How to map assumptions for health & care innovations without ignoring the principles of evidence-based medicine

For innovators, the core challenge is not to come up with novel ideas or problems to solve. They’re abundant. The struggle is to find out what the most important next step is in advancing innovation. Startups die of indigestion rather than starvation, so having a clear focus is critical. A dependable way of setting the right priorities is by mapping your riskiest assumptions and gaining clarity on how much certainty you have about them already. It says: find out what assumption is most important for the success of your innovation. If you’re sure you need it, build it. If you have doubts, test it first, e.g. with prototypes.

“Riskiest Assumptions Mapping” is a great way of getting a common understanding of the assumptions in a team and figuring out what to do with them.

Over the past two years, I relied heavily on David J. Bland’s fantastic Assumptions Mapping Framework. However, since I work mostly in healthcare, I kept running into one core problem that appears when you move into spaces where you expose people to risks that they might not even notice. The problem lies in the limitations of the three traditional lenses of Design Thinking. A solution can be perfectly desirable to customers, it can be feasible, and be economically viable to sell — but it might cause harm (think of vapes) or claim to improve your health but have no effect at all (like snake oil). An article I wrote about this together with Anja Mayr will be published soon. To make a long story short, we need a fourth lens if people’s health is affected: we call it effectiveness, i.e. evidence of a solution’s positive effects and safety.

So, Anja and I set out to develop a new canvas that includes this Fourth Lens. We added questions that prompt innovators to think more about the complex market access challenges that are typical for health and care solutions. Here it is:

This is the Health Innovation Canvas. I can send you a high-quality PDF of the canvas for printing in A1 if you like. It’s licensed under Creative Commons, so it’s free to use! Just reach out by e-mail or LinkedIn.

How to use it

Use it alone or for ideation sessions in teams.

• Print it out or use it digitally.
• Write only one clear statement per sticky note (no bullet points).
• Then put it on the 2x2 diagram, cluster your thoughts.
• Discuss why it is as (un)-important and well or poorly understood as you think it is.
• Create a prioritised backlog

What to do with your assumptions once you mapped them on the 2x2

• Begin planning the implementation of solutions that cater to the important and known assumptions (you still need to keep testing them once you implement them).
• By known / unknown we mean how well they are known to you? For example, if you think that patients want a chatbot rather than a call centre: what makes you sure about that? Have you conducted research? Have you found evidence for that through your desk research?
• Begin planning the evaluation of the important but unknown assumptions. They can, if proven false, quickly kill your venture.
• What falls in the bottom right quadrant is worth further problem space research, including interviews, ethnographic research, and contextual inquiry.
• Anything that is in the bottom left quadrant is irrelevant for you, don’t waste your time on it.

You can also use it as a checklist before pitching to stakeholders.

Since you asked—some general comments on using this canvas:

• Who is this canvas for?
  Entrepreneurs and product development teams working in healthcare, e.g. digital health.
• What’s the purpose of the canvas?
  To enable innovators to prioritise the development of health and care solutions along dimensions that are crucial for success in the industry.
• Reality is always different!
  Keep in mind that this canvas aims to the impossible: giving structure to chaos. Don’t obsess with the structure and questions that we provided, they’re only here to guide your thinking, not restrain it.
• Shouldn’t “effectiveness” be a pre-requisite rather than a Fourth Lens?
  We discussed this ad nauseam in our teams. The reason why we didn’t put the effectiveness dimension separately as a “pre-requisite” checklist is that we think it’s easier to integrate these questions into an actual ideation session when they are part of the assumption mapping. There are features that might not need evidence of effectiveness or safety, like perhaps the UI of a chatbot. Unless, of course, you might create an app for people who have impaired sight or struggle to type (e.g. because of rheumatoid arthritis). There are clear cut cases where you exactly know if you are falling under a medical device regulation and there are a lot more cases where you are in a grey zone and need to think carefully, which is what this canvas is supposed to help with.
• Your users are heterogenous
  Remember that patients are defined by more than just their disease. If you build an app for people with hypertension, mind that you will have to further subgroup them by psychographics or the jobs they’re trying to get done. You have individuals who avoid speaking with a doctor until there’s no more alternative left. Others take great pride in adopting a super healthy lifestyle. Again others are afraid of pharmaceuticals and prefer alternative treatments. Don’t put them all in one b, be sure you truly know your target personas.
• Figure out what’s most important
  The many questions might be overwhelming. Don’t worry, they’re just an inspiration. You might only need a few. Or you might need others. Your success hinges on your ability to figure out what’s most important given the problem, target population, and solution.
• Everything you map should be grounded strictly on what you know
  Be honest with yourself and remember there’s no shortcut around engaging directly with your customers.
• Consider the value you deliver to individuals and society
  Are there any lower value interventions their innovation can replace, thus increasing the overall value of the system? Will the system you operate in be able to afford a solution even if it is cost-effective? Many costs in healthcare are intangible, indirect or externalised. If you aim to reduce these, how do you capture some of that value?

What do you think?

This canvas and the explanation have received excellent feedback over the past years. However, I am always pleased to read your thoughts and feedback. Please leave them in the comments section or per e-mail or LinkedIn to help improve this canvas further.

Let’s connect

Stay in touch! You can find out more about my current thinking and discover practical guides in the MedTech space by going on my web page www.svenjungmann.de

Acknowledgements

Getting innovations right in healthcare requires innovators to understand the principles of evidence-based healthcare that doctors rely on today to serve their patients. Thank you to everyone willing to lean into the discomfort of bringing human-centred innovation into such a complex industry. It’s worth it.

I would like to thank my health innovation team (Marina, Felix, Andreas, Frederik) at FoundersLane for the many conversations we had that also inspired this canvas. Thank you Nico Hribernik, co-founder of spring, for pointing out the importance of really differentiating patients along their psychographics and health-seeking behaviour. Thank you Anant Jani for your excellent input on ethical implications and for adding the population health perspective (which is represented in this text, not the canvas). Thanks, Ali Ciğer at Pfizer, for helping me add clarity on why effectiveness is a Fourth Lens and not a separate pre-requisite and making the how-to more understandable. And you, my dear colleagues Tobias Porz and Mazin Alsaffar from our PGDE-cohort at the Cambridge Judge Launchpad.

Please let me know what you think of it. Is it useful? What would you change?