BUSINESS INNOVATION AND DESIGN CASE STUDIES...enrolled in the Business Design Study tour course in...

CASE STUDIESBUSINESS INNOVATION AND DESIGN

2018 MBA INTERNATIONAL DESIGN STUDY TOUR

This booklet is a documentation from the 2018 MBA International Design Study Tour course at the Rotman School of Management at the University of Toronto.

The MBA students in this course responded to the challenge of mapping the innovation process of five internal projects inside two organizations based in New York City.

Produced by Angèle BeausoleilEdited by Randy Fisher, Angèle Beausoleil and Lauren EdgarAuthored by the students of RSM2109 in May 2018.

TABLE OF CONTENTS

Preface 401 MSK Direct 502 MSK: Exam Room 1103 MyMSK Mobile 1704 Openbox + Allegory 2305 Openbox: Designing Scale 29Reflection on Process 35Acknowledgements 38

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PREFACE

ANGELE BEAUSOLEILAssistant Professor, Business Design and InnovationRotman School of Management [email protected]

This booklet is a collection of five business innovation case studies crafted by Rotman School of Management Business Design MBA students, from the University of Toronto. The cases describe how five design-led innovation projects were undertaken by two New York city organizations.

This publication showcases the work produced by 20 MBA students enrolled in the Business Design Study tour course in spring 2018. In only 10 weeks, they learned the most prolific design methodologies used in business, practiced how to map innovation processes, and then co-authored the following case studies. The cases are presented using the four-phase innovation process learning framework that include: initiation, investigation, integration and implementation 1.

The initiation phase comprises all of the activities involving exploration and discovery of a specific problem, need or opportunity of key users or customers. It is focused on need or problem finding. The investigationphase comprises all the activities involving research and validation of assumptions about a specific need or problem. It Is focused moving from need finding to problem framing and reframing. The integration phase comprises all the activities involving the integration of resources, systems and contexts to introduce the solution for testing and adoption. It is focused on problem solving and solutions testing. The implementationphase comprises all activities involving the introduction of the solution (i.e. innovation) to users and evaluating if the need or problem was solved or opportunity accepted. It is focused on problem solving through solution diffusion.

Three student teams engaged in investigating, analyzing and synthesizing specific projects led by one of USA’s leading cancer research centres, and two teams traced projects led by an innovation agency start-up. All teams conducted secondary research on these respective organizations, interviewed key project stakeholders and spent time at the specific business locations. From their analysis, they translated their findings into business process maps (showing a series of events and interrelationships between events and stakeholders) and visual tracings of the organizational innovation process for each project.

The following case studies describe how two organizations engaged in diverse business innovation processes to resolve client needs and business problems through human-centred invention. The cases also offer visual tracings of five unique business innovation projects.

1 Beausoleil, A. M. (2016). The case for design-mediated innovation pedagogy (Doctoral dissertation, University of British Columbia).

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Authors

EXECUT IVE SUMMARY

Daniel Bacinello

Adittya Khan

Wanda Li

Alicia Riolino

In February 2014, Memorial Sloan Kettering Cancer center (MSKCC) noticed

trends in the New York state health care market, which posed a threat to their

patient pipeline. The trends included the consolidation of health services and a

narrowing of insurance services channels. In response, MSKCC made a strategic

decision to leverage their expertise in high quality patient care, and attract new

clients through corporate employer benefits programs in the New York city

region. In discussions with clients and other stakeholders, MSKCC realized that

the greatest threat to its patient pipeline was not the initial trends, moreover it

was the patients’ perception of limited access to their services.

An internal innovation process was launched to design an alternate route for

patients from large employers, unions and consolidators, and provide guided

access to MSKCC services. The process was led by MSKCC’s SVP and the Strategy

and Innovation Team, and included stakeholders such as executive teams,

strategy and innovation managers (SIMs), and program sponsors representing

ambulatory care, oncology nursing, administration and existing patient access

services (PAS).

MSKCC co-created their innovation process in partnership with corporate

employers interested in the potential of MSK Direct, as a value-added service.

MSKCC surveyed the needs of affected patient groups, and used the knowledge

and insights to develop their first prototype. The MSK Direct team worked with

the patient groups and the internal teams to coordinate the implementation of

specific features designed to meet the specific needs of the represented patient

groups.

This co-creation process remains in place today, as new clients and patient

groups are connected and contribute to MSK Direct. A continuing feedback

process allows the MSK Direct’s team to receive additional information to add

new service features and overall value. As a new service offering, MSKCC

continues to look ahead to scale specific features of the MSK Direct program and

expand its reach to other large patient groups.

CASE STUDYMSK DIRECT01

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In early 2014, MSKCC observed two market trendsthat triggered the need for innovation: the growthof consolidated healthcare systems, and theincreased influence of insurance companies onhealthcare provider choice.

The persistent growth of large healthcare systems(e.g., Northwell, NY Presbyterian, Mount Sinai andNew York University), was the result of healthcareindustry consolidation from mergers andacquisitions of primary care facilities. These newand larger systems had begun to siphon patientsaway from MSKCC.

At the same time, a number of insurancecompanies were reducing their selection of specificcare providers resulting in patients having fewercare choices and a ‘skinny’ network for providers,such as MSKCC to access. This trend leftspecialized facilities like MSKCC marginalized byinsurers and pushed patients towards systems withbroader healthcare offerings.

In response to these market trends, MSKCCengaged in patient feedback activities anddiscovered a third and critical trend impacting theirpatient pipeline: the perception that MSKCC was anelite institution that was difficult or impossible toget into. This appeared to be one cause forpotential patient to opt-out of services. From bothmarket trends and patient perceptions, MSKCCinitiated a project with the goal to maintain andgrow its patient pipeline by reducing barriers toentry into MSKCC.

INITIATION INVESTIGATION

MSKCC’s Strategy and Innovation team undertookthis process to: address their loss of patient-clientsto competing healthcare facilities; shield itself fromthe threat of larger health systems in NYC; and, tochange the perception of MSKCC’s service accessfor prospective patients.

MSKCC recognized they could capture largepopulations of patients by appealing directly tolarge employers (i.e., those who provided patientswith health insurance). By targeting largeemployers, MSKCC could develop advocates andinfluencers and advocates for its services.). MKSCCalso believed it could leverage its reputation as aleading care facility to appeal to large employergroups.

The Strategy and Innovation team performedbroad landscape analysis to address patient accessby reviewing other health care systems’ offerings,and analyzing comparable healthcare systems’offerings to patients and larger clients.

They also conducted primary and secondaryresearch with employers to identify key pain pointsfor patient access.

The key finding resulting from the research wasthat the problem or barrier to entry was actuallythe patients’ perception of restricted access andhigh wait times at MSKCC.

Memorial Sloan Kettering Cancer center (MSKCC) is the world’soldest and largest not-for-profit comprehensive cancer careinstitute. MSKCC is focused on delivering world-class cancer care toits patients and leveraging institutional knowledge and exceptionalpatient outcomes to improve cancer care. MSKCC offers threeservice platforms: (1) research; (2) education; and (3) patient care.


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INTEGRATION IMPLEMENTATION

As a non-profit organization focused on providingthe highest quality cancer care to patients, MSKCCdepends on patient care contributions to fundoperations and research initiatives. Therefore, it iscritical for them to pursue larger pools of patientsor prospective clients. MSKCC ha been successfulwith securing long-term relationships with largeemployers and insurers in the NYC area, withunique, appealing offerings for their employees,and prospective patients.

This project required a balance of effectivenesswith minimum disruption to MSKCC’s corebusiness and operations.

The research surfaced the patients’ need toguarantee appointments within 48-hours andsecuring their employers’ support for care provider.This 48-hour feature required alignment betweenmultiple service units and a review of MSKCC’spatient intake processes.

MSKCC would design and develop a pilot with oneclient-employer, which involved creating a newdepartment with a separate office space, phonelines and training for the Care Associate team.

From the pilot’s beginning, a continuousrecruitment effort was integrated and accompaniedthe launch / testing, and as more clients(employers) joined, more program features wereadded.

MSK Direct was designed to integrate with theseservices and provide guided access to largepopulations of patients who received their healthinsurance through large employers, unions andconsolidators. MSKCC sought to incentivize largeemployers to advocate for MSKCC’s inclusion inhealthcare networks, as provided by insuranceproviders.

Before finalizing the MSK Direct concept, MSKCCconsidered several options to address concerns oflarge employers and patient access, includingdirect contracting with large employers andbypassing the insurance companies.

The primary criteria for evaluation were: (1) valueto patients; (2) value to clients; and (3) the impactof disruption to MSKCC operations.

Monetization of the MSK Direct service throughincreased employer premiums or membership feeswas considered, but not implemented becauserevenue-generation from MSK Direct was not theprimary driver / benefit desired. MSK Direct was astrategic means for building long-termrelationships with clients (i.e., patients); and heldthe key to repositioning MSKCC as an accessiblepatient care provider.

MSK Direct was launched with a single client andcontinues to increase in functionality. The firstMSK Direct prototype included: 48-hourappointments, care advisors, real-time care,dedicated phone lines and extended familyinclusion. The first phase of implementation beganwith the first MSK Direct client (pilot), with theunderstanding that it would be delivered as aniterative process and Minimum Viable Product.

MSK Direct’s 48-hour appointment feature provideda strategic advantage over other cancer care centresin bringing the first users of MSK Direct on boardquickly and allowing MSKCC to go live. Productofferings and services were developed with patient-clients and internal staff. The executive teambrought internal sponsors, knowledge andfeedback from MSKCC’s ambulatory care, nursingand social work divisions into the developmentteam.. To date, this program has resulted in anincrease in new patient-clients.

Each platform enables MSKCC to meet its institutional goal of improved cancer care. For example, MSKCC’s research arm leverages insights gathered through patient care to inform its curriculum and pedagogy. Likewise, the education service platform uses highly specialized training to build relationships with physicians globally; they contribute to research in their home countries and also partner with MSKCC to develop a research pipeline.

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Business Innovation Process Map for MSK Direct


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Visual Tracing: Innovation Process for MSK Direct


Strategy & Execution

Trend analysis Pitch Meetings

Patients

Patient Access Service (PAS)

Research Loop Share data

Knowledge transfer

Epiphany

CBS

Feature development

48 hr request approved

Resources

PAS

MSK Direct

Launch

LegendPatient Access Service (PAS)Strategy & ExecutionPatients Sponsorship teamLarge employersMSK Direct

Pitch Meetings

MSK engages with large employers to pitch MSKCC as a center of care to cover their employees through their benefits packages and insuranceproviders.

Share Data

MSK generates and disseminates data showing decrease care costs for employers and significantly higher 5-year survival rates for patients through treatment at MSKCC compared to other care providers

Knowledge Transfer

Employers tell MSKCC, “We know you are great, but our employees can’t get in!”

Epiphany

MSK generates and disseminates data showing decrease care costs for employers and significantly higher 5-year survival rates for patients through treatment at MSKCC compared to other care providers.

CBS

The first large client to work in-depth with MSKCC on development of the MSK Direct

Feature Development

The features of the MSK Direct were informed largely by the capabilities of MSKCC and the needs of the patient groups represented by CBS. Features were developed and implemented by the internal team and project sponsors.

48 hr Request Approved

This was a key feature of MSK Direct which would provide a strategic advantage over other care centers and be the key feature of the program. This feature was pivotal in bringing the first users of MSK Direct on board and allowing MSK to go live with MSK Direct.

ResourcesResources and infrastructure for MSK Direct began to be implemented months ahead of initial launch including dedicated phone lines, hiring and training of 4 care advisors and furlough of a full-time nurse and part-time social worker dedicated to MSK Direct.

MSK Direct:Enable access to MSKCC for patients who

have high interest but low access to MSKCC’s services

External Trends: - Consolidated

Markets- Narrow Insurance

NetworksInterest

Acce

ss

How do we increase access to patients seeking treatment?

Go straight to large employers

MSKCC has the best patient outcomes &

lowest cost of treatment

We know. But people can’t get

in.

We aren’t creating demand. We are

servicing it.

How can patients hack into MSK?

Partnership with CBS

1. Patients are scared

2. They can’t get through on the phone

3. They can’t get in

1. Dedicated Care Advisors2. Dedicated Phone Lines3. 48 hour appointment option

Align our

teams and set up shop

Innovation breeds

innovation

Employers that consider their

employees talent will sign on

MSK DirectReimagining access to quality cancer care

Trend Analysis

Strategic analysis of patient groups by ability and interest in accessing MSKCC as well as review of broader trends in health network consolidation and narrowing of insurance networks.

MSK DirectBusiness innovation process map

Daniel Bacinello | Adi Khan | Wanda Li | Alicia RiolinoRotman MBA

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EXECUT IVE SUMMARY

Memorial Sloan Kettering Cancer Center (MSKCC) is a leading US cancer treatment

institute based in New York City. It is a patient-centered hospital that strives to

promote continuous improvement in cancer care.

While the “Exam Room of the Future” opened in 2014, an extensive, multi-phase

process began in 2010. In the initial stage, the design team, worked with design

students from Rhode Island’s School of Design to draft the framework from an

architectural standpoint. Activities included: observations within the clinic;

collaboration with nurses and physicians; and meetings with the patients and

families’ advisory committees. In the next stage, the ambulatory care, design and

construction, and IT teams started the formal facility design process which

included applying for permits, procuring new equipment, and ensuring that all

elements were aligned with MSKCC’s design standards.

This case investigated the design process led by MSKCC to bring the “Exam Room

of the Future” project to life. A series of interviews with key stakeholders revealed

the complex nature of innovating inside large organizations. Careful attention was

given to the four stages of innovation: initiation; investigation integration; and,

implementation.

Key case analysis findings reflected the critical success factors associated with

MSKCC’s innovation process: (a) Client-centricity: Placing patients in the center of

the innovation process is key to ensuring MSKCC innovation and accomplishing its

mission to provide exceptional patient care. (b) Leadership buy-in: Establishing

champions in leadership positions proved to have a significant impact on

innovation adoption, enabling more access to company resources necessary to

fund and support the innovation process; (c) Collaboration and communication:

Open lines of communication and involving every level of the organization in the

innovation process ensures alignment from initiation to implementation.

Communication breakdowns lengthen the process and pose risks that can

significantly divert the innovation from its intended impact; and, (d) Mixed

measures: Having quantitative measurement in place to complement qualitative

metrics are necessary to effectively evaluate innovation impact on the

organization and to assess future project scalability.

CASE STUDYMSK EXAM ROOM02

Authors

Jiayan (Maggie) Chen

Hassan Kenawi

Priscilla Sam

Aaron Xu

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With the mission to prevent, treat, and cure cancer,MSKCC is the world’s oldest and largest privatenon-profit comprehensive cancer institute. Theyfocus on delivering world-class cancer care throughpatient care, research and education. Supportingand leading MSKCC’s strategy is the Senior VP ofStrategic Planning who directs the Department ofStrategy and Innovation (DSI) team. This team wascreated 11 years ago and uses design, analytics,and strategy to tell MSKCC’s story.

The DSI team observed two key issues: patientswere spending a lot of time alone duringappointments and the consultation rooms wereunder-utilized. These findings prompted theopportunity to explore what an “Exam Room of theFuture” might look like when a new site wasscheduled to be constructed. The “Exam Room ofthe Future” was proposed as an innovationdesigned to: increase patient satisfaction; increasehigher patient throughput; and, scale innovationactivities at new facilities.

Applying innovation to increase patient satisfactionwould deliver higher quality care and enhancecancer treatment experiences. Driving higherpatient throughput would get more people throughthe doors and ensure MSK could treat more peoplefor cancer. Scaling the innovation would activateMSKCC’s leadership’s vision and enable care tomore patients. Such innovations could position theclinics to provide the latest in cutting-edgeapproaches to treatment, and ultimately the goal ofconquering of cancer.

The research phase began with observing andempathizing with the patients and their families. Inthe Discovery phase, the MSKCC team useddivergent thinking to generate many ideas toenhance the patient experience while receivingcare. A team of trained design students from RhodeIsland School of Design observed clinic flowpatterns and clinician-patient interactions inoutpatient clinics to inform their design. By puttingthemselves in the patient's position they were ableto understand each step of their journey -- fromentering the clinic through the treatment and thenleaving the premises. Using students from outsideMSKCC also provided a fresh pair of eyes to noticeand gather new insights. The resulting key findingsand insights included: inefficiencies and under-utilization of consultation rooms; long patient waittimes before physician checks; inconsistent patient-family-physician consultation; and, a lack ofintimate personal spaces for patients and theirfamilies.

During the definition stage, the team engaged inidea generation and converged on the best ideas.This process involved building virtual prototypesand collecting patient feedback, then tweaking theprototypes and making improvements. This stagewas led by the Head of Design Strategy &Innovation and supported by the Medical Director(i.e. the Physician Champion) who advocated acrossthe organization and within MSKCC’s leadership.This level of expertise and direct experience wasused to identify the best and most practical ideasthat could be implemented, helping MSKCC’sbecome a world leader in cancer treatment.


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MSKCC’s innovation strategy connected the user’sproblem to a business need, and sought to answer“How might we design and deliver superior cancertreatment and care to our patients and increaseoperating efficiencies?” The resulting prototype forthe “Exam Room of the Future” project had todeliver on patient satisfaction, patient throughput,clinician and staff buy-in; and scalability, while alsomanaging costs and return-on-investment (ROI).

Collaborating with internal teams (e.g. clinicians)and external design partners (Rhode Island Schoolof Design students), the DSI team prototypedmultiple elements for the “Exam Room of theFuture” incorporating feedback from clinicians andpatients. They included: a flex room designed forboth examination and consultation; curved-walls topromote a more patient-friendly, welcoming and“less clinical feel” environment; motorized curtainswhich “hide” the clinical tools during consultationand provide greater patient privacy duringexaminations; a hybrid chair which can converteasily (i.e., in 15 seconds) between an examinationbed and a consult chair via a programmable controlpanel; and, jump seats that retract against the wallwhen not in-use yet provide flexible and additionalseating for residents and fellows. “Smart RoomTechnology” was also developed and integratedfollowing 50 iteration cycles.

The best solution was a Lazy-boy style hybrid chairthat could easily transform from a consult chairinto an examination bed. A third-party furnituremanufacturer produced the final product. Thehybrid chair was selected as it offered comfort,durability, patient satisfaction, patient throughput,clinician and staff buy-in and cost.

The Exam Room of the Future project aimed toextract the maximum value out of the new space,provide the best patient-centric care withinnovative design methods, and integrate new‘smart room’ technology. As the capacity of theclinic increased, more patients benefited fromMSKCC’s world-class cancer services.

The success measures identified by MSKCC focusedon the project’s benefits, including: increasedpatient throughput by 10%-15%; decreased numberof rooms allocated to each physician therebyincreasing room utilization (e.g. from 3 to 2.5rooms per physician); decreased patient wait-timefrom 60%-30%; and, increased efficiency gains viathe full technology-integrated room; and increasedphysician and patient interaction time.

Building the right team to execute on innovativeprojects is essential. Identifying and aligninginternal stakeholders and external strategicpartners is critical. Securing funding for a pilotproject vs. for an organization-wide initiative wasmuch easier in order to scale the project. This pilotprovided justification for scaling it across MSKCC’scomplex operations.

Engaging early adopters with gravitas to shape theteam’s mindset was very important forimplementation. As the champion for MSKCC’s64th street location, the presence of a leadphysician ensured minimal resistance to adoption.Implementing this vision without the participationand involvement of team champions proved to bechallenging when introduced to other hospitals.The Exam Room project took four years frominitiation to implementation; demonstrating thedifficulty in quick and successful innovation insidelarge complex organizations.

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Business Innovation Process Map for MSK Exam Room of the Future

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Visual Tracing: Innovation Process for MSK Exam Room of the Future

Innovation Trigger:New Facility

Internal Strategy and

Innovation

Idea: Exam Of The Future

Observe & Research

Architecture

Construction

Prototyping

Experience Mapping

Finish

Evaluation

Iteration Loop

StartAmbulatory Care

Doctors & Nurses

Patients

Construction & Design

Strategy & Innovation

LEGEND

“DRIVING” INNOVATION TO MSK’S NEW EXAM ROOM Jiayan (Maggie) Chen, Hassan Kenawi, Priscilla Sam, Aaron Xu

Innovation Trigger:New Facility

Internal Strategy and

Innovation

Idea: Exam Of The Future

Observe & Research

Architecture

Construction

Prototyping

Experience Mapping

Finish

Evaluation

Iteration Loop

StartAmbulatory Care

Doctors & Nurses

Patients

Construction & Design

Strategy & Innovation

LEGEND

“DRIVING” INNOVATION TO MSK’S NEW EXAM ROOM Jiayan (Maggie) Chen, Hassan Kenawi, Priscilla Sam, Aaron Xu

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EXECUT IVE SUMMARY

In the summer of 2010, Memorial Sloan Kettering Cancer Center (MSKCC), New

York’s world-renowned private cancer center, was seeking to provide a superior

customer experience to their patients. They explored options that were human-

centred and highly engaging, and decided to conduct an Innovation Jam. This

interactive event would result in a decision to create a mobile application for

patients and partner with a creative agency called Moment Design.

The premise for the mobile app would focus on improving the lives of cancer

patients. Throughout the ideation process, prototypes were developed from the

patient’s current and ideal experiences, and feedback from patients and internal

MSKCC stakeholders.

The working title for the app was MyMSK. It was conceived and introduced to

patients through an initial participatory design and socialization phase. MSKCC

and partner agency Moment Design, would iterate on the design of MyMSK for

almost a year using a business design process, involving user research and

prototyping. In 2011, the app-prototype would be launched and act as a platform

for patients to record information, provide reminders and support patients 24/7

or 365 days a year, based on their needs.

In 2013, the app-prototype evolved and offered new features from technology

partner, European software integrator (EPAM). The MyMSK mobile app was once

again redesigned, integrating user feedback through a series of beta testing cycles

involving a group of patients and MSKCC stakeholders. In 2015, the final MyMSK

Mobile app was completed, and a communication and launch plan developed for

its official launch on the iOS platform.

CASE STUDYMyMSK MOBILE03

Authors

Duygu Yucesoy

Eleni Schetakis

Nav Dhillon

Mert Yucesoy

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The goal of MSKCC’s Design Strategy andInnovation (DSI) team is to engage patients indesigning superior care services and programs. TheDSI team initiated a service innovation process incollaboration with patients and nurses, to addressthe need to increase their patient/customer andcaregiver engagement with MSKCC. To generateideas relating to superior customer experience, theDSI team engaged internal customer-facing teamsand all employees in an ‘Innovation Jam’. The DSIteam focused on opportunities for innovation whilethe internal parties brought an operationalperspective and the motivation to innovateaccording to real patient-needs and situations.

One of the ideas from the Innovation Jam was amobile platform that patients could access anytime,anywhere. Initially, 30 patients were interviewed toassess if a mobile application would be a valuableaddition to the MSKCC offerings. Once validated,the DSI team involved two in-house designers and anurse leader to provide further insights. The teamwere then introduced to Moment Design, a mobileengagement agency, who would provide pro-bonoservices for this project.

The mobile application would have to addresspatient and caregiver engagement needsthroughout their entire MSKCC healthcareexperience journey -- from onboarding newpatients, enrolment in the hospital to providing thebest possible healthcare support and treatments.

MSKCC identified a need to develop a mobilepresence with their patients (customers), observedtheir patients needs for mobile access to theircancer care treatments; and understood seniormanagement concerns with technological, financial,and legal costs and related activities.

The design for a mobile application would be costeffective via a pro-bono service agreement withMoment Design. The agency led preliminaryethnographic research to investigate the problemstatement and understand patients’ needs andinterests. They researched how technology couldimprove the experience of patients undergoingchronic cancer treatment and conducted industryresearch to benchmark mobile innovation.

As project collaborators, MSKCC and MomentDesign conducted workshops with internalstakeholders; developed customer journey maps;and conducted focused ethnographic research. Theethnographic interviews were conducted withpatients inside MSKCC’s clinics in Manhattan. Thequestions were open-ended and also includedfollow-up probing to discover how the patientswould interact with the mobile app and the MSKportal.

The initial problem statement evolved from “Howcan mobile technology improve the experience ofsomeone going through chronic health problemsspecifically chemotherapy?” and redefined fromresearch findings, as “How can MSKCC use a mobileapp to engage more efficiently with their patients?”


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The primary internal challenge for MSKCC’s DSIteam was to convince senior management andinternal stakeholders to support mobile technologyintegration. Other issues included security andprivacy issues, IT, and the costs and decisionsassociated with development timeliness, research,and testing.

Strategic alignment with MSKCC’s goal to providesuperior patient experience through the addition ofmobile application was understood. In addition,MSKCC had a portal that served the currentpatients. Having a member of the IT (Portalservices) team on the project was critical to theintegration and development of the app into theexisting web-based system. To mitigate mobiledevelopment costs, MSKCC hired an offshore firmto work closely with the internal/external projectteam and provided specific and detailedrequirements for coding. The cost of hiring EPAMwas 30% lower than the cost of hiring a localdeveloper.

Considering the app would resolve the need tomake the healthcare treatment process easierthrough a more convenient and useful tool. MSKCCteams focused on engagement measures overfinancial metrics. The organization saw the longterm investment of providing a superior customerexperience, resulting in future fee premiums for itsservices and revenue increases.

One challenge was identified between theintegration and implementation phase of theproject: the handover of the applicationdevelopment from the offshore mobiledevelopment team to internal mobile developers;and between Moment Design to MSKCC’s internaldesigners – as these teams were unfamiliar with thedevelopment processes experienced by each group.These handovers took place after user testing andbefore the beta testing; some of the app’s featureshad to be changed after beta testing.

After the integration phase was completed, thesolution was implemented over six months. Theimplementation project team comprised of twomembers of the DSI team; an internal mobiledeveloper; and several patients. The plan includedbeta testing; communication launch; and a roll-out.The beta testing involved 25 patients in 2 clinicsfor 10 weeks. During beta testing, the DSI teamobserved patient engagement with the app andcollected feedback.

The testing surfaced user experience issues andpatient priorities. Unused features were removed,and other issues were resolved. The final version,entitled “My MSK” was released.

The solution was measured by the number ofpatients who downloaded and used the app. Thesolution solved the original problem by increasingpatient engagement. In addition to enhancingpatient care, which aligns well with MSKCC’s goals,the project also opened doors to other digitalinitiatives for the hospital, aligned with theinstitution’s innovative human-centered approach.


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Business Innovation Process Map for MyMSK Mobile

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Visual Summary: Innovation Process for MyMSK Mobile


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EXECUT IVE SUMMARY

Established by Marquise Stillwell in 2009, Openbox is a boutique design and

innovation consultancy firm in the heart of New York City. Their mission, “design

for trust”, originates from the notion that trust is a valuable yet vulnerable

currency that should be curated with clients and and their end users. By involving

their clients throughout each step of the design process, Openbox is able to

develop and strengthen relationships; learn what works and what could use

improvement; and leverage “between the lines” research insights, leading to

transformative customer-centric solutions.

This case highlights Openbox’s design process pertaining to its work with

Allegory. Allegory is a cloud-based collaborative litigation platform used by many

of the most prestigious law firms, corporations, and government agencies in the

United States. In 2016, Allegory approached Openbox with a novel product that

lacked market traction. They engaged Openbox to seek additional insights into

their product’s shortcomings. Openbox undertook a rigorous “discover” phase, to

address a disconnect between Allegory’s product and its user base. Using a

customer-centric approach, Openbox discovered the product had an

underdeveloped user interface (UI), and an unsatisfactory user experience (UX).

Openbox employed an iterative Make-Test phase with wireframe prototyping and

user-led tests for a UI/UX redesign. Their approach provided valuable market

insights to inform the evolution and improvement of the product design. Allegory

incorporated this UI / UX research and feedback, into its product design and

construction. Openbox also provided a Pedagogical Implementation Guide for

Allegory’s software development team to contextualize user insights and share a

successful human-centred approach and design.

As a result of the design-centred process and implementation, Allegory was

acquired by Integreon in November 2017.

CASE STUDYOPENBOX + ALLEGORY04

Authors

Stephanie Pennal

Andrew Del Fatti

Sarah Badun

Artem Zemskov

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Historically, the US legal industry has been paper-based and hierarchical which has restricted theflow of information between legal parties. In 2011,Allegory identified the legal industry’s need toimprove case information processes and designedand proposed a new platform to resolve thelitigation legal teams’ needs.

In 2016, Allegory engaged Openbox to develop abetter user interface and user experience of theirnew platform. The aim was to improve theirproduct and increase market adoption.

The platform redesign had to offer significant valueby improving the process and successful outcomesfor legal professionals at multiple levels. The newinterface and application functionality wasexpected to increase the speed and ease ofinformation-sharing; leading to ultimatelyimproving a lawyer’s success rate and experienceduring litigation.

The initial design began when Allegory’s founderengaged Openbox to lead the Innovation process.Openbox’s team worked with a law firm to developcustomer-centric insights to define the finalproduct. The Make-Test design process comprisedof Openbox staff who identified, then investigatedsix (6) distinct personas within the law firm. Theteam focused on product design and functionalityprior to developing the final prototype.

Openbox used their proprietary framework toresearch Allegory’s business innovation challenges,guide the human-centered design process andfocus on areas for people-centered product designimprovement and optimization.

The Openbox team encountered challenges due tothe complex and private nature of the legalindustry, and opted to design a process to ensure avery detailed and comprehensive two-step researchplan. Step 1 involved an in-depth review of the legalindustry and the competition. Step 2 involvedinterviewing and shadowing key stakeholders (i.e.law firm partners and lawyers); and, visiting courthouses to witness legal proceedings. Openboxdiscovered distinct stakeholder groups andsubgroups with different needs. Each grouprequired a customized interface to accessinformation either during live court cases or, vianumerous visits. This led to a deeperunderstanding of the need for simplification due tothe high number of information sources requiringaccess, when lawyers were in court.

As a result, six user personas were created to guidethe design of a modular platform that could becustomized for each persona’s goals and needsthroughout their individual litigation processes.

Openbox’s Make-Test cycle helped the teamdevelop insights to significantly change theproduct’s design by ensuring the different usecases could be developed for each user’s personaldashboard. This functionality enabled the productto serve the specific user needs within a usergroup, and offer greater interface flexibility forfuture modules.

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After the Discover Phase of Openbox’sinvestigation, it became apparent that the tool wasnot solving the lawyers’ business needs/problemsbecause it was not designed for the variety ofpeople who were using it. Existing customers wereabandoning their use of the tool and/or did notwant to pay for it, in addition to the other servicestheir firm required.

Openbox applied their Make-Test phase as aniterative prototyping process in direct collaborationwith end users from each of the six persona clientgroups. Working closely with Allegory’s team andclients, Openbox’s prototypes were divided intoseveral modules to allow for optimum userengagement and testing.

This approach enabled Openbox to understand thedistinctive functional needs of the differentstakeholders, and design a modular system thatcould customize the platform’s dashboard withdesired tools for each user group (i.e. persona).

After each stakeholder (individually and groups)was satisfied with the platform’s usability, a finalversion was recommended. This was packaged forAllegory as a Pedagogical Implementation Guide,which provide User Experience Maps (and context)for the insights generated by Openbox.

Allegory’s software team was provided with thisframework to develop a platform / tool informedby human-centered design for functionality, ease ofuse and adoption. Openbox provided Allegory withbranding recommendations and further designsupport, as required.

The primary stakeholders involved in the Allegory-Openbox platform innovation process included senior executives or partners -- those seeking insights into the numerous cases under their supervision; and the information management leaders -- those seeking to prove that the product’s use-case for law firm partners and other internal stakeholders offered value.

Secondary stakeholders included associate & paralegal professionals -- those who used the tool frequently at court and their offices; and, corporate counsel representatives – those seeking visibility of the general litigation case processes.

Openbox’s process, findings and insights were made available to Allegory throughout the project.

Allegory was responsible for implementing the prototypes into their final platform solution. Although this case does not offer details on the implementation process of the user experience redesign, the changes were made by Allegory’s software team.

Allegory was acquired shortly after working with Openbox, strongly suggesting the human-centered design approach to the platform’s interface and experience generated added value for the company.

Openbox is a design-thinking agency founded by Marquise Stillwell with a vision for the evolution of design-thinking.The organization’s mission is to help its clients design for trust, which ensures that the firm puts people at the centerof everything it does. Openbox uses its methodology to help good ideas scale with meticulous flair for social impact.Openbox has three verticals: (1) Design; (2) Film; and (3) Venture. Through its capabilities in design and film, Openboxis able to create people-centric experiences and convey powerful stories through film. This combination was veryeffective when showing the impact of its social-impact projects, such as the Lowline underground park and GirlTrek.

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Business Innovation Process Map for Openbox + Allegory

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Visual Tracing: Innovation Process for Openbox + Allegory

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EXECUT IVE SUMMARY

Openbox is a design-thinking agency founded by Marquise Stillwell with a vision

for the evolution of design-thinking. The organization’s mission is to help its

clients design for trust, which ensures that the firm puts people at the center of

everything it does. Openbox was approached by Allegory, a legal technology

start-up, to scale their new platform and attract business investors. Allegory was

created with the intent of simplifying how law firms use to manage all the

paperwork and developments of a legal case. While Allegory received a

tremendous amount of interest with their platform, it had difficulty building a

customer base and therefore, scaling its business.

To solve this problem, Openbox applied their Discover, Make, Test, and Activate

process to Allegory and its new platform product. As a result of the ‘Discover’

phase, Openbox understood there were three impediments to the scaling of

Allegory: (1) The tool was not user-friendly nor robust enough, and also failed to

consider the needs of multiple types of users. It was only designed for only one

of the five users identified; (2) Allegory did not have a clear identity. Establishing

trust with clients without a compelling identity was extremely difficult;: and, (3)

As a result of the first two problems, the sales process was inefficient and failed

to take into account the difference between product users and and purchasers

(or those approving the purchase) of the product.

Openbox co-created solutions for each problem stream and tested them with

Allegory and its customers. It delivered a holistic solution that included

recommendations on how to drastically improve the Allegory's user-experience

and interface; its new identity and branding; and how it should be applied to all

facets of the business, including and a new sales process and pitch deck.

As a result, Allegory successfully addressed its challenges, and was acquired by a

large legal-technology firm after the project was completed.

CASE STUDYOPENBOX: DESIGNING SCALE05

Authors

Bridget Lipman

Joshua Zachariah

Shijing Wang

Tarek Mavani

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Allegory is a legal tech startup that came toOpenbox to help scale its platform. Allegory's newapplication was designed for law firms seekinggreater ease in tracking and centralizingdocumentation for their case team members.Allegory was founded by Alma Asay in 2011, withover six years of experience practicing law in alarge commercial litigation firm.

Allegory was in operation for a short-period of timeand actively selling and implementing the newproduct with its client firms. Although clientsvalued its promise, the platform did not deliver itsanticipated value. Consequently, Allegory wasunable to build a strong client base and could notscale its business.

Allegory engaged Openbox to assist them withplatform redesign to grow their client base anddemonstrate a scalable business model. Openboxled a proprietary innovation process that involvedfour steps: Discover, Make, Test, and Activate.Openbox’s role was to: (1) Understand the productand market contexts, and Alegory’s operatingprocesses and organizational structure; (2) Ideateand prototype potential solutions that address theplatform design issues; and, (3) Engage keystakeholders (i.e., Allegory, law firms, etc.) todetermine how the solution could be improved andsuccessfully implemented.

The research methods used during the ‘Discover’phase by Openbox were: (a) product walkthroughsconducted by Allegory sales staff providinginsights into the product’s user-experience andsales pitch; (b) interviews with Allegory leadershipto better understand Allegory's vision andobjectives and its organizational structure; (c)observational research to understand the salesexperience from differing perspectives potentialusers, clients and stakeholders; and, (d) industryresearch focused on changing consumer behaviorfrom different sectors.

Multiple design methods were used during theseactivities including: user-empathy and need-findingthrough observation; user-interviews; andlandscape analysis of other products that solvedproblems similar to Allegory's.

The ‘Discovery’ phase findings surfaced three inter-connected problems impeding Allegory's growth:(1) The tool was not user-friendly or robust enough,and it also failed to consider the needs of multiplekinds of users. It was only designed for only one ofthe five users; (2) Allegory lacked an identity.Establishing trust with clients without an identityto build around was going to be extremely difficult;and, (3) As a result of the first two problems, thesales process was inefficient and failed to take intoaccount the difference between product users andpurchasers (i.e., product approval).

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As a strategic and agency partner, Openbox workedcollaboratively with Allegory to develop and testthe prototype and the implementation plan.

During their “Make” stage, Openbox engaged in co-creation with Allegory to identify ideas to solve theproblems identified. The “Test” stage involvedleading a series of user-testing activities withAllegory on the product iterations, brand identityconcepts, and sales process.

Openbox then conducted the prototype testing inthree different streams: product, identity and sales.The final prototype offered improvement to theproduct design in terms of usability. The brandidentity iterations involved new options for thelogo, colors, typeface, and messaging. The salesprocess prototypes offered three different modelsfor Allegory to consider.

The process from initiation to integration occurredover approximately six months and involvedOpenbox’s stages of ‘Discover’ to ‘Activate’.

While Openbox designed and delivered high-fidelity mock-ups of the new tool. Allegory was responsible was for the tool’s front- and back-end development.

Openbox provided Allegory with an “Activation Guide” manual. This contained everything regarding the firm’s new identity; the rationale behind it; and how Allegory's internal processes should be conducted to ensure its identity was consistent across all activities.

In addition, Openbox provided sales training and a revamped pitch deck to Allegory. The pitch deck and training were designed to fix the problem of Allegory only targeting users and not decision-makers. It also ensured that users were comfortable with what to expect once they purchased the product.

As a measure of successful implementation Allegory was successfully acquired after the completion of this project, suggesting that Openbox had effectively designed a solution for the Allegory's three original business problems.

Openbox is a design-thinking agency founded by Marquise Stillwell with a vision for the evolution of design-thinking.The organization’s mission is to help its clients design for trust, which ensures that the firm puts people at the centerof everything it does. Openbox uses its methodology to help good ideas scale with meticulous flair for social impact.Openbox has three verticals: (1) Design; (2) Film; and (3) Venture. Through its capabilities in design and film, Openboxis able to create people-centric experiences and convey powerful stories through film. This combination was veryeffective when showing the impact of its social-impact projects, such as the Lowline underground park and GirlTrek.

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Business Innovation Process Map for Openbox: Designing Scale

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Visual Tracing: Innovation Process for Openbox: Designing Scale

REFLECTION ON PROCESS

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This course was all about corporate innovation processes. The class was tasked

with studying different innovation models, how and why they exist. During the

preparatory course work in Toronto, they practiced studying how innovations

happen and how they are mapped onto design thinking based frameworks. Once

the projects kicked off with the organizations in New York, we all experienced the

messy reality of “innovation,” or creating and implementing something new. The

innovation frameworks where helpful when dealing with ambiguity and how very

big ideas get started. They proved to be more useful as a guide to stay on track

and create something that truly connects with the user. In only a few short weeks,

the class worked tirelessly to learn the innovation frameworks, research and

interview the organizations in New York, analyze their innovation process, write a

case study, and illustrate the case study visually. This crash course in innovation

processes and case study analysis will help the students when working at their

own organizations. They know that documenting processes will serve them well as

road maps for successful projects. Through this intensive class, this cohort

experienced how to tear an innovation down to its bare essentials, how

organizations are organized to initiate and create new ideas, and what steps to

take when integrating and implementing the new idea as an effective solution.

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CASE WRITING COLLABORATION

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Students synthesizing their research and creating the case studies

ACKNOWLEDGEMENTS

The course, study tour and booklet were supported from many individuals and organizations. We want to thank the following for your participation and contribution to the 2018 edition of RSM2109.

NYC study tour companiesMemorial Sloan Kettering Cancer CenterOpenboxSY PartnersVerizonDoblin NYCCooper Hewitt Design MuseumBig SpaceshipFahrenheit 212R/GA

Rotman School of ManagementFreeda KhanLauren EdgarEdith Cheung

Contributing editorRandy Fisher

Business Process Model Notation (BPMN) tutorial provided by:www.bpmn.org

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Copyright © 2018

Distribution is limited to students, faculty and administrators at the Rotman School of Management, Memorial Sloan Kettering Cancer Center and Openbox.

www.rotman.utoronto.ca

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