Divining your future in healthcare

Imagine that by the year 2020 retail pharmacies everywhere are shuttering their doors due to the direct distribution by physicians of so-called 'polypills': personalised, all-in-one tablets combining a range of new prescription (and non-prescription) medicines.

Now, imagine instead a world where big pharma companies are hailed as heroes across the globe for a set of dramatic breakthroughs, whereby AIDS and heart disease have been all but eradicated, and most forms of cancer can be reversed. What about a world where a flu pandemic has killed 20 per cent of the earth's population, travelling rapidly through a transportation network that is evermore globalised and connected?

In each case, ask yourself: how could this have happened? What could the implications be, in terms of opportunities and risks, and who might be the winners and losers among the stakeholders in the healthcare system? In the first case, for example, what change of perception had to occur among medical doctors to inspire them to prescribe and dispense medicines in this new direct way? And what long-held assumptions might executives at retail pharmacies, healthcare organisations and pharmaceutical companies have been harbouring that prevented them from anticipating - and taking advantage of - this promising new polypill strategy? Perhaps the biggest winners in this world, other than the patients, would be the manufacturers of 3D printers, and physicians using these technologies to dispense medications to patients, in their offices, clinics and hospitals.

The goal of thinking in new boxes is to help you stretch your perceptions

Keeping pace with change and sustaining your organisation's capacity for practical ongoing creativity and innovation requires you and everyone at your organisation to constantly reevaluate and eventually replace the key ideas, assumptions and rules you rely upon to operate and build your business. Throughout life you will create countless such mental models - or what we refer to as 'boxes' - to understand and make sense of the world. Many of these boxes can and will help you for a while - “Here at HealthAid Pharmacies, we can count on customers filling prescriptions and getting flu shots to drive sales of the cosmetics, toiletries and other household items available in all of our stores.”

Yet these very same mental models, especially if you don't take stock of them thoughtfully, will eventually hold you back. People's brains pull them towards the familiar, leading them to cling to old boxes that may no longer be helpful or relevant. They make them averse to risk and to loss, and they lead them to try to confirm their existing opinions and deny the extent to which things are changing around them. 

A key distinction between organisations that soar in the face of change and those that are defeated by it, is the ability of their leaders to engage in an ongoing process of strategic creativity that we refer to as 'thinking in new boxes'. This process - which you can use to sharpen your organisation's vision, sketch alternate futures and/or strengthen your firm's capacity to innovate - marries imaginative, free flowing idea generation with practical analysis. To facilitate this process, we have broken it down into five key steps, as follows:

Step 1: Doubt everything
Step 1 asks you to doubt everything you know at present, to remember that all your ideas are hypotheses, not gospel. We ask you to challenge the boxes that currently make up how you perceive the world and think creatively about how you're defining and articulating the specific problems you're hoping to solve. When we work with clients, we often ask them to prepare for Step 1 by conducting a 'beliefs audit' so that they begin to reconsider the most established beliefs and assumptions that they and their organisation have been relying upon.

Executives at PharmaCo might instinctively feel: “Polypills are controversial and will always be a small part of the business.” Or, “Polypills, with pre-set dosages of multiple medications in one pill, will be seen as limited and dangerous since not all people need the same dosages or the same combination of medications.” When we meet with our clients to begin Step 1, we discuss the boxes they've identified, but only after first ensuring the environment is conducive to doubt.

This can mean physically using an offsite location, but more importantly, it is about opening up minds to be willing to look at the world in front of them with fresh lenses. Our goal is to help them begin questioning conventional wisdom and realise how the ways they've been pre-wired to see the world might be curtailing their ability to develop new helpful perceptions and ways of thinking. People often develop a spurious sense of certainty, and an over-reliance on quantitative and other seemingly logical, objective approaches to problem solving. Step 1 encourages people to begin stepping outside this narrow cognitive comfort zone and carefully re-examine their most important current boxes. It pushes them to contemplate how to frame the primary question or problem they're hoping to explore so that, in the steps that follow, they can generate a lot of promising new ideas.

If we were advising executives at PharmaCo about how to develop new exciting products and product-delivery strategies for the future, perhaps Step 1 would lead them to frame their central question as follows: “What new products, manufacturing processes and distribution strategies would ensure that by 2020, every day, every physician in New York and Moscow talked enthusiastically about our company to their patients?”

Step 2: Investigate the world in front of you
Step 2 asks you to re-examine the real world in front of you and begin thoroughly investigating the core question or issue you began to formulate during Step 1. In Step 2, you'll consider some of the most essential changes that you and your organisation believe are most likely to influence and shape not only your firm but also the entire field you're in over the next several years.

For example, you'll explore who your clients or customers will likely be, what your competitors will be doing to attract and retain their business, and what global waves of transformation are expected to occur in different areas of business, culture, technology and society. In this connection, we again encourage our clients to consider radical 'what if' situations.

For instance, what if, by 2018, most customers purchasing the statins PharmaCo manufactures were children and adolescents? What if, just a few years from now, your key competitors were no longer other pharmaceutical companies, but instead organisations from completely different industries (a sporting goods company, an energy drink firm, or a start-up that designs, manufactures and distributes 3D printers)? By the end of Step 2, you will have established a very clear sense of the issues you want to address and the objectives you hope to accomplish during Step 3. Are you seeking to generate new products and broaden your customer base, or a fresh vision for your company? New marketing strategies that will dazzle physicians and patients everywhere? What sort of new boxes do you want to create?

Step 3: Diverge
Step 3 is based on the proposition that the best way to have a good idea is to have a lot of ideas - and that no idea is itself born good. Divergence calls upon you to create many possible new models and ways of thinking.

This phase of the 'new box' process entails using your knowledge, imagination and ingenuity, even a spark of magic, to generate numerous plausible boxes in reaction to the questions you refined during Step 2. It entails a freeing-up of the mind and spirit such that even what may seem like foolish or ill-advised boxes are not rejected or judged as such - yet.

For instance, if you were an executive at PharmaCo, we might ask you to think about what would happen if the company were to enter into a joint venture with one of the surprising future competitors you identified during Step 2. What if a major sporting goods firm created a 'Big Heart' promotional campaign and agreed to put discount coupons promoting your leading pharmaceutical product in every shoe sold in its retail stores worldwide? What if the world's largest energy drink company were to create a 'Safe Heart' energy drink that includes your most effective statin together with vitamins and a small dose of blood-thinning aspirin? If the manufacturers of 3D printers could apply their technologies to 'cut' custom-calibrated polypills offering patients just the medications (and dosages) in a single pill, how might PharmaCo collaborate with that manufacturer to make those polypills just what cardiologists everywhere are talking about to all their patients in 2020?

Step 4: Converge
Convergence, the theme of Step 4, asks you to switch from the open-minded delight of divergence to the more analytical process of examining and testing your ideas. Convergence is where your ideas transform from a long list into a more select group that can actually be implemented, operationalised, and turned into reality.

Viewed another way, convergence can be thought of as the starting point for implementing your new boxes, making them operational, and innovating based on, or within, them. Perhaps you'll use a democratic voting process among your colleagues to decide that developing drinkable statin products is too fraught under restrictive local regulatory regimes, or that the beverages would raise insurmountable health and legal risks. Maybe you'll decide that the sporting goods company will only reach a narrow customer base (athletic people) and confuse your currently broad clientele about the true benefits of the statins you make. Perhaps you and your team will overcome many of the historical objections that PharmaCo has had to developing polypills.

Ask yourself: How did this happen? What are the implications?

Step 5: Re-evaluate
Now, imagine that your company ended up developing the first inexpensive 3D polypill printer and that, five years from now, doctors and health clinics the world over were purchasing this printer, and the pharmaceutical compounds you manufacture, to provide patients with single 'healthy heart' and 'healthy liver' medications and similar all-in-one pills that could be instantly and inexpensively custom-calibrated and dispensed directly in the doctor's office or clinic. Your success might be tremendous, yet we would still encourage you to take ongoing steps to be sure that you survive that success! Here, we ask you to remain vigilant so that you can detect 'weak signals'. Even the most creative thinkers can become overly attached to the boxes of yesteryear, necessitating a whole new process of 'doubt' - and starting Step 1 all over. The key objective of this fifth step, and indeed of the entire cycle of five steps, is to help you foster a new kind of creative process that is not only practical, but also sustainable.

In the end, the goal of thinking in new boxes is to help you stretch your perceptions, and look at the world in front of you in fresh ways. If you succeed, your company will be making change happen, instead of having to react to changes initiated by others. Remember: every box, no matter how useful and brilliant it may be, will eventually need to be replaced with a new one, and so in a world where the lifespan of a good idea is getting shorter and shorter, thinking in new boxes is more important than ever.