Volume 8 no 2

We have a great idea, now what? Using the Canadian Healthcare Lean Canvas for implementing innovation

Mamta Gautam, MD, MBA, and Scott Comber, PhD, MBA

 

 

Back to Index

We have a great idea, now what? Using the Canadian Healthcare Lean Canvas for implementing innovation

Mamta Gautam, MD, MBA, and Scott Comber, PhD, MBA

 

The Canadian Healthcare Lean Canvas has successfully provided a manageable and actionable innovation framework with which to capture the key aspects of proposed health care innovation projects as used by participants in a physician leadership development program to address large-scale complex issues in health care.

 

KEY WORDS: innovation, framework, lean canvas, health care, tool, problem-solving

 

Gautam M, Comber S. We have a great idea, now what? Using the Canadian Healthcare Lean Canvas for implementing innovation. Can J Physician Leadersh 2022;8(2):67-70.

https://doi.org/10.37964/cr24751

 

A dilemma in Canadian health care innovation occurs when excellent ideas and good science fail to reach the bedside.1 Physician leaders know that innovation can improve patient outcomes; however, it continues to be difficult to enact. Although innovation is often supported in theory, it can be difficult to go from ideation to execution. This requires physician leaders to adopt a new way of thinking, to identify and address a different approach to creating solutions. An innovation framework that helps physicians describe the rationale of how their new idea creates, delivers, and captures value in economic, social, cultural, or other contexts can be of help.

 

Such frameworks are not usually part of a medical school curriculum, and yet we know that physician leaders need innovation processes and tools to move their ideas to solutions. There is a whole field of implementation science dedicated to this concept.2,3 In this article we present the one-page Canadian Healthcare Lean Canvas, a practical tool that reflects many of the concepts implicit in implementation science and that can be used by physician leaders to outline and implement innovation. Top

 

The Lean Canvas

 

The Lean Canvas, in its original iteration, is a one-page business model template that summarizes a proposed solution for a defined problem. It was created by Ash Maurya to assist in deconstructing an idea into its key assumptions and is widely used in business and entrepreneurship.4 It is adapted from Alex Osterwalder’s Business Model Canvas and optimized for lean startups. Similar to a startup, it is quick, easy, effective, and concise. Unlike elaborate business plans, which can take too long to write, are seldom updated, and are almost never fully read by anyone other than the authors, consider the Lean Canvas as a fancier way to sketch out an idea for a project on a napkin over a lunch meeting. Ideally, it should be quick to create, adaptable, and easily read and understood.

 

Maurya describes four key aspects and benefits of a Lean Canvas.4

 

  1. Fast: While writing a business plan can take weeks or months to complete, one can easily outline multiple possible business models on a canvas in an afternoon.
  2. Portable: Captured on a single page, this business model is much easier to share, revise, and update.
  3. Concise: The Lean Canvas template forces one to distill the essence of your product from which you can easily create your elevator pitch.
  4. Effective: This is a great tool that allows one to effectively document and communicate progress, whether it is to an investor, a project sponsor, a board, or your team. Top

 

Adapting the Lean Canvas for health care

 

When we were asked to design and develop a longitudinal physician leadership development program (PLDP) in partnership with Doctors Nova Scotia and CMA Joule, it was agreed that one of the goals would be to help participants develop skills in leading change and innovation in medicine. Within the PLDP, participants are presented with action learning challenges where teams work to propose solutions for current, real challenges facing health care. This provides an opportunity for applied innovation, working and learning as a collaborative team through deliberate practice.

 

We introduced the participants to the Lean Canvas template as a way to map their innovative ideas. The original Learn Canvas model was geared mostly to for-profit organizations and did not entirely meet the social aspects and culture of health care. We searched the Internet for other versions that were more applicable to social entrepreneurships such as health care.5 We found templates that were better, but still not ideal. Finally, we modified the Lean Canvas to suit the needs of health care specifically and designed the first Canadian Healthcare Lean Canvas (Fig. 1).

Using the Canadian Healthcare Lean Canvas

 

The Canadian Healthcare Lean Canvas consists of 11 elements, with specific questions posed for each element. It is designed to help you consider and complete each aspect of your idea. First, you are encouraged to take time to reflect, define, and articulate your overall Top

 

  • Purpose: What is your reason for creating this product/service/process, clearly defined in terms of the health care problem you want to solve?
  • Impact: If your project were successful, what would be the intended health care impact?

 

You are then ready to move on to the other boxes.

1.  Problem: This is the first    and most important box    to complete. What specific   problems are you trying to   solve? List the problems    being experienced.

  • As Charles Kettering, head of research at General Motors from 1920 to 1947, stated, “A problem well stated is a problem half-solved.”
  • Most projects fail, not because they do not build what they set out to build, but because they waste time, money, and effort building the wrong product. A significant contributor to this failure is a lack of proper “problem understanding” from the start. Before one invests months developing something, it is critical to determine if it is worth doing.6 It can help to decouple the problem from the solution and test through customer interviews to validate its worth.

2. Stakeholders: Who do you    need to have on your team?   For whom are you creating value? Who are your internal   and external stakeholders?

  • There are two main groups of people interested in or impacted by your idea. Inside, or internal stakeholders, are those who are closest to or have the strongest influence within an organization. Outside, or external stakeholders, are those who do not own, nor are employed by the organization, yet have some basic interest in its activities.
  • It helps to identify for whom you are creating value and to create a typical “customer” profile so that you can best develop and sustain these relationships.

3.  Unique value proposition: How does this product/

 service/process meet the identified needs? How is it better or different than what currently exists?

  • Here, you can identify what value you plan to deliver to the customer, which one of your customer’s problems you are helping to solve, or which customer needs you are satisfying.
  • There may already be some other solutions, so you will need to demonstrate how what you are proposing will be different and better than what already exists, including in what way, for whom, and why you believe this.

4. Solution: How do you    solve the problem? Define    the top three features of the   proposed product/service/   process.

  • This box essentially outlines the features that correspond to the specific problem your customer wants to solve. Ideally, it consists of must-have features, performance enhancers, and delighters.
  • Start by identifying the top three features that you want in your solution.
  • In health care, you can consider the Quadruple Aim of patient experience, population health, cost of care, cost to caregiver. Which of these are you enhancing, and how?

5. Success factors: Why do you   think this will succeed?

  • Here, you can add any details that highlight what is different about this idea and if it has an advantage that cannot easily be copied or bought.
  • These can include factors, such as inside information, in-depth knowledge that is critical to the problem/domain, a single-minded focus on one domain, personal authority resulting from experience and expertise, a community of network and partners, or the culture in which you are introducing this idea.

6.  Sustainability: What resources   (financial, human, support)   do you need to sustain this project once it is implemented?

  • In this and the next box, you will address the key resources and financial aspects of the proposal.
  • Take time to consider which key resources and key activities will be the most expensive, what resources you will need to keep it going, whether there is a revenue model, and if so, what that might look like. Consider whether any of your customers need to, or may be willing to, pay for any of the services?

7. Feasibility: What are the major costs (financial and other resources) associated with running this project?

  • Many solutions are too costly, extensively use resources, or are not sustainable. You will need to understand and develop feasibility criteria to ensure that the solution is “doable” within the constraints of your organization.
  • Can you identify in advance any major costs or resources that may render this project unfeasible?

8. Key metrics: How will you know you are successful? Identify key metrics you will measure.

  • It is important to identify the right balanced set of key metrics/measures for the project.
  • In this box, add things that you can easily measure: SMART (specific, measurable, achievable, relevant, time bound) goals that will best capture the strength of your proposal. The metrics can become your research objects, the measures for which you gather and plot data over time, and the evidence of efficiency and success that you will show to your stakeholders.

9. Pathways: How will your product/service/process reach your target group? How will they access it?

  • Once you create your innovative idea, you need to ensure that people will know about it and be able to use it to solve their problem.
  • Here, consider through which channels your customers want to be reached, how do other companies/organizations reach them now, and which channels work best and are more cost-efficient.
  • Define how customers will learn about this offering, how they can access it, and how it can be integrated with their routines.

 

The Canadian Healthcare Lean Canvas template can be used in various formats depending on the project group. In a small group, each member can have a full page-size copy of the template to write down ideas and thoughts. In larger groups, the template can be drawn on a white board and members can place Post-It notes in each box. The goal is to be flexible and easily adaptable as you move through the process. Once the items in each box are agreed on, details can be written concisely and shared with everyone. Top

 

The idea is to be messy, flexible, adaptable, and fluid with your thinking. For example, thinking your way through an element in one box can often lead to a change in a previous box. We are often asked by physicians why the boxes are not numbered in logical order. The Canadian Healthcare Lean Canvas follows the structure of the original Lean Canvas which presented the boxes in a similar fashion. It was intentionally designed to stimulate original and innovative thinking by moving away from a linear model of thought.

 

Proven value

 

We have used the Canadian Healthcare Lean Canvas for the past two cohorts of the year-long PLDP offered by Doctors Nova Scotia.7 It has been easily introduced to and understood by physician leaders. Although the impact of using this tool has not yet been formally investigated, anecdotally, the template has served program participants well, as they design and complete their action learning challenges and consider and propose solutions to actual challenges in health care in Nova Scotia. Examples of some of these completed projects, which provide recommendations on real-life health care issues, resulting from the use of the Canadian Healthcare Lean Canvas, can be found on the Doctors Nova Scotia website.8 Top

 

Acknowledgements

 

We are grateful to Doctors Nova Scotia and its CEO, Nancy MacCready-Williams, for the constant support they have shown as we developed the PLDP, created the Canadian Healthcare Lean Canvas, and shared it with course participants.

 

References

1.Ilan Y. Why scientists, academic institutions, and investors fail in bringing more products to the bedside: the active compass model for overcoming the innovation paradox. J Transl Med 2021;19:55. https://doi.org/10.1186/s12967-021-02726-4

2.Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol 2015;3(1):32. https://doi.org/10.1186/s40359-015-0089-9

3.Rapport F, Clay-Williams R, Churruca K, Shih P, Hogden A, Braithwaite J. The struggle of translating science into action: foundational concepts of implementation science. J Eval Clin Pract 2018;24(1):117-26. https://doi.org/10.1111/jep.12741

4.Leanstack. n.d. Available: https://leanstack.com/

5.Moskovitz D. The social lean canvas. Dave Moskovitz blog 2020;29 May. Available: https://tinyurl.com/4ankfj5b

6.Blank S. Customer development. Steve Blank blog 2009;1 May. Available: https://tinyurl.com/y7e8xbf6

7.Physician leadership development program. Dartmouth: Doctors Nova Scotia; n.d. Available: https://tinyurl.com/2p9bbax7

8.Cohort 3 action learning projects. Dartmouth: Doctors Nova Scotia; 2021. Available: https://tinyurl.com/33tyfz7a

 

Authors

Mamta Gautam, MD, MBA, FRCPC, CPE, CCPE, is an Ottawa-based psychiatrist who has been working with physicians since 1990. Among her areas of expertise are physician health and physician leadership.

 

Scott Comber, PhD, MBA, MA, BEDS, is a university teaching fellow at the Rowe School of Business, Dalhousie University, Halifax. He consults to organizations nationally and internationally in the areas of leadership development and change management.

 

Correspondence to:

mgautam@rogers.com, scott.comber@dal.ca

 

This article has been peer reviewed.

 

 

 

Top

We have a great idea, now what? Using the Canadian Healthcare Lean Canvas for implementing innovation

Mamta Gautam, MD, MBA, and Scott Comber, PhD, MBA

 

The Canadian Healthcare Lean Canvas has successfully provided a manageable and actionable innovation framework with which to capture the key aspects of proposed health care innovation projects as used by participants in a physician leadership development program to address large-scale complex issues in health care.

 

KEY WORDS: innovation, framework, lean canvas, health care, tool, problem-solving

 

Gautam M, Comber S. We have a great idea, now what? Using the Canadian Healthcare Lean Canvas for implementing innovation. Can J Physician Leadersh 2022;8(2):67-70.

https://doi.org/10.37964/cr24751

 

A dilemma in Canadian health care innovation occurs when excellent ideas and good science fail to reach the bedside.1 Physician leaders know that innovation can improve patient outcomes; however, it continues to be difficult to enact. Although innovation is often supported in theory, it can be difficult to go from ideation to execution. This requires physician leaders to adopt a new way of thinking, to identify and address a different approach to creating solutions. An innovation framework that helps physicians describe the rationale of how their new idea creates, delivers, and captures value in economic, social, cultural, or other contexts can be of help.

 

Such frameworks are not usually part of a medical school curriculum, and yet we know that physician leaders need innovation processes and tools to move their ideas to solutions. There is a whole field of implementation science dedicated to this concept.2,3 In this article we present the one-page Canadian Healthcare Lean Canvas, a practical tool that reflects many of the concepts implicit in implementation science and that can be used by physician leaders to outline and implement innovation. Top

 

The Lean Canvas

 

The Lean Canvas, in its original iteration, is a one-page business model template that summarizes a proposed solution for a defined problem. It was created by Ash Maurya to assist in deconstructing an idea into its key assumptions and is widely used in business and entrepreneurship.4 It is adapted from Alex Osterwalder’s Business Model Canvas and optimized for lean startups. Similar to a startup, it is quick, easy, effective, and concise. Unlike elaborate business plans, which can take too long to write, are seldom updated, and are almost never fully read by anyone other than the authors, consider the Lean Canvas as a fancier way to sketch out an idea for a project on a napkin over a lunch meeting. Ideally, it should be quick to create, adaptable, and easily read and understood.

 

Maurya describes four key aspects and benefits of a Lean Canvas.4

 

  1. Fast: While writing a business plan can take weeks or months to complete, one can easily outline multiple possible business models on a canvas in an afternoon.
  2. Portable: Captured on a single page, this business model is much easier to share, revise, and update.
  3. Concise: The Lean Canvas template forces one to distill the essence of your product from which you can easily create your elevator pitch.
  4. Effective: This is a great tool that allows one to effectively document and communicate progress, whether it is to an investor, a project sponsor, a board, or your team. Top

 

Adapting the Lean Canvas for health care

 

When we were asked to design and develop a longitudinal physician leadership development program (PLDP) in partnership with Doctors Nova Scotia and CMA Joule, it was agreed that one of the goals would be to help participants develop skills in leading change and innovation in medicine. Within the PLDP, participants are presented with action learning challenges where teams work to propose solutions for current, real challenges facing health care. This provides an opportunity for applied innovation, working and learning as a collaborative team through deliberate practice.

 

We introduced the participants to the Lean Canvas template as a way to map their innovative ideas. The original Learn Canvas model was geared mostly to for-profit organizations and did not entirely meet the social aspects and culture of health care. We searched the Internet for other versions that were more applicable to social entrepreneurships such as health care.5 We found templates that were better, but still not ideal. Finally, we modified the Lean Canvas to suit the needs of health care specifically and designed the first Canadian Healthcare Lean Canvas (Fig. 1).

Using the Canadian Healthcare Lean Canvas

 

The Canadian Healthcare Lean Canvas consists of 11 elements, with specific questions posed for each element. It is designed to help you consider and complete each aspect of your idea. First, you are encouraged to take time to reflect, define, and articulate your overall Top

 

  • Purpose: What is your reason for creating this product/service/process, clearly defined in terms of the health care problem you want to solve?
  • Impact: If your project were successful, what would be the intended health care impact?

 

You are then ready to move on to the other boxes.

1.  Problem: This is the first    and most important box    to complete. What specific   problems are you trying to   solve? List the problems    being experienced.

  • As Charles Kettering, head of research at General Motors from 1920 to 1947, stated, “A problem well stated is a problem half-solved.”
  • Most projects fail, not because they do not build what they set out to build, but because they waste time, money, and effort building the wrong product. A significant contributor to this failure is a lack of proper “problem understanding” from the start. Before one invests months developing something, it is critical to determine if it is worth doing.6 It can help to decouple the problem from the solution and test through customer interviews to validate its worth.

2. Stakeholders: Who do you    need to have on your team?   For whom are you creating value? Who are your internal   and external stakeholders?

  • There are two main groups of people interested in or impacted by your idea. Inside, or internal stakeholders, are those who are closest to or have the strongest influence within an organization. Outside, or external stakeholders, are those who do not own, nor are employed by the organization, yet have some basic interest in its activities.
  • It helps to identify for whom you are creating value and to create a typical “customer” profile so that you can best develop and sustain these relationships.

3.  Unique value proposition: How does this product/

 service/process meet the identified needs? How is it better or different than what currently exists?

  • Here, you can identify what value you plan to deliver to the customer, which one of your customer’s problems you are helping to solve, or which customer needs you are satisfying.
  • There may already be some other solutions, so you will need to demonstrate how what you are proposing will be different and better than what already exists, including in what way, for whom, and why you believe this.

4. Solution: How do you    solve the problem? Define    the top three features of the   proposed product/service/   process.

  • This box essentially outlines the features that correspond to the specific problem your customer wants to solve. Ideally, it consists of must-have features, performance enhancers, and delighters.
  • Start by identifying the top three features that you want in your solution.
  • In health care, you can consider the Quadruple Aim of patient experience, population health, cost of care, cost to caregiver. Which of these are you enhancing, and how?

5. Success factors: Why do you   think this will succeed?

  • Here, you can add any details that highlight what is different about this idea and if it has an advantage that cannot easily be copied or bought.
  • These can include factors, such as inside information, in-depth knowledge that is critical to the problem/domain, a single-minded focus on one domain, personal authority resulting from experience and expertise, a community of network and partners, or the culture in which you are introducing this idea.

6.  Sustainability: What resources   (financial, human, support)   do you need to sustain this project once it is implemented?

  • In this and the next box, you will address the key resources and financial aspects of the proposal.
  • Take time to consider which key resources and key activities will be the most expensive, what resources you will need to keep it going, whether there is a revenue model, and if so, what that might look like. Consider whether any of your customers need to, or may be willing to, pay for any of the services?

7. Feasibility: What are the major costs (financial and other resources) associated with running this project?

  • Many solutions are too costly, extensively use resources, or are not sustainable. You will need to understand and develop feasibility criteria to ensure that the solution is “doable” within the constraints of your organization.
  • Can you identify in advance any major costs or resources that may render this project unfeasible?

8. Key metrics: How will you know you are successful? Identify key metrics you will measure.

  • It is important to identify the right balanced set of key metrics/measures for the project.
  • In this box, add things that you can easily measure: SMART (specific, measurable, achievable, relevant, time bound) goals that will best capture the strength of your proposal. The metrics can become your research objects, the measures for which you gather and plot data over time, and the evidence of efficiency and success that you will show to your stakeholders.

9. Pathways: How will your product/service/process reach your target group? How will they access it?

  • Once you create your innovative idea, you need to ensure that people will know about it and be able to use it to solve their problem.
  • Here, consider through which channels your customers want to be reached, how do other companies/organizations reach them now, and which channels work best and are more cost-efficient.
  • Define how customers will learn about this offering, how they can access it, and how it can be integrated with their routines.

 

The Canadian Healthcare Lean Canvas template can be used in various formats depending on the project group. In a small group, each member can have a full page-size copy of the template to write down ideas and thoughts. In larger groups, the template can be drawn on a white board and members can place Post-It notes in each box. The goal is to be flexible and easily adaptable as you move through the process. Once the items in each box are agreed on, details can be written concisely and shared with everyone. Top

 

The idea is to be messy, flexible, adaptable, and fluid with your thinking. For example, thinking your way through an element in one box can often lead to a change in a previous box. We are often asked by physicians why the boxes are not numbered in logical order. The Canadian Healthcare Lean Canvas follows the structure of the original Lean Canvas which presented the boxes in a similar fashion. It was intentionally designed to stimulate original and innovative thinking by moving away from a linear model of thought.

 

Proven value

 

We have used the Canadian Healthcare Lean Canvas for the past two cohorts of the year-long PLDP offered by Doctors Nova Scotia.7 It has been easily introduced to and understood by physician leaders. Although the impact of using this tool has not yet been formally investigated, anecdotally, the template has served program participants well, as they design and complete their action learning challenges and consider and propose solutions to actual challenges in health care in Nova Scotia. Examples of some of these completed projects, which provide recommendations on real-life health care issues, resulting from the use of the Canadian Healthcare Lean Canvas, can be found on the Doctors Nova Scotia website.8 Top

 

Acknowledgements

 

We are grateful to Doctors Nova Scotia and its CEO, Nancy MacCready-Williams, for the constant support they have shown as we developed the PLDP, created the Canadian Healthcare Lean Canvas, and shared it with course participants.

 

References

1.Ilan Y. Why scientists, academic institutions, and investors fail in bringing more products to the bedside: the active compass model for overcoming the innovation paradox. J Transl Med 2021;19:55. https://doi.org/10.1186/s12967-021-02726-4

2.Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol 2015;3(1):32. https://doi.org/10.1186/s40359-015-0089-9

3.Rapport F, Clay-Williams R, Churruca K, Shih P, Hogden A, Braithwaite J. The struggle of translating science into action: foundational concepts of implementation science. J Eval Clin Pract 2018;24(1):117-26. https://doi.org/10.1111/jep.12741

4.Leanstack. n.d. Available: https://leanstack.com/

5.Moskovitz D. The social lean canvas. Dave Moskovitz blog 2020;29 May. Available: https://tinyurl.com/4ankfj5b

6.Blank S. Customer development. Steve Blank blog 2009;1 May. Available: https://tinyurl.com/y7e8xbf6

7.Physician leadership development program. Dartmouth: Doctors Nova Scotia; n.d. Available: https://tinyurl.com/2p9bbax7

8.Cohort 3 action learning projects. Dartmouth: Doctors Nova Scotia; 2021. Available: https://tinyurl.com/33tyfz7a

 

Authors

Mamta Gautam, MD, MBA, FRCPC, CPE, CCPE, is an Ottawa-based psychiatrist who has been working with physicians since 1990. Among her areas of expertise are physician health and physician leadership.

 

Scott Comber, PhD, MBA, MA, BEDS, is a university teaching fellow at the Rowe School of Business, Dalhousie University, Halifax. He consults to organizations nationally and internationally in the areas of leadership development and change management.

 

Correspondence to:

mgautam@rogers.com, scott.comber@dal.ca

 

This article has been peer reviewed.

 

 

 

Top