Case Study: Patient Compliance Small Picture
Editor | On 10, Feb 2019
Back in April we wrote an article about the difficulties of achieving patient compliance within the healthcare sector (Reference 1). The focus there was very much on the big picture, and, as such, the conclusions we drew could be read as fairly depressing: the three main downward spiral issues conspiring to make patients not comply with their medication all seemed to be beyond the capabilities of today’s highly siloed healthcare sector. What it effectively also said was that there was little point in devoting lots of resource to solving the compliance problem until such times as some of the silo walls have been removed. One or two readers in the healthcare sector subsequently wrote to us to challenge the conclusion. Surely, they pleaded, there must be something we can do to help nudge the various disconnected systems in the right direction.
This article is a response to those questions. We’ll remain with the patient compliance theme, but at the same time hope that the specifics of the situation won’t detract from the more generic situation where innovation teams find themselves in similar ‘can’t do anything about the big picture, but want to do something to make progress in the right directions’ situation. Put another way, if we’re in a complex environment, what are the ‘adjacent possible’ solution directions.
A good way to start answering this kind of question is to go back to the Perception Map used to help manage the complexity of the overall situation. Figure 1, for example, reproduces a part of the Reference 1 article showing one of the big-three downward spiral issues:
Figure 1: Patient Non-Compliance Loop 1 – Control/Guilt
Our focus back in April was on the downward spiral loop. Something we didn’t talk about during the original discussion were two other features of this Figure 1 map excerpt, namely the yellow Perception at the top centre of the map and the green perception on the top right. This pair of perceptions represent the significant Collectors ‘driving’ the downward spiral. The most important of which is the top-centre yellow perception, ‘denial or trivialization of symptoms’.
One thing we could usefully do – given that this Collector leads-to the ultimate downward spiral – is to tackle this issue. When we combine the Collector statement with the initial Perception Map starting question, in this case, ‘patients don’t comply with medication regimes because…’ question, we are able to formulate a conflict pair:
Figure 2: Mapping The Collector-Point Conflict Onto Business Matrix 3.0 (Reference 2)
One of the important factors in mapping problems onto the Business Matrix is distinguishing between tangible and intangible parameters. Compliance – or non-compliance – is very much a tangible issue. Patients either take their medication or they don’t. The phenomenon is very measurable. Hence Figure 2 shows how we have mapped the issue onto one of the tangible parameters in the Matrix. ‘Denial or trivialization of symptoms’, on the other hand is a much more intangible factor. Hence we have looked at the list of intangible parameters available in the Matrix and concluded that ‘Engagement’ is the one that appears to fit best. Having made our improving/worsening pair choice, we can then look up the appropriate Inventive Principle solution strategies successfully deployed by others in similar situations.
Translating these generic solutions into specific ideas to help the compliance problem, if we’re to do it in any kind of meaningful way, demands that we have some specific connection points we can make. Herein lies one of the fundamental difficulties of any ‘generic’ TRIZ/SI case study.
One way to make things concrete is to take a specific element of the current means of providing medication to patients. We could look at the process, the associated services, or the physical elements of the system. Actually, if we were looking at the problem for real, we really ought to explore all three. For the sake of this article and a hopefully concise but coherent deployment of the tools, we have decided to start with a very standard, very simple physical element in today’s systems, a strip of pills:
Figure 3: Simple Physical Aspect Of Patient Compliance Opportunity: A Pill-Strip
One of the downsides of choosing something so specific is that it brings a considerable degree of constraint to how the Inventive Principles might be deployed. It is difficult, for example, to see how Principle 21, Hurrying, can have much to do to provoke us to re-think a 30-day course of pills, above and beyond, of course, reducing the course considerably.
On the other hand, one of the upsides is that when we can make a connection between Principle and the object under consideration, it will likely lead to some much more tangible solutions. We can see such a thing by examining the second Principle in the Figure 2 list, Principle 3, Local Quality… which instructs us to look for things that are homogenous and then make them non-homogenous.
The most immediate ‘homogeneity’ in Figure 3 is that all of the pills are the same. On one level, this goes without saying – a course of pills is a course of pills. The clinician wants each pill to be the same (well, this may not actually be true – it may well be advantageous, for example, to alter the concentration of active ingredients over the course of a treatment to give a boost at the beginning, and tail-off gradually towards the end – but the option to make every pill different to every other one appears to present something of a logistical nightmare. All contradictions are, of course, solvable, but already the idea of different pills in the same strip with different properties sounds like a step too far.
On the other hand, a potentially much simpler way of introducing a non-homogeneous bit of Local Quality into the pill-strip packaging would be to colour the strip differently on different days. A good way to do this, knowing something about patient psychology, would be to colour the pills for the last week of treatment differently than the pills for the first 23 days.
If that sounds trivial to you, it probably is. But then think about what you would do if you were given such a pill strip. Do you think you’d be more likely to stay the course if the last week’s worth of pills looked different? Or how about if each week had a different colour?
We’ve recently had occasion to try the idea. You wouldn’t believe how effective it is. To the point that, apart from the fact that we’ve now revealed the idea, it might even be worth patenting.
Who knows, the fact that we have revealed the idea – so nobody can patent it – is potentially a good thing. Now every pharma company on the planet can explore the idea, see how effective it is, and put it on all their pill-strips.
- Systematic Innovation e-zine, ‘Case Study: Patient Compliance Big Picture’, Issue 194, May 2018.
- Mann, D.L., ‘Business Matrix 3.0: Solving Management, People & Process Contradictions’, IFR Press, 2018.