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The digital ecosystem: 5 approaches to transforming health and social care

Digital health has the potential to transform healthcare systems but this is not news. For several reasons, it’s a promise that is yet to be fulfilled and has kept many of us waiting for this change since the mid-2000s. We strongly believe that its impact can only be delivered through a collaborative, ecosystem approach.

What is digital health and what’s the big deal?

Digital health is a broad subject. So broad, in fact, that at times it leads to confusion and lack of clarity. The subject ranges from wearables (such as Fitbits, the Apple Watch) to diagnostic technologies connected to online databases, telemedicine (and its lesser known sibling telecare), ehealth (electronic health records and in-hospital applications that increase productivity) and mhealth (mobile smart phone apps). Add Big Data to this list and the digital health pot-pouri could mean everything and anything to do with health as long as it is “connected".

As we have seen in other sectors such as online banking and e-commerce, digital health technology has the power to transform the traditional health care sector, which is in dire need of systemic change. Why? The biggest concern is the global economic downturn which has led to a tightening of public health purses. The driver for change, however, was already prominent before the crisis. Our ageing population has and is pressurising both welfare and private healthcare systems. Before the 90s, hospitals were like garages: you could walk in with an issue, get “repaired” and there would be no need to go back until the next “service” was due. Today people live longer, which is a good thing but they are not exactly living longer heather lives. The 75 and over often live with co-morbidities,chronic illnesses, such as arthritis, heart disease and COPD, that need several “services” a month and not just from one specialist or discipline, nor one hospital department or community service. It requires a combination and digital health has the power to bring these diverse disciplines together. The onus, however, is not just on the provider. Digital health also has the power to empower citizens to take care of themselves so that they don’t end up in A&E so often. This is a bottom-up approach based on the fact that prevention (and therefore early investment) is better than cure.

So why haven’t we seen change yet?

Unfortunately, neither approach has worked so far. The top-down approach of implementing digital health has suffered from various setbacks that have led to loss of trust between the providers and citizens. Take the UK’s National Program for IT (NPfIT) which intended to build a digital “spine” across the UK connecting hospitals and sharing information on a grand scale. From the very beginning, it was beset with IT problems (replacing legacy systems) and financial issues, finally resulting in massive scale backs. During this time it went through several IT providers and re-definition of goal posts. The same could be said about other national (and over ambitious) programs such as Obama Care. With so much investment from governments, why was change resistant?

People not technology

If there is one thing the changes in the NHS UK has taught us, its that change comes at the speed of trust. Health is not about technology, it is about people. People here include not just the patient but also the provider workforce. If the workforce is not willing to embrace new technology and adapt it to their traditional knowledge of medicine, change will be piecemeal rather than systemic. In light of this, a more bottom-up approach was prescribed, where the patient (or citizen) was placed at the centre. Everyone knows prevention is better than cure. If we can remain healthy we wouldn’t need to visit the hospital so often. Today, products from FitBit and Apple will tell you exactly how many calories you have burnt, how many steps you’ve taken and whether you have slept well enough.

What does the patient do with all this data if the doctor cannot use it?

There is a wealth of data at our fingertips but existing health systems are not willing or cannot implement this into their recently digitised EHRs. Email exchanges, for example, between patient and doctor are still not widely accepted. Emails with data attachments from wearables is even further away. Even if they were, and the interoperability issues (more on that later) were solved, we would still be left with the big data problem: rubbish in, rubbish out. Modern healthcare is not so modern: medical students are taught first of all, to talk to the patient, not listen. This is changing but students are also taught how to rely on gold standards when taking measurements. A blood pressure monitor is a gold standard, a wrist blood pressure monitor made by iHealth is not (yet). Trackers that measure pulsations and analyse stress may be useful information but not strong enough to make serious decisions until combined with other information around context.

5 approaches to changing the digital health landscape

Ideally what we need is a combination of approaches, or an ecosystem approach. The digital health ecosystem includes everyone that plays a part in a person’s health and care. Bringing them together is the first step but once they are there it is important to take action and not just talk. Here are our recommendations:

 

  1. Change comes at the speed of trust. Organisations must first embrace change. Whether its an app for mental health or a new SPECT/CT, if the organisation cannot implement a different workflow, there will be slow or no change. And the change in the digital technology scene is not showing signs of slowing down.
  2. People not technology. Digital technology is only an enabler not the answer to everything. Here “people” are those that surround a person’s life when they decide to take a decision around health. A person living with dementia needs a diverse workforce (neurologists, psychologists and speech and language therapists to name a few), their informal carers and their family and friends. Each of these actors can use a variety of digital technology to enhance the care they provide. Ideally that technology must be designed and developed with
  3. Support interoperability. There are several applications, wearables and technologies that can solve problems but they need to be able to take to each other if they expect to make an impact on someones life. Data sharing needs to be supported across departments in hospitals, community services and even volunteering organisations. Data sharing needs to be supported between providers (as a whole) and the citizen. Finally, data sharing needs to be supported between startups, SMEs and large corporations. There is no one size fits all here and therefore we must take a collaborative approach.
  4. Consider the whole system. This is a much more complex problem. If what we want is sustainable health systems, then we must think of the big picture. The big picture for a 75 year old with chronic illness, includes not just healthcare provision but also social insurance, pension and public transport. Those aspects may not need to be fully part of the transformation program but they certainly need to be aware of the changes taking place and be open to adapting their existing systems.
  5. Embrace the lean startup way. Past experiences have shown us that we should not build something that no one wants. Governments and providers have mistakenly built the full product well before understanding the customer’s problem. In healthcare, we should learn how to iterate exactly how startups learn by doing in other sectors. Of course, the lean startup needs to be adapted to health systems: we shouldn’t put the patients life at risk trying something. However, startups working in health must be allowed through the door with paper prototypes and policy and change makes must learn to iterate as often as entrepreneurs do.

The virtue of patience is not on the list but it is key to transformation. Change does not happen overnight nor should it be expected to happen in "x years". Investors (not just venture capitalists but everyone with a soft to hard investment in healthcare transformation) expecting immediate ROI should also take a hard look at what ROI means. In health it is much more than financial. Social impact is as, if not more, important. Implementing this into the value of a company or product needs a completely new way of thinking. We believe the best way to think is by doing with others and being part of an ecosystem is the first step.

(originally published on Aug 17, 2016 @ 12:51, on samuhya.com)

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Time to go back to the WHY

A woman flings herself in a glass house, like a puppet whose master has no care for his actions, she desperately tries to break free of her cage and reach us, the audience. This piece of modern dance, is part of the events related to the DementiaDeal, an initiative led by the Province of Brabant, to raise awareness of the impact of early stage dementia and the value of the local grassroots initiatives. It is being held at a local theatre in Breda, a theatre which within its building houses a stage, networking area and three semi-circular corrugated steel tents that make me feel like I’ve accidentally stumbled into Che Guevara's underground revolutionary camp. But a camp that offers plenty of coffee and Dutch pancakes.

At first glance, none of this may sound like neither the setting nor programme for Dementia but that is ok because as with everything creative, impact is relative and dependent heavily on the context of the individuals in the audience. To me, having recently lost someone to a disease, the woman in the glass house is a stark reminder of the isolation a person can experience in real life when they sadly become a statistic on the annual WHO report. She ends up being watched but not helped, heard but not listened to and unable to interact with the outside world.

But this isn’t about pleasing everyone just as much as the realisation for the team behind the Dementia deal that the impact of a product is not its measure of sales across the globe. Like the audience is made of individuals with different backgrounds, the market is made of customers who live in different contexts. Some families are empathetic and open to confront their elderly parent’s problems like disorientation during the day and memory lapses, while other families would prefer to label it as senile behaviour related to old age or “just not that serious".

This is displayed to great effect in the short film produced by Whalebone & Greenstone which was show at short intervals during the program. The film follows a family of four on a holiday trip, cut short at the start when the elderly grandmother gets frustrated and wants to go home. As the film continues, we see the family, each in their own way, coming to terms with their grandmother’s issues which may or not be dementia but is something that has to be confronted nevertheless.

And this of course is what we are terribly good at: the solutions. So concerned are we, the consultants, the experts, the scientists, with finding solutions that we often forget whether the so-called demand is indeed ready to consider their problems and accept that they need to look into it first. Product exhibition stands at the eHealth week in Amsterdam this year, as with other years, are littered with solutions that have been built based on latent demand and views of focus groups, who are hardly representative of personal context and local communities. Driven by a top down approach (healthcare sustainability, cost cutting, the right not to be institutionalised) solutions have been created while leaving the customer behind with glossy product specification leaflets and reports detailing the statistical and medical impact.

So how do we (re-)connect with those we are trying to help in a time when technology is driving us further apart? How can we get back into the trenches and get a feel for whom we are really fighting for? How can we come back down from the top and take a more grassroots and bottom up view? How can we do all this and still increase impact and ensure sustainability?

This has been a key question for the team behind the Dementia Deal, a journey that began almost four years ago and at that time concerned with scaling innovation. The suggestion, then, was to create a global product for a global problem. This kind of strategy may certainly equal income and growth but it may not achieve sustainability. The Province of Brabant who lead the Dementia Deal initiative argue that sustainability comes from building trust in the local community, allowing for diversity in solutions and building on the local infrastructure of each individual.

After years of focusing on the technological aspects of solutions, diversity is something they have learnt to embrace and today’s programme represents this well: it is a pot pourri of conversations from (and at one point between) patients, elderly citizens, technology companies, researchers, care organisations and politicians. At intervals, the event is peppered with sketches from Marie, a patient, and her carer Kees (can’t get more dutch than that) played by Ben and Julie, two improv theatre actors. At various stages through the morning, Marie finds herself in precarious situations of forgetfulness, stress and frustration, and at one point on the verge of tears.

It is clear the different stakeholders in the room have distinct viewpoints on how to approach early stage dementia and improving quality of life: after all, we too have context and background, and that is what makes us individuals.

This is shown to great effect, when, and very naturally, the actors step into the shoes of the health tech professional and traditional carer, each carrying their philosophy: the former believing that health can be taken care of by technology and the latter believing that human contact is vital. They begin their conversation butting heads but end eventually by finding common ground because they realise they want the same thing: better life for the person.

And this, for me, is where the key to change lies: the individual. We all have a purpose in this world that drives us. As Kees Klomp, a mentor to social businesses explains, People, Purpose and Progress are vital today more than any other time in history. However, the majority of the time, when we go about our daily grind, we forget those 3Ps. In the process, our individual selves are hidden behind our organisations, job functions and budgets naturally setting the stage for years of “not seeing eye to eye” which we mistakenly confuse as being a clash of principals. Everyone will agree that the ultimate vision in health of the ageing society is that quality of life is increased as we live longer. Yet, how many of us remember the “why we do it” by the time we get to the “what we do”? The result is duplication of effort and the “people” part of it disappearing between the cracks.

But as Ben and Julie show us, we need to build trust with the people behind mission statements by having a deeper conversations but consciously leaving our egos at home. This is the first step to making change.

Julie Arts, a member of the Presensing institute, tells us we need to search deep within us. what is your purpose? Not your organisation’s but yours. Then the next step is “what you mean to others”. what is the value you give to someone else’s life? That is the “what we do” connected to the “why we do it”.

As the morning comes to a close and we mingle outside for lunch in the pretty Breda sunshine, I wonder how many of us have digested the message, how many will remember after the networking, and how many will live their purpose the next day.

Did I mention by the way that today’s proceedings were all in Dutch? Well, I don’t speak a word and understand even less. Somehow it didn’t matter...

(Originally published on Jun 8, 2016 @ 13:07, on samuhya.com)

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Being an entrepreneur at 40...

Since when was there an age limit on taking risk and solving a problem?

Entrepreneurship has often been hailed as a means out of the Great Recession and although economists and academics will continue to argue its true impact on the economy well beyond the crisis, there is no doubt that entrepreneurship and entrepreneurial education are on the rise in Europe. There is no shortage of help for entrepreneurs and accelerators for startups: an online portal tells me there are around 350 masters courses in entrepreneurship and I’ve read that there are almost 100 accelerators in Europe today. This doesn’t include the specialised programs for startups (e.g.mentoring) and the financial incentives, such as seed money, from governments. Most, however, seem to be directed towards under 35s. And this is where I have a bone to pick…

A month ago, I was invited to be a mentor to entrepreneurs in an international program called Youth Business Spain but its been a challenge for them to find entrepreneurs in the province of Aragon (Spain) were I reside because it turns out most entrepreneurs here are over 40, and this program, you guessed it, is for entrepreneurs under 35. This really grated me the wrong way especially because the word “youth” and “entrepreneur” is being associated with under 35s. Suddenly, everywhere I look I see the age limit on entrepreneurship support from governments. In Spain, where I live, age is an obsession: from CVs (which by the way also require mug shots) to newspapers articles that almost always mention the date of birth of their subject. Last year, a famous startup program in Madrid asked me for my age and then told me that to enter, not only did I have to be under 30, but that I also need a team (sorry, forgot to mention: I’m an “old” AND “lonely" entrepreneur ) and my startup had to be something digital!! Whats next? We need to look the part? (tight jeans, trainers, hoodies and geeky haircuts).

Does being 40 mean I’m not motivated anymore to give it my everything? I admit I might be going through what others call a mid-life crisis: I went back to reading real books (that you can hold in your hands as opposed to ebooks), bought a second hand CD player (to listen to CDs as opposed to streaming off my laptop) and I’m thinking of investing in a vinyl player. I also admit, rather reluctantly, that I cannot beat a hangover as quickly as I could twenty years ago. And two weeks ago, while out on my 40th birthday bash in London, I ended up in A&E because I had severe  - wait for it - constipation and gases.

But since when did being 40 mean I can’t solve problems? Isn’t that essentially what entrepreneurs do? And isn’t that the only thing governments should worry about: supporting people who solve problems? To this, no doubt, the governments will tell me that there is, as a consequence of the crisis, an increase in youth unemployment and that entrepreneurship should be targeted at youth more than anyone else. And its true: almost 45% of under 25s are out of jobs in Spain, the highest in Europe after Greece (around 50%). I used to be unemployed and I know what it feels like. Its actually not that far from being 40 and an entrepreneur without clients. Every morning I have to fight off the feeling that nothing could work out and I could be living on the streets. Worse, I have two kids and there are some mornings when I think: I really don’t want to get out of bed and face yet another uphill climb. (Thankfully I have no choice because I have to take my kids to school!!).

So, yes, under 35s need our help. But so does everyone else outside this age bracket. There’s also an ageing crisis, you know. Europe isn’t getting any younger: its getting older. The 65+ (often associated with the “elderly”) also need our help. Not all 65+ want to retire and live off their pensions. In about 20 years those under 35s in my mentoring program will need to be thinking about what they are doing next. Perhaps they’ll be on their 5th business or career. What kind of infrastructure will be there to support them? When I was in Liverpool last year, visiting startups, I met a really awesome entrepreneur who made straps for hearing aids (so you don’t lose them). I didn’t ask her age (because it didn’t matter) but she created her first prototype for her mum (who was around 90), so I’m guessing she was in her early 70s. I remember that nothing stopped her from approaching me, asking for my help and most of all her enthusiasm inspired me to stop bitching so much (well, obviously, that didn’t last).

So, I think, us "over 35s” have a lot to offer the world of entrepreneurship. In fact, we have much more to offer than just the years clocked up on our CVs, the titles and work experience. We have living experience and years of being responsible and that’s important ammo for an entrepreneur. When everyday is like walking off the edge of a cliff, you need to trust yourself. And, besides, why should only the under 35s have to be burdened with bringing us out of economic recession? We should all be “entrepreneuring" together on this.

To end on a bright note: I was invited to a conference in Budapest last week where I brought this up (if you haven’t already noticed, I have a big mouth). Someone (important) in the panel said there needs to be an age limit on entrepreneurship (I think she said around 45-50). Naturally she got shot down, the crowd applauded and it turns out that this relatively new accelerator/hub has no age limits. All they want is a really good business model. But, best of all, the moderator who gave me the mike thanked me for bringing it up because he’s 50 and an entrepreneur. That makes the two of us…anyone else out there who feels the same way?

(Originally published on May 5, 2016 @ 21:13, on smauhya.com)

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Scaling across cultures

Why is it that some people have the urge to ask questions whose answers are so obvious the question is almost rhetorical? Getting on a train to Amsterdam Schipol, I asked the man opposite me if the train is really going to Schipol and luckily for me he didn’t respond: “No, the sign on the platform says “Amsterdam Schipol” because the Dutch tourism authority like to trick people into getting on the wrong train and visiting otherwise unknown villages.

No big deal, you say, there’s nothing wrong in confirming. But no one else on this train did it. Writing this blog on the very same train I can’t help but reflect on why i asked the stupid question. The countries where I’ve lived (England, India, Spain, Zambia) often have the wrong platform information or a delayed train sitting where it's not supposed to be and yes I have gotten on the wrong train once (okay, maybe several times under the influence). There is nothing better than having a service conductor at the door to reassure conspiracy theorist paranoid passengers like myself. In fact, train conductors or station conductors on platforms in England are often hogged but the same question: “does this train really go where it says its going? ”. In our digital age, no doubt, there is an app to take care of this.

It may sound obvious but culture really plays an important part in the impact we create on our society. I’m in Holland this week (still part of my Europe wide whirlwind tour of entrepreneurs and investors) to hear from expert investors how to export smart health solutions to China. Startups also pitched during a Pecha Kulcha (nothing to do with sushi like I once assumed) to see if they could be the lucky ones to enter China. By 2020, 1 in 5 people will be over 65. This is a nightmare for a country that is not prepared for this change and it's a "silver mine” (sorry for the pun) for European startups fed up with our heterogeneous system, its regulation, its bureaucracy and struggling to scale.

But is it really?

According to Brian O’Connor and Mark Ennis, investors with tons of experience in China, its not as simple as, translate your app into Mandarin and then you have a 2bn x 0.99€ revenue. Brian, who began travelling to Hong Kong in the early 90s every two weeks still refuses to call himself an expert on China. Yet he will tell you need to find a partner and a distributor, earn their trust and work with them on the ground to deploy your solution. Sounds like hard work? Well there’s always help...

Jumo Group in Shanghai, a company that helps you find export opportunities in China, says it is very hard to enter the Chinese market but if you're willing to go the distance, there is opportunity. Jumo works like an entrepreneurial firm that finds you customers until you achieve the sales you want to and the targets you set: capturing clients and, like William Klique their Co-founder says, making money. When, he hands me his business card, he does so in both hands and with a little bow. “You need to understand their culture and customs. In China it would be difficult to expect a 65+ to use smart phone because many for the elderly still listen to radios”. So how on earth (or in China) could AAL solutions breach the Chinese market?

Well, just because they listen to their radios doesn't mean they don’t need care. The consequences on China’s one child policy (which recently ended) means that parents have to rely on their other relatives (uncles, aunts) sometimes neighbours. Although, as William explains, China is going the route of nursing homes and institutionalised care  (something Europe is trying very hard to move away from) there are still gaps for those that live in remote areas.
The elderly in many situations live away from their only child, who works in the city, and can’t be with them immediately. So there is an opportunity for telemedicine. (Sometimes I can't help but feel that the concept of telemedicine would work so much better in places like China and India because citizens hardly see their doctors. So an SMS asking how you are today, makes a deeper impact there than it does (and did in the last decade) in Europe.)

Sure, the access and usability will be an uphill struggle. Plug and play it is not but consumer demand will ultimately prevail. One of the med tech devices featured on our Pecha Kulcha pitches at the is a stroke monitor. “there is no one who needs that more than the one child who every one depends on”, says Stephen Henderson, Commercial Director at Intelesens (http://www.intelesens.com/inhomemonitoring/index.html), whose heart monitor device is a non-invasive vital signs monitor, recently approved by the FDA. I don't know about China but I do know that when I go home to India, it would take me at least 20mins to the nearest hospital when there is no traffic. And there is no such thing as an empty road in India!

Our last stop of the day was at a community/training centre, Neunen (near Eindhoven), where I meet Frans Stravers, International business director of TKH care group. First of all, this is no ordinary community centre: in fact, I'm now writing this I'm not even sure it was a community centre. There were students there, attending courses, so I think it was also a school. At least thats what I deduced when I got lost looking for the bathroom. However we had our meeting in a type of community centre-ish place. Open plan, it was furnished with a dining table, kitchen, waiting area and even a pool table, but one without any holes (turns out it was a Caroms Billiards table and donated by someone). So here we were listening to Frans, talking about their platform VieDome that connects care applications from other vendors to provide a holistic solution for the elderly, while around us young students were cooking. Lunch. Students were cooking lunch for us and some elderly people who began to arrive one by one, almost on cue as the table was laid. I forgot I was in a meeting. Turns out the centre is also a training grounds for students who have difficulty in school. These students take a basic first caregiving course and this gives them passage onto more difficult tiers of the same course. One of the students, Nikki, tells us in her, broken but perfectly understandable English, that what she enjoys the most is solving problems for the elderly. Like how to use an iPad. The rest of the conversations are in Dutch. But thats ok, William and I enjoy the fancy grub. I chat to Jos, sitting next to me. I'd guess he was about 60 and I'm not sure why he's here because he looks perfectly healthy. Jos tells me he likes to collect stamps and his most sought after stamp is one from the Vatican. I think I can help you get one through my (Holy!) contacts, I say and get out my phone so he can type in his name and address for me. But he preferred to write using a pen and paper because he couldn't keep his hands steady and needed his 5 inch think glasses. I make a mental note NOT to assume everyone is mobile friendly.

After bidding farewell (and losing my way to the bathroom) I arrive at Schipol only to find that my flight operator, Iberia, is not featured anywhere on the departures tables. I have a fear: is my flight not today?  Is it not from schipol? is this why the Iberia site wouldn’t let me check-in online? is it cancelled? Iberia is notorious for poor service and I am notorious to book really cheap without thinking of anything else. A quick glance at my email confirmation tells me yes…I’m definitely in the right place, right time. It's here but the only company flying to Barcelona today is Vueling. Isn’t that a subsidiary of Iberia?…i take a chance to walk up there. And yes, I'm right. Being English its customary to grumble and mutter how terrible it is that it doesn’t say anywhere that Iberia and Vueling are the same and its only obvious to those that read the business section in newspapers. Being partly Spanish, my muttering is loud enough for the customer service attendant to explain rather mockingly "it says so in small print on my ticket". That serves me right! Businessman Shabs! Pity for people like Jos, though. Well, thats customer service for you from a Spanish company….no doubt they will excel in China (sarcasm) and no doubt I will confirm with the stewardess as I enter the flight: “we are bound for barcelona aren’t we?" (fact).

First published on Jan 27, 2016 @ 18:45, on samuhya.com

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Want to make impact? Start by listening...

In the AAL (Ambient Assisted Living) community we often say we want to make an impact, using technology, in the lives of the elderly. But how many of us, tech entrepreneurs especially, have spent time with the elderly? How many of us have shared experiences with them? And listened to their stories?

I’m not a “techy” but I call myself an entrepreneur. At the AAL forum in Ghent, I admitted to myself that I spend most of my time talking rather than listening and, man do I have a big motormouth, often diagnosed with verbal diarrhoea. I went to Ghent with a purpose: find entrepreneurs for my multi-sided platform on social impact investing in elderly care (impact investors on the other side). To be honest, it was a bit disappointing: most project owners I met assumed product market fit because they had sat through user group testing or product design with focus groups, which if anything, resulted in adding or eliminating features on a solution, a solution which already received investment before the start of the project.

So there I was throwing at them my take and solution, also based on literature reviews and other people’s comments and interviews. By 4pm on the last day, my own concept of an impact investment fund had been ripped to shreds by various investors, experts and gurus, and I’d brought out the shovel and spade for a nice big hole in the middle of the auditorium. Luckily for the other guests and the building administrator, that’s when I met Bas and being too tired to sell, and Bas being open enough to talk, I just listened.

Bas Goossen, through his company MiBida, makes a social impact while providing communication technology for the purpose of care. I’m pretty sure his website can explain the technology better than I can but what I learnt by just listening to him is something I wouldn’t have picked up from his website, nor a literature review on the subject matter. To some extent I visualised “a one day in the life” of a social care tech entrepreneur…

So, naturally, after not having to listen to the sound of my own voice for 10 mins (I know its not that long) I ask myself: why don’t I listen more often?

I think we all want to make a social impact in what we do but few of us take the plunge to reach out to the people whose problems we want to solve. I have several excuses for not taking that plunge and my current favourite is: “but there are user experience experts who do that”. Of course, those experts have a lot to offer but I’m sure you’ll agree that listening to gain an understanding of how a person lives doesn’t need any expertise at all.

Take for example, my wife’s grandmother at 90, who used to play tennis and loved to hang out with her friends and family, until she fell, broke her hip and her life completely changed. My initial reaction was “it was bound to happen one day” and then my suggestions to her family were pretty much something out of the AAL project handbook: domestic robots, robot walkers etc. What good is that to a person who loved to play tennis? Have you seen Jimmy Connors play tennis with a robot walker? Actually has anyone seen Jimmy Connors play tennis recently?

So with Bas, I took the first step by listening (and not talking, well… he may tell you I talked but definitely not as much as I do). But how do you really listen without thinking to yourself: “how can I solve his problem?” or “how can I solve his problem AND make money out of it”? My colleagues Astrid Kaag and Marielle Swinkels (from the Province of Noord-Brabant) during one of the last sessions at the forum (and undoubtedly my most inspiring), explained that when we listen to people’s problems or just plain conversations we often do it without immersing ourselves in their world. When I listen, the problem solver in me just wants to jump in straight away and solve it using my CV, and the immediate solution or response can be very detached, and usually useless. But to really understand or for want of a better word “put myself in someone else’s shoes” I learnt that I need to visualise the problem, and to do that I really need to let go of my ego. Huh with my ego, thats a challenge in its self…

So, using my grandmother’s example, we tried this concept of immersion by first opening your mind and heart and then by building a lego representation of her problem. I promise you, we were not smoking anything. The result was a very natural, simple solution.

So imagine what the result would be like if it were my grandmother actually making the lego. Well, probably disastrous because I don’t think she’s ever played with lego but anyway…the exercise is based on Theory U by Otto Scharmer and right now playing out as a big MOOC across the world and the lego building in our forum session was an accelerated version of it. Theory U deserves its own blog piece, probably its own site, so I shall refrain from writing more. Besides, I’m still learning about it…

So what with Bas and my exercise in listening? Well, I admit it was not so easy to keep my ego at bay…so I’m pretty sure tidbits of advice based on an extensive literature review of caregiver randomised control trials surfaced before him. But actually I had no idea how to solve his problem which initially made me feel a little bit…thick? So, needless to say, I’m keen to learn more, especially to understand, in his words, “how intensively he works with them”. This would probably mean shadowing him…and if he gives me the chance I guarantee I’ll be in “listening mode” because he works in Dutch and I can’t speak a word!

(This post was originally published on 16.11.15 by the same author on www.samuhya.com)

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