mary’s Hospital, London. “These companies apply this methodology to every small and big challenge within the hospital, and the sky is the limit,” he says.
Over the past three years Miller has pioneered his own programme of design-thinking, called Team of Accelerators for Innovative Solutions (TAXIS), to embed its principles throughout UCB’s global operations. Based on the idea of creating change agents, it recruits some 40 innovators, across geographies and functions, to participate in an annual curriculum on design thinking and apply their learnings to their existing roles.
“We bring them on a journey in a very structured and rigorous way,” says Miller. “Staff keep the same objectives but the way to reach them might differ, because we give them additional competencies that make them more successful. We now see that design thinking is everywhere in the company. It’s a new way of thinking, working and collaborating.”
This process is very visible in the test case TAXIS teams were given, which was to redesign the lunch experience in UCB’s cafeteria. Initial observations focused on the long queues and the food offerings. “If we didn’t apply design thinking with rigour, people would have simply redesigned these,” says Miller. “But by going deep, with empathy research, we realised the problem to be solved was that people don’t want to be seen going to eat alone, and it’s more to do with identity and social connection. We ended up designing a vastly different solution.”
UCB has identified six dimensions of impact and see clear metrics of success. Counter-intuitively perhaps, one measure of success is that more projects are killed as a result of this approach, as it’s easier to identify when they’re not addressing a user need. Meanwhile, projects with promise which had been stuck are now accelerated and made more impactful thanks to enhanced creativity. Design-thinking is also harnessed externally as a way to engage UCB’s customers.
Embedding this approach inside an organisation is not easy for a number of reasons. The ambition to become more patient-focused is often at odds with how a pharma organisation is set up, for example, often requiring larger restructuring and capacity building projects. “It’s a difficult path because most corporations are not incentivised to think differently but to perform the way they’ve always performed,” says Miller.
Designing for the future
For organisations that do successfully embed a human-centred design approach, however, the “potential is unlimited,” says Hammershoy. “We've seen through our work in medical devices, health insurance, wellness services and pharmaceuticals that human-centric design has the potential to change the whole fabric of how healthcare is delivered. Getting patients and users engaged in their own healthcare is key to making any intervention work, and to engage patients or users we need excellent design.”
The future is collaborative, says Nilsson, reflecting on the open innovation approach at LEO. “From a long-term perspective, you’re investing in a network and scientific community and your ability to try things that you wouldn’t otherwise do. It’s difficult to go out there and find something that you don’t even know exists but that’s the only way you can drive novel research, that together with patient engagement can generate innovative solutions.”
Being prepared to take these first steps into the unknown is vital to success, says Miller. “There is a saying in design thinking: start small, think big. Very often in companies we think big and we don’t start, because it’s almost too big.
“For me, a good example is Facebook. Mark Zuckerberg didn’t wake up one day in his dormitory in Harvard and say, ‘I’m going to change the world; I’ll have 2 billion people on Facebook.’ It was a small start on his campus and he was smart enough to iterate and to learn it was about social connection.
“It didn’t come from a vision but from addressing a small challenge. This is design thinking. We never start by saying, ‘The future will look like this.’ We fall in love with challenges, not solutions. That’s what unique about it.”
Whether you take a Design Thinking or Human-Centred Approach, or attempt to combine both, it’s clear that we in pharma have a huge amount more to provide. Moreover, we’re probably not yet even aware of what we should provide. Going forward, a holistic, patient-first approach must be far more than lip service, in the same way that design itself must be more than a cosmetic addition. We need a defined framework for maximising value, and we’re only at the very beginning.
We created this content in association with the 18th annual eyeforpharma Barcelona Conference where we’ll bring together design-thinking leaders like this together to hear from Janssen, Novartis, Pfizer and more about how they are pioneering for the patient.