By Craig Scherer and Carolyn Rose, Insight Product Development
Introducing a new product into a hospital or other healthcare system is an increasingly arduous task. Compelling, user-centered design alone doesn’t ensure a product’s successful introduction or adoption. Striking the right balance to ensure key priorities are met — across both the complex healthcare ecosystem and the larger audience of device stakeholders — could be the difference between market failure and commercial success.
In order to compete effectively in today’s healthcare marketplace, a company must recognize the adoption drivers at play and be cognizant of how its product values and infrastructure align with those drivers in the healthcare ecosystem. While adoption drivers and their relative importance can vary across facilities, our experience in medical device development has revealed to us that three drivers appear to remain constant: clinical goals, contractual relationships, and cost.
An understanding of these drivers and their relationship to new product introduction is key to achieving significant market adoption — and avoiding user abandonment.
It goes without saying that a medical product must align with clinical goals to gain market acceptance. In general terms, these goals fall under four broad categories: clinical efficacy, workflow efficiency, usability, and expectations management. While it’s important that any new product meet baseline expectations in these categories, real value is derived from credibly demonstrating meaningful differentiation across all of these clinical goals.
1. Clinical efficacy extends beyond answering the question, “Does the product accomplish the job as intended?” Because of the FDA’s detailed protocols, this efficacy is more an assumption than a means of differentiation. For this reason, efficacy is most meaningful when linked directly to patient outcome. Demonstrating an evidence-based relationship between product use and patient outcome and satisfaction is not only a compelling way to foster adoption, but it is increasingly a requirement among care management organizations (CMOs) and other payers.
2. Workflow efficiency also is recognized as providing significant benefit, as hospitals and healthcare facilities constantly seek ways to optimize and expedite workflows. In order to demonstrate meaningful differentiation through efficiencies achieved with new product use, it’s important to recognize that the ultimate goal of clinical efficiency is increased patient throughput. Timesaving is most meaningful when quantified to demonstrate actual impact on patient turnover rates, in the form of more consultations and cases per day.
When considering the impact of disruptive innovations and technologies, it is particularly important to consider the effect that implementing a new system may have on current workflows. If a new offering requires a clinician to add steps or time to their familiar workflow, then it does not make sense from a throughput perspective, which often leads to early abandonment by the clinician.
3. Usability also can be leveraged to drive adoption, though it is arguably the most challenging variable to demonstrate in an unbiased, data-driven way. This goal appeals primarily to the end-user (clinician, surgeon, nurse, etc.), and its value is not as demonstrable as the previous two unless it can be linked to efficacy (better outcomes due to fewer errors) or efficiency (better throughput based on easier-to-use systems).
However, usability is the goal most likely to drive brand loyalty, encourage long-term usage, and avert abandonment. Its benefit likely is best communicated through product demonstrations and trials. Typically, ease of use is only recognized once the product is in the hands of end-users, so user familiarity with systems or devices that perform similar tasks is something to capitalize on. The consumerization of healthcare has led, in general, to users who expect devices to work in similar ways. Although not every medical product should mimic an iPhone, consumer products can guide design teams toward user interactions that are effective, efficient, and even desirable — all of which systemically support user adoption and market acceptance.
4. Stakeholder expectation management presents another challenge, as well as an opportunity to support adoption at the clinical level. As discussed earlier, clinicians desire products and systems that don’t disrupt their workflows. But, regardless of the benefit a new product provides, clinicians might be resistant to change and rarely have the authority to make purchasing decisions. For this reason, it's important to engage at the hospital system level, as some disruptive technologies may require adaptive behavior on the part of clinicians to support full implementation.
Thus, the key here is to create solutions that show demonstrable system-level benefits, such as improved outcomes or lower costs. These solutions also should show an understanding of current system workflows, and application of that understanding to minimizing disruption, managing the clinicians’ expectations and optimizing their product-use experiences.
Vendor relationships and contracts — commonly group purchasing organizations (GPOs) — also play a major role in new healthcare product adoption. Often, these facets prove to be limiting factors for smaller-scale organizations and startups, and enablers for those that can leverage established competencies (e.g., sales force, brand equity, etc.). Recognizing this dynamic will likely influence go-to-market strategies for both types of organization.
While recent legislation has changed the role of sales representatives and the ways they can engage with clinical stakeholders, this relationship remains a key adoption driver, as reps are frequently the vehicles to new product introduction. This is particularly true among surgeons, who commonly rely on reps to keep them current on new offerings and techniques. Vendor relationships also extend to those in purchasing, biomed, and materials management in terms of customer service, maintenance, logistics, and inventory and supply. A positive experience will encourage continued use of existing products and adoption of new ones, while a negative experience is likely to impede future business.
More than any other driver, cost has the ability to trump all. Facilities generally are willing to pay a premium for products delivering value that can be realized in the form of efficacy, efficiency, and usability. But, all too often, manufacturers price themselves out of the market or become a niche offering because a disconnect exists between the product’s intended value and its associated cost.
This is particularly true in healthcare, because reimbursement rates remain constant or are driven downward, regardless of incurred expenses (i.e., the tools and supplies that act as a means to an end). Due to the indirect relationship between incurred expenses and clinical profit margins, pricing tends to be more of a burden unless a demonstrable value can be “reclaimed” via user satisfaction, time savings, ease of use, and improved outcomes.
Device developers that factor clinical goals, contractual relationships, and cost into their development decisions increase the probability of product adoption and, ultimately, market success.
Contextual research is the best way to really understand how users relate to their environments, to their products, and to each other. A deep understanding of these complex interrelationships will lead to more appropriate design goals and guidelines.
To accommodate existing workflows and manage user expectations, consider as an example the da Vinci Surgical System. With this robotic system, surgeons manipulate tools manually and view the object anatomy on-screen, as they always have. Thus, it is clear that Intuitive Surgical’s developers had a thorough understanding of the surgeon’s workflow and expectations, and applied that knowledge to their development and market-entry strategies.
Finally, with the push toward evidence-based outcomes, the importance of understanding and reducing system costs is greater than ever. The success of systems like da Vinci and Stryker’s MAKO has paved the way for new systems, such as Medrobotics’ Flex Robotic System (FDA cleared), which enables minimally invasive procedures in lieu of more costly open procedures, and Virtual Incision’s miniaturized robotically assisted surgical device (in clinical trials), which cuts cost by cutting size, and is designed to utilize existing tools and techniques familiar to surgeons.
In the end, better medical outcomes are the sum of doing everything better. They lead to a lower burden on the healthcare system overall, create market success and, best of all, improve patients’ lives.
About The Authors
Craig Scherer is senior partner and co-founder of Insight Product Development. Craig plays an active role in key account management, working with companies ranging from early stage tech organizations to the largest healthcare OEMs. He is also a director of Insight Accelerator Labs, Insight's in-house med device accelerator, helping medtech start-ups deliver transformative technologies to healthcare. Craig holds a BFA in industrial design from the University of Illinois at Urbana-Champaign and an MBA from the University of Illinois at Chicago.
Carolyn Rose is director of research and strategy at Insight Product Development. Carolyn works with Insight's clients generating meaningful research insights and defining actionable market opportunities. She manages a team of researchers in an immersive, process-oriented approach to better understand the behaviors, expectations, and motivations of end-users, as well as the environments, attitudes, and trends that shape them. Carolyn earned BAs in both industrial design and Spanish linguistics and literature from Syracuse University, and holds a master’s in design methods from IIT’s Institute of Design.