ASSESSING IMPACT
Although design thinking may seem at odds with a bottom-line mentality, thinking creatively about how to assess impact can be as essential as thinking creatively about solutions. Organizations today live in quantitative cultures, so figuring out how to put together a compelling financial case for an idea’s potential value is often crucial in finding the support, funding, and other resources needed to launch a creative concept. Such an assessment helps determine whether the concept really “wows” and delivers to the organization and its stakeholders anticipated benefits that justify the investment needed to scale it.
A Closer Look at Ignite
Let’s take a closer look at the Ignite process in its current form. Read Holman contrasts the Ignite Accelerator with the government’s “business as usual” approach (which looks a lot like Innovation I):
The standard governmental process is—and this is definitely a broad, sweeping stroke but there are definite truths here—put a bunch of experts in a room, usually with a nice big oak table and leather chairs, and have a series of meetings for six months, where they chart out what needs to happen. Then they write a statement of work. Then dollars, typically millions of dollars, are put towards that statement of work, and a contractor comes in to build and launch it. And then it turns out most of these new programs don’t work quite like they were supposed to. The Ignite Accelerator is trying to provide a space for testing the idea prior to the point of putting funds towards a contractor.
Two years after the Whiteriver team joined Ignite, HHS announced the fifth round of the accelerator. In the HHS IDEA Lab blog, Read gave these reasons why HHS staff might consider one or both of the programs:
• Because you know that there’s got to be a better way to do things.
• Because that annoying operational problem isn’t going to fix itself.
• Because you’re seeking a professional growth opportunity.
• Because you’ve been at HHS for under 5 years and you’re starting to lose your mind.
• Because you’ve been at HHS for over 5 years [and] wouldn’t mind a spark to (ahem) ignite a significant effort.
• Because you’re an example of how wrong the stereotype of the government employee is.
• Because…Well, why [the] heck not?
Even the tone of the announcement makes it clear that Ignite is far from government as usual.
In selecting its fifth class from among eighty-two ideas and teams from across HHS’s dozen agencies, the IDEA Lab worked to ensure rigor and validity, with a twist. Assigning scores based on a project’s alignment with both HHS’s and the specific agency’s mission, their description of the problem and its related systemic issues, and the anticipated merits of any proposed solution, HHS used twenty-five reviewers, in panels of five, to ensure that each team’s idea was analyzed thoroughly. If any review panel unanimously voted to advance an idea—even if it didn’t produce a top score—that team also made the finals. And then, outside of all scoring, IDEA Lab staff pulled another sixteen wild card teams into the finals. “We believe in rules and algorithms to ensure fairness, but we also hesitate to over-rely on them at the risk of losing the touch of human judgment,” Read explained.
Finalists were introduced to human-centered innovation tools and techniques and received mentoring from former Ignite program winners. Each finalist team completed at least ten interviews to ensure that their ideas were in line with their stakeholders’ reality. In this discovery phase, the finalist teams became acquainted with the ethnography to address the What is? question. They then produced a five-minute pitch for a handful of Read’s staff and faced thirty minutes of questioning in hopes of becoming one of twenty teams to advance to the full Ignite Accelerator program. In the full Ignite Accelerator, the twenty winners received intense design thinking training at the three-day boot camp in DC, and a $5,000 stipend.
Winners also had the inside track to compete for venture funding, a post-Ignite extension offering funds to assist innovative teams and ideas in taking their validated concepts to the next phase. Although HHS hopes that the final Ignite teams find money within their agencies to continue piloting any innovative ideas—as Whiteriver Hospital did—they also provide $50,000 to $100,000 grants to innovation as part of a venture fund.
Overall, the HHS approach works to ensure good use of resources. IDEA Lab staff judge the depth of the teams, the strength of their commitments, and the general feasibility of their ideas. They are especially interested in the passion, determination, and curiosity of the applicant teams, more so than the strength of whatever idea they are proposing. The question is whether teams can back off their personal investments in already existing “solutions”—solutions that, after all, got them into the Ignite finals—if and when the data fail to support their assumptions. Fighting the urge for winning teams’ original ideas to focus all thinking and drive all research efforts, IDEA Lab staff constantly underline the research, insight, and reasoning underlying any concept, before it is chosen for a learning launch. Staying in the “question space” until the team truly understands a problem and the stakeholders involved with it can seem inefficient to type A “doer” personalities—often the types of people who apply for projects like the Ignite Accelerator—but IDEA Lab constantly works to counterbalance that natural yearning, because a rush to judgment can mask major issues.
Ignite’s three-day design thinking and innovation boot camp in Washington, DC, designed to transform the twenty winning teams into innovation champions, is not unusual in today’s world. Across government and business, many attempts to spread design thinking use such workshops, which build enthusiasm for new ways of doing things. But we worry that many of the ideas they generate end up on the cutting-room floor when employees return to their day-to-day obligations. Through the entire Ignite process, HHS is working to ensure that this doesn’t happen. Besides requiring the teams to commit up front to a three-month program, of which the boot camp is just the kickoff, the IDEA Lab requires supervisors’ agreement to provide the teams with time to work on their projects during a full quarter of the fiscal year. In fact, the twenty winning teams are told to expect that 25 to 50 percent of their time in the three months after the boot camp will be spent brainstorming, honing, and reimagining their projects. During that time, they receive consistent mentoring and often find that their original solution missed the problem, as Whiteriver did.
One team in the 2015 Ignite class, for example, entered the Ignite Accelerator process with the intention of redesigning an awkward eleven-page form used in the Centers for Disease Control and Prevention (CDC). Instead, doing ethnography with CDC scientists, team members discovered that, more than anything, the scientists wanted to understand the whole technology transfer system. In the end, rather than simply redesigning the form, the team developed cartoon videos and an electronic tracking document, which were well received by CDC staff. One participant highlighted how the program encouraged a new mindset: “I think about problems differently now and focus on what a user actually needs. Just because we see something as problematic, doesn’t mean that’s the problem users want us to solve!”
The Ignite process stresses the iterative nature of design thinking, and the IDEA Lab encourages teams to remain open to divergent thinking even into the learning launch and piloting stages of the project. “There’s the notion of low-resolution prototyping,” Read noted. He explained:
Instead of automatically putting funds towards a contractor that does the work, we make all teams go through a stage of low-resolution prototyping where they do the prototyping themselves. They use basic paper and pencil to start and then iterate through regular engagements with end users, constantly getting feedback and testing the underlying business assumptions.
Often, as happened at Whiteriver, the discussions with stakeholders and end users can result in the need for substantial change to proposed ideas. For this reason, a thorough up-front analysis of stakeholders can be an effic
iency booster as teams select areas of opportunity to explore with design thinking. This includes involving others beyond just the end users that the new service targets. Creating great solutions for problems others don’t think they have can frustrate would-be innovators. The “back burner” problem—that is, delays by senior management—often kills innovation because delayed decision making can create timing issues and frustrate potential innovators. Ignite has crafted a solution to this difficulty by using their staffers’ clout on behalf of innovators throughout the organization. In addition to webinars and conference calls across all the final teams, mentors reach out to ensure ongoing progress and help the teams by utilizing their own extensive networks within HHS. Innovators without this kind of high-level support need to think carefully in advance about the campaign they need to wage to get such attention on their own.
The Evolution of Ignite Accelerator
The continual reshaping of Ignite itself illustrates learning in action. In its first three years of existence, the Ignite Accelerator evolved with each successive offering as Read and his team gained new insights each time they ran the program. Changes have included shortening Ignite team time from six to three months, reducing stipend funding from $5,000 to $3,000, and working harder to embed creative thinking throughout HHS by means of weekly contact with winning teams. Realizing that more money and longer training do not necessarily lead to better innovation—in fact, often the opposite is true—has led the IDEA Lab to recognize the potential of small, fast bets produced under the agency’s political radar.
Building comfort with these new methods involves battling practices that can be deeply entrenched. One of the major changes over the years is that Ignite now offers consistent mentoring from prior IDEA Lab winners, between the boot camp and final presentations. Read says this was the most difficult aspect of putting together the program, because innovators are “super smart people who would make great mentors” but “because they’re super smart, they are really, really busy,” but it has paid off.
The twenty Ignite teams face IDEA Lab staff and an assembled team of experts in a “shark tank” to hone their final pitches to upper management. In the shark tank, the polished concepts are tested against the realities of funding, team assumptions, and even personality conflicts. “We want to put them in front of the key decision maker within that agency, and it’s up to them to make that pitch and sell it, to present what they’d do next if they had further funding and investment,” Read explained. “A little more than a third of our teams have actually gotten funding. Only a handful have not gotten anywhere.” The original shark tanks, Read explained, were brutal, but the IDEA Lab team has backed off to ensure that good ideas don’t get buried, and their proposers discouraged, by negative feedback. Yet again, the IDEA Lab team iterates their own concepts and practices. Indeed, a recent Ignite Accelerator participant commented on the supportiveness of the program:
Ignite gave me the courage to challenge myself in a safe space: I am not one who enjoys public speaking, but the Ignite environment, mentors, and other teams were all very encouraging so I volunteered a bunch to speak up and even gave our team’s final pitch on Demo Day. Last but not least (and this will be cheesy), Ignite really did “ignite” a part of me to help promote innovation.
Reflections on the Process
As Marliza reflected on her Ignite experience, she pointed to several aspects of the IDEA Lab, in addition to the educational component, that made a difference in inspiring her to try creativity, and then continued to engage her throughout the messy process of innovation. One was the simplicity of the tools. She especially found HHS’s suggestion of the Business Model Canvas helpful and became deeply interested in the fiscal concepts around innovation. She recalled:
I thought this was ingenious. Rather than an old-school business plan, the size of a big binder book, that you’d give to investors and bankers, they took us through an easy business model, which we had to work out on butcher-block paper. Who were the customers, what were we trying to do, who might support us, what resources. We had to do a lot of brainstorming on that.
Whiteriver’s Business Model Canvas. Source: Strategyzer.com.
Even more significant for Marliza was IDEA Lab’s continual involvement in the Whiteriver project, primarily through its mentoring program. Mentors constantly asked if there was anybody participants needed help to sell their ideas to. Since the Whiteriver team had strong support from its direct management, the answer was always no, but for others, subtle pressure from the office of the secretary of Health and Human Services—where IDEA Lab is headquartered—nudged management to pay attention to innovative concepts. Again, being able to reach across the network mattered, as Marliza explained:
They know everybody in DC, and they could get the head person to back you up. When dealing with all these heads of agencies, you could run into some obstacles, and even at a lower level, with your supervisor, your director. IDEA Lab wanted to ensure that, once we started, we had all the support we needed from our own agency. If they needed to intervene, they would. They asked, “Anybody you need us to talk to; anyone we need to get information to; anyone we need to sell to?” They asked over and over again.
Another helpful aspect of Ignite was the internal political “cover” that involvement in the program gave Marliza within Whiteriver Hospital itself as she devoted half of her time to the project, having to exercise extensive prioritization to fulfill her full-time, day-to-day responsibilities. The existence of a formal program and process, with small potential funding grants, made it easier to justify her time and efforts to the Whiteriver leadership. “Once involved, we got very excited, but it was really stressful,” Marliza said. “It required a lot of time and resources backing us up. We had to have almost all the employees supporting us when we did our beta test.”
A final valued aspect was the camaraderie and networking the other Ignite teams provided. The connections formed at the boot camp were lasting. The teams coached each other, both formally through the conference calls and informally through personal communications. Providing access to this new network was an important element of Ignite. Marliza noted:
The other teams were extremely supportive. We got to know each other during boot camp as we had to listen to each other’s presentations quite a few times. Their stories were compelling and we wanted to support them too. Some of those other agencies—CDC, NIH [National Institutes of Health], places I’ve never heard of and things I’ve never imagined—all those little things they were trying to do in background, wow. Later, when we made the final presentations, everybody was hugely supportive. A lot kept in touch afterwards, and as a result of that, along with the folks in the shark tank, the who’s who in business of what you need, we learned so much from their questions. IDEA Lab chose people who knew what we do in patient health and made them part of our shark tank; they were basically the people we had to sell our idea to. What we kept hearing was, “Hey guys, this is a no-brainer.” That gave us the confidence that we needed to go to leadership.
Recently, Marliza left her role at Whiteriver to attend law school. She told us:
I thought about how having those credentials could not only help within the Indian Health Service and serving the Indian community, but also my passion with wanting to help the immigrant women and children get out of these for-profit detention centers in Arizona. Law school won’t teach me how to think like an innovator, but it will certainly help move my innovative ideas forward.
As this book goes to press, Whiteriver’s plans have evolved into a multimillion-dollar construction concept across the hospital, and the new emergency supervisor, Emily Gaffney, is building on the fasttrack idea and meeting with architects in preparation for construction. “We are doing fast track right now when we can, even though the space which we have is not ideal,” she explained to us. Triaging patients early, even without the best space, has helped to lower Whiteriver’s left-without-being-seen rate to 9 percent, about half of what
it was in 2014. She believes the new hospital construction, when finished, will drive the number even lower.
CREATIVE CONFIDENCE
What is creative confidence? Popularized by the famous Kelley brothers in a book of that name, creative confidence is defined by a follower of IDEO, a design consultancy, as “having the freedom and courage to fail/take creative risks and the knowledge that all of the ideas you create have value.” Sounds like an apt description of Marliza and her team.
Some might argue that what Marliza and her team accomplished is not dramatic enough to be classified as “innovation,” but we disagree. What if even a fraction of HHS’s eighty thousand employees around the United States were motivated to follow the lead of the Whiteriver team? Imagine the increase in the quality of experience of patients at the many HHS hospitals. Imagine the savings to taxpayers. We’d call those outcomes dramatic. That’s the point of Ignite—tapping into even a small percentage of the innovation potential of the agency’s vast employee base could make a big difference.
By encouraging and enabling small changes that can accumulate to have a large impact, the Ignite Accelerator demonstrates the power of democratizing innovation. The creation of an infrastructure that offers training, mentoring, and resources like time, supervisor support, and access to the HHS network is fundamental to creating the kind of context in which employees like Marliza, with her passion for improvement, can succeed.
Design Thinking for the Greater Good Page 7
