Transforming health and care ecosystems: A model of value evolution
In any health or care service ecosystem (a set of health service co-creation practices organised around common contexts of purpose, beneficiary actors and situation), I identify seven classes of value proposition that may be designed and introduced, whether individually or in combination. These are: Value-in-function, value-in-experience, value-in-sensing, value-in-learning, value-in-flow, value-in-diversity and value-in-transformation. Each is distinguished by the purpose, nature and form of the value embodied in the proposition, and the nature of outcomes or value that may be realised in the ecosystem. In brief, they are as follows:
Value-in-function – These propositions allow ecosystem actors to attain or improve core functional or clinical outcomes for a service for a health context, such as prevent disease, diagnose a condition, treat an illness or manage a condition, amongst others.
Value-in-experience – Propositions in this class focus on creating or improving the experience that beneficiary actors (patients and health seekers) and service providing actors (e.g., clinicians) have when interacting with tangible and intangible resources, with other actors and when performing or obtaining services in health service ecosystems.
Value-in-sensing – This class of value enables actors to sense and detect patterns, identify, respond and adapt to risks, changes, problems and opportunities. They provide a greater peripheral and predictive capability to deal with problems.
Value-in-learning – Learning propositions help actors to better understand cause and effect, remember patterns and relationships, provide instruction and guidance, co-create new knowledge and help actors assimilate it to make smarter and better adaptations.
Value-in-flow – Flow is an important class of proposition. These interventions seek to connect actors within and across practices in an ecosystem, and in doing so, amplify the flow of learning, sensing, experience and functional value. Flow propositions support the sharing of knowledge; they enable collaboration and monitoring, and boost adaptive capacity and overall ecosystem wellbeing. Also, they may increase access of actors into ecosystem services, and reduce inequities in service provision.
Value-in-diversity – Diversity value propositions support actors to be more creative, allowing them to respond to unique situations and adapt services to their particular circumstances. They promote variation and divergence from established routines and standard ways of “doing things around here”. A lack of diversity is often the reason for health service ecosystems becoming stuck and complex health problems arising and persisting. Building diversity through values innovation, adaptive technology and organisational design leads to greater ecosystem resilience. Also, divergent contexts may be introduced into a service ecosystem from adjacent ecosystems, changing the boundaries of service context, enabled by new connective (flow) technologies.
Value-in-transformation – Finally, transformation value propositions overhaul individual or multiple practices, or whole health service ecosystems. They may seek to shift services at one level of co-creation practice to another, to combine practices from within or from adjacent ecosystems, to eliminate ineffective practices, or redesign new service ecosystems altogether. Transformative propositions are needed when the adaptive capacity of an ecosystem is no longer sufficient to address complex persistent system problems. This can occur when there is a dominant, entrenched logic that persists, is routinised, and where outcomes plateau or worsen.
The Service Ecosystem Evolution Spiral
The sequence of the seven value proposition classes listed above is significant. Each successive class of value in the list expands the total amount of value co-created in each and all of the preceding classes. In other words, each class moving through the sequence holds greater value co-creation opportunity within a health service ecosystem. This value-intensifying dynamic is expressed as follows:
Function enables a service to be performed or improved or disrupted for a purpose and beneficiary actor; Experience enhances and may differentiate function; Sensing allows actors to detect problems, risks and opportunities; Learning reinforces the ability and memory to sense and adapt; Flow connects interactions and co-creation practices and enables collaboration; Diversity builds wider perspective, and boosts adaptive capacity, and Transformation of all classes is needed when adaptation has reached its limits, an ecosystem becomes unsustainable or in crisis.
We illustrate the seven classes in the form of a logarithmic or golden spiral shown above, a frequently occurring pattern in natural ecosystems found in multiple species and environmental contexts. We call this the Service Ecosystem Evolution Spiral (this applies to all service ecosystems, not just health). We use a spiral metaphor as it represents a universal path of value evolution that any health innovator can pursue to know where and how to co-create value.
A health innovator can search for opportunities by studying practices in the ecosystem using the value classes as a guide to explore and understand problems, resources and shortcomings in adaptive capabilities. In any ecosystem at any time, multiple value propositions in each class are being co-created, introduced, adapted and used. The situation is always dynamically emerging.
In an Umio study, after carefully framing a health service ecosystem, we capture metrics for each of the value classes. These help identify and prioritise opportunities for improvement and intervention of all kinds - products, experiences, services, technologies, drugs, devices, collaboration, strategies, organisations etc.
For more on the model, to see example value propositions of the different value classes and to learn how to design and transform value in health ecosystems, download our publication from the Umio website.
Alternatively, come along to one of our upcoming half-day introductory Value Design for Health Ecosystems workshops, details for which are below. Early birds still available...
 Examples of the golden spiral in nature include sunflower seed heads, pinecones, snail and nautilus shells, spiral galaxies, hurricanes and the aerial spiral formed by a peregrine falcon when stalking its kill.