1. A Living Architecture for Transformative Change in Healthcare The Long and Winding Road to Adoption Professor Daniel Steenstra Royal Academy of Engineering Visiting Professor in Medical Innovation at Cranfield University

2. The work I do The two sides of disruptive innovation: ‘Shop floor’ healthcare innovation - Diagnostic ultrasound in community setting - Augmented Reality for complex surgical procedures - Genetic therapies Whole system transformation of health care

3. My observations and insights Adoption and diffusion is hit & miss especially if provider has to pay and implement This applies across the board – medical devices; drugs and Health 2.0 products Too much technology push; not enough pull Technology itself is straightforward – lots of people are capable to develop effective solutions ‘Warehouse’ of great technologies not being used The ‘layered consumer’ User ≠ payer ≠ beneficiary Patients do not behave like consumers

4. How health-technologists work …

5. Views of the NHS …

7. Whole system breakdown Lack of design-thinking of large public sector provider No design means no vision no leadership no innovation no user focus Political control rather than enabling Not all stakeholders involved

8. Whither Health2.0 Health 2.0 as enabling technology for: medical process core medical technologies health and social care processes

9. 5 Rules 1.Own the area - fully understand the domain – e.g. clinical syndrome; current pathway; reimbursement 2.Differentiate between who pays for the product; who is going to use it and who benefits 3.Determine who are all the stakeholders and involve them throughout development 4.Apply design principles – co-design; early prototyping 5.Pre-empt all aspects of implementation Be patient; find friends with deep pockets; get a hobby or consider doing something else

10. Solutions for whole system Political disengagement; from control to enabling Embed design including associated aspects such as leadership, vision, innovation