Interactional Creation of Health: Experience Ecosystem Ontology, Task and Method

Interactional Creation of Health: Experience Ecosystem Ontology, Task and Method

By Christopher Lawer

Copyright © 2021 Christopher Lawer. All rights reserved.

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Published by Umio Limited 2021

Oxford Centre for Innovation, New Road, Oxford. UNITED KINGDOM. OX1 1BY.

E-book ISBN: TODO

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Praise for Interactional Creation of Health

I'm speechless - in a good way. In the book, Chris describes his Health Ecosystem Value Design framework. And wow, it's a complete model... and I mean COMPLETE. It's a holistic, unified model of lived experiences with health; a model that leaves no factor or root cause unexplored. The HEVD model captures every force affecting the lived experiences of people with health issues; providing a path and a hope for improving the lives of those who suffer. What nobler pursuit is there? Thanks, Chris for this amazing contribution.

Scott Burleson, Author of The Statue in the Stone: Decoding Customer Motivation with the 48 Laws of Jobs-to-be-Done Philosophy

Over the last 10 years or so I have watched Chris unfold his ecosystem ontology based on extensive readings of philosophy, journal research, practice and deep, deep reflection. I’m not surprised the five-star reviews he’s receiving. Leaders in the health field should view some of his conference talks as a taster before reading his book on total health systems. Simon Knox, Emeritus Professor at the Cranfield SOM and Honorary Professor at the UNSW Business School, Sydney

Chris does not allow us to be sloppy or lazy. If we let him, he will guide us on a better path forward. His book and models are cutting edge and essential to thinking differently and well about healthcare. Peter Sorensen, Organization Design Consultant, Adjunct Professor at SMU Lyle School of Engineering, Board President STS Roundtable

A much-needed paradigm shift in co-creating transformational change toward an enhanced state of our wellbeing. An outstanding, remarkable and masterful job. Professor Venkat Ramaswamy, Ross School of Business, Michigan University

Chris Lawer's re-conception of value provides the breakthrough thinking that health systems need to repurpose resources and transform delivery systems. Professor Neal Halfon, UCLA Fielding School of Public Health, inventor of Life Course Health Development model

Chris Lawer's Health Ecosystem Value Design is an invaluable framework for understanding how to reimagine, redesign and transform our global health ecosystem. This book is an extraordinary next step in your leading edge thinking on the evolution of health and care systems. Kudos to you for providing a pathway towards a new paradigm of global health. John Scully, retired US healthcare executive

Awesome! Brilliant! And super impactful! I admire and appreciate your work and your deep ecosystems approach. I can see how it would extend and enhance my work in terms of clinical reasoning for advanced practice in nursing. The Umio framework is comprehensive and just what we need to help deal with the complexities of health care as we learn to value differences and activate capacities. Chris Lawer is doing amazing work. Daniel Pesut, PhD, RN, FAAN, Principal Consultant at Strategic Foresight Consulting and Coaching, Emeritus Professor of Nursing, University of Minnesota

Chris Lawer’s model is way ahead of how medical service providers and pharma / device manufacturers think today. It gives them a way to categorize and simplify complexity and understand healthcare interactions at a much more actionable level. Rob Schade, Chief Customer Officer, Strategyn

Acknowledgments

I am delighted to present the full second version of my Health Ecosystem Value Design® framework, the product of three years intensive development, six years of continued evolution since I first began conceiving the idea, and a very focused low-risk lockdown experience in which I barely left the house. It is no exaggeration to say that the framework has consumed thousands of hours of my life since 2015 and there are a number of people who I would like to thank for their support, creation, inspiration and encouragement.

First, I would like to give very special thanks to Venkat Ramaswamy. I am extremely indebted for his deep words of Vedanta-inspired co-creation wisdom, sage advice and unstinting commitment to read and proof my work and ideas. Thank you to for your wonderful foreword. I look forward to many more stimulating conversations and the further enrichment of our collaboration as we progress our ideas and take them to the world together in publications and projects. I will get up-to-speed on that whole one consciousness unified ontology soon.

No book of this detail and effort can be produced without the help and conversation with many who have input and suggested improvements to my work and given me a platform to speak. I owe a debt to all who spent some time and energy with me to discuss, listen, affirm, critique and challenge the ideas in earlier frameworks that set me on the path to this book. My thanks to Julia Chamova, Dan Pesut, Paul Hobcraft, Bob Heath, Paul Barnett, Bernard Mohr, Mike Taylor, Bill McAllister-Lovatt, Tilly Briggs, and Gianluca Gambatesa. Special thanks to Neal Halfon and Peter Long for bringing me over to California to explore version one of the framework at Blue Shield Foundation.

I wish to pay special thanks to all my former Strategyn UK and ZinC colleagues, Nicki Sutton, Gillian Brydon, Javier Romero, Jerry Hutchinson, Lance Bettencourt, Sandra Bates, Eamonn Murray, John Scott, Petr Salz and Bruno Levy who undertook a number of brilliant health and other innovation research projects with me all around the world and who so ably helped laid the foundations of my enthusiasm for innovating in health. Thanks to Rob Schade at Strategyn who saw my OMC work and brought me into the Strategyn fold.

I have been inspired by several thoughtful clients, particularly Paolo di Vincenzo at S&N, Peter Kragh of Coloplast, Calum Mayland, Patricia Seigle-Vatte and Omar Hoek of Ahlstrom and John Boyer at Mundipharma.

Thanks also to my long-term health care system partners, Andres Melik, Joan Escudero and Frank Weber with all of whom I have spent many enjoyable days roaming the EU hunting down research grants. I hope that despite Brexit we can continue to work together to tear down the walls of EU Horizon projects and challenge their technology-first thinking.

Special thanks to my PhD supervisors at Cranfield, Prof. Simon Knox and Prof. Stan Maklan, for knocking my writing into shape in the early days and for your commitment and patience during my ups and downs with health problems and work. I suppose this is the PhD I never completed. I just need to add the references….

I could not have written this without the unwavering support of Mum and Dad. Thanks too to Emilia and Tom for their patience and tolerance. Thank you for all your love, help and encouragement.

Finally, I would like to give a very special thanks to Seonad for her incredible love, support and sacrifice throughout the development of this work. The capacity to immerse myself in a prolonged real duration of creation (as Henri Bergson would say) would not have been possible without her.

I sincerely hope this book inspires you to widen and elevate your perspective to that of experience ecosystems, and to see the power and potential of an interactional creation mode of health in all our lived experiences.

Chris Lawer, Buckingham UK, January 2021

Interactional Creation of Health: Experience Ecosystem Ontology, Task and Method

Foreword by Venkat Ramaswamy

The late C. K. Prahalad and I began exploring the implications of the Fourth Industrial Revolution (or Industry 4.0) with the advent of Internetworked enterprises at the turn of the new millennium. We co-authored a book, The Future of Competition (2004), in which we put forth the idea of co-creation, one based on the experiences of individuals in an interconnected world of de-centered and democratized value creation through event-based networked flows of interactions. A few years later, Francis Gouillart and I co-founded the Experience Co-Creation Partnership and wrote a book together on The Power Co-Creation (2010) based on our consultative engagements with over forty organizations across twenty sectors of the modern economy. By then it had become evident that industry 4.0 was about harnessing the power of interactive intelligence in the daily lives of people to design and augment value in ways not possible before.

The first industrial revolution was powered by water and steam in the wake of mechanization, then electric power in the second, and computer power in the third. Industry 4.0 not only entails cloud computing and smart, connected devices from mobile phones to the Internet of Things, but also social media and community engagement with the Internet of People who are connected and active in their own ways. It calls for an Internet of Experience with a value design process that is open, participatory, inclusive, collaborative, and ultimately co-creative, with the opportunity and challenge for enterprises to engage in designing platforms of offerings, engagements, and organizations, together with stakeholders in all-win more fashion.

Fast forward to today, and as I write this, we are in the midst of a global COVID-19 pandemic crisis. While the pandemic disrupted lives and livelihoods in unprecedented ways, it simultaneously accelerated the adoption of digital technologies, increasing the digitalization of interactions by several years. Consider, for instance, Microsoft’s Cloud for Healthcare offering, rolled out amidst the crisis, offering service capabilities to address challenges faced by healthcare organizations in engaging with patients. It enables individualized experiences of healthcare, empowering employee experiences, and improving care provider and clinical operations experiences, while amplifying systemic capacities through an enhanced network of partners. Its Healthcare Bot Service enabled healthcare organizations to build and deploy AI-powered virtual health assistants and chatbots during the crisis, augmenting care provision and patient self-service. In about two months, more than 1500 instances of COVID-19 service bots had gone live, impacting more than 30 million people in over 20 countries, and ultimately reducing the strain on emergency hotlines and hospital visits.

The above example points to how harnessing the interactive intelligence of connected offerings and enterprises can help in navigating our way through a health crisis. But, going beyond the crisis itself, it points to the importance of organizations connecting beyond mere delivery of care with the lives and lived experiences of individuals, underscoring a declaration of interdependence as it were. It emphasizes the need to go beyond the B2B2C (business-to-business-to-consumer) industrial system of goods and services toward I2N2I (individual-to-network-to-individual) ecosystems of experiences that enable interactional flows and valuable experienced outcomes of impacts as a result. This entails a transformative shift, not only in becoming more resilient and adaptive to individual experiences but anticipating a better future by co-creating them. Organizations must engage with all stakeholders in their respective ecosystems of experiences by conceiving environments as assemblages that engender valuable impacts of economic, social and ecological well-being, which are developmentally sustainable. This includes Mother Nature and in the case of a pandemic, the virus itself. As Laura Spinney, a science journalist writing in The Guardian noted, The key thing to understand is that we are not passive bystanders; we form the virus just as it forms us.

Conceptualizing co-creation of value as a joint enactment of interactional creation via (increasingly digitalized) ecosystems of experiences, and entailing all actors, human and nonhuman, has occupied much of my research over the past decade. Around 2010, Kerimcan Ozcan (whose dissertation I had chaired in 2004), introduced me to the work of Gilles Deleuze, and others including Felix Gauttari, Manuel DeLanda, Bruno Latour, and

Michel Callon, to name a few. I resonated with it all, given my earlier exposure to the lofty Advaita (nondual) philosophy of the Vedanta, elaborated in the Upanishads, in the Indian spiritual metaphysical tradition (via the exposition of Swami Krishnananda). In our quest for a more unifying ontology of co-creation, we began a deep scholarly, but equally practice oriented, dive into synthesizing various strands of metaphysics and philosophy of experiences, phenomenology, psychology and cognitive neurosciences, morality and ethics, economics and social sciences, information, design, complexity sciences, natural sciences, policy, and organizational and business studies, which contributed to a more progressive, pluralistic, and constructive foundation of an interactional creation paradigm of value co-creation in contemporary enterprises, markets, economies, and societies.

In 2014, we published The Co-Creation Paradigm that articulated a foundation of joint creation and evolution of value, intensified and enacted through platforms of engagements, virtualized and emergent from social, business, civic, and natural ecosystems of capabilities, and actualised and embodied in domains of experiences, expanding wealth-welfare-wellbeing. Then, in a series of papers, we expanded upon this foundation by theorizing experience ecosystems as assemblages having affective agency and perceptive experiences, whose capacities engendered valuable developmental impacts from platformized resourced capabilities, via enactment of interactional flows. This interactional creation foundation of co-creation went beyond the integration of resources in exchange of service, as in the Service-Dominant Logic (SDL) work of Robert Lusch and Stephen Vargo, to theorize the very act of creation through interactional flows involving matter, energy, communication, data, capital, images, meanings, and narratives. It also put the spotlight on the lived experiences of individuals. The enactment of interactional creation of lived experience value was central to what we have come to call as a Co-Creation Paradigm (CCP).

Following the CCP, the unit of inquiry is not only the patient seen as an assemblage of agency but also as an experiencer acting as a system-environment hybrid together with its environment, with the latter also being an assemblage. In other words, health is conceived in terms of experience ecosystems of assemblages having particular affective capacities and engendering qualities of experienced outcomes. Health becomes an emergent adaptive process of experience and capacity formation formed from relational interactions of forces, affects, and events over lived time. Suboptimal health and care and inappropriate use of treatments can lead to delayed healing, and increased infection and pain, all of which impact a patient’s quality of life. Assemblages of health can suffer from ineffective orchestration of ethological means from a patient’s perspective of lived experiences. At the same time, as Cameron Duff has argued from a Deleuzian perspective of Spinoza’s ethics of joy, there is a need for a more positive and substantive account of health capable of yielding diverse ethical principles for the restoration, maintenance and/or promotion of health in an assemblage of human and nonhuman forces.

This brings me to Chris Lawer’s outstanding framework and book on Health Ecosystem Value Design. Chris Lawer is no stranger to rethinking, redesigning, and actualizing greater health and wellbeing having immersed himself in a parallel journey over the past decade, by diving deep into the lived experiences of individuals, following his large-scale studies of health in Europe (and Ireland in particular) and the US, and thinking long and hard about the deep systemic challenges that persist in our health and wellbeing today. What naturally drew me to Health Ecosystem Value Design (HEVD) was the shift made in this updated version, beyond the earlier SDL based perspectives, toward a whole and unified view of lived experience with health, and the very visual and dynamic way in which interactional flows of creative differentiation, and the production of experience in assemblages was communicated and articulated, from the perspective of both assemblages as affectors and affectees. What was even more remarkable was how