Pioneering Ideas

Congratulations to the Winners of Innovations for Health: Solutions that Cross Borders!

Today at the World Health Care Congress, Pioneer's Team Director Brian Quinn announced the winners of the Innovations for Health: Solutions that Cross Borders competition, supported by Pioneer and Ashoka Changemakers.  Innovations for Health looked to the international health community for forward-facing, transformative ideas with the potential to change health and medicine here in the United States.

We wanted to find cutting-edge solutions from anywhere in the world that have the potential to be applied in other countries to improve health and health care. While the Robert Wood Johnson Foundation is devoted to improving the health and health care of Americans, this competition arises from what we call our “Flat World” work. That is the name we’ve given to our efforts that look around the world for innovations that could be used to solve the health and health care challenges we’re facing here in the United States.

In March, our expert panel of judges narrowed down the competition from more than 370 entries from 73 countries to 15 finalists who best met the competition criteria of innovation, social impact, and sustainability. Today, we’re proud to announce the three winners who represent some of the best ideas for bridging gaps in health models around the world.

The winning solutions are:

• E-HealthPoint: Transforming Rural Healthcare, India
• VaxTrac: Improving Immunization in Developing Countries, Benin
• Saúde Criança: Holistic Health Solutions for Low-Income Families, Brazil

Read more about the winners on the Ashoka Changemakers blog.

Meet the Innovations for Health Competition Finalists!

Last year, the Pioneer portfolio partnered with Ashoka Changemakers to launch the Innovations for Health: Solutions that Cross Borders competition to find health care solutions from anywhere in the world that have the potential to be applied in other countries to improve health and health care.

After nearly 400 entries from 73 countries, we’re pleased to announce the finalists, and share a blog post with more details from Ashoka Changemakers. Stay tuned for the winners announcement on April 16!

Introducing Innovations for Health: Solutions that Cross Borders

At RWJF, we’re focused on solving the most intractable health and health care challenges in the United States, but we recognize that innovations come from all over the world and that many effective health solutions are emerging with the potential for immediate adaptation, replication and impact. That’s largely because, despite their differences, many countries throughout the world face a surprisingly similar set of health care challenges.

In today’s interconnected world, we have an important opportunity to learn from each other – especially when a new idea has the potential to make a difference in a big way. For example, the New York Times recently released a special section, “Small Fixes,” which focused on low-cost health care innovations to improve global health. The small fixes ranged from simple, self-adjusting eyeglasses for those who don’t have access to optometrists to the sophisticated, Gates-funded “postage stamp” paper to detect liver disease nearly instantaneously—the samples don’t have to be sent to a laboratory to be processed.

The innovation that most caught my interest in this article was one in Mozambique that organized patient groups to take turns picking up their medications, thereby forming strong social bonds, reducing stigma and increasing adherence to antiretroviral drugs. The organized patient groups also reduced the burden on health care workers while increasing patient engagement and self-management of care. Some consider this “small fix” a potential game changer for HIV care.

What’s striking about many of these solutions is that they highlight the universality of health problems faced throughout the world, such as lack of preventive care, provider shortages and rising health care costs. And, while most of the solutions are geared towards solving health problems outside of the United States, with some imagination, I believe many of these fixes could easily improve people’s lives in our country.

It’s this desire to accelerate change by tapping into unconventional thinking around the globe that led the Pioneer team to partner to launch the Innovations for Health: Solutions that Cross Borders competition with Ashoka Changemakers. We’re looking to find solutions to these universal health care issues, and are most interested in those that have potential to:

• Increase capacity and training for health care workers and providers;
• Scale low-cost interventions to increase access to medical, preventive, or dental care;
• Reduce barriers to health information and services;
• Provide high-quality care in non-traditional settings; and
• Engage patients directly in their care, particularly those managing chronic illnesses.

We’re thrilled to seek these global health care solutions and hope you’ll check out the competition, learn more about the three $10,000 prizes, and share the link with your network of pioneering thinkers. And why not submit an entry yourself, nominate an organization to compete, or comment on the submissions? We can’t wait to see what ideas you might have.

And the Winners Are...

As I mentioned back in August, RWJF joined the Health 2.0 Developer Challenge by offering small prizes for three different challenges:  1) building apps that leveraged the Blue Button initiative; 2) apps that bring the data from County Health Rankings into everyday decisions; and 3) bringing Project HealthDesign designs to life by building apps that work on commercial PHR systems.  At the time I said that we wouldn’t know what to expect – that we might not get anything useful at all from this exercise.  WRONG!

The response was terrific.  I won’t say overwhelming, but given the modest amount of prize money (okay, Markle scored coffee with Clay Shirky, which is no small deal) and the relative short amount of time to respond (barely a month), I’d say pretty darn good.  And definitely useful.

I’m a big fan of the Blue Button initiative for two reasons:  1) it gets the data out of the health care system and into the hands of users, where a marketplace of translators, interpreters and other tools can grow around making data useful to people; and 2) it’s beautifully simple.  The response highlighted the potential of this market:  we had large companies like Adobe and Microsoft build really valuable utilities – to translate a largely unreadable ASCII text files into very nicely designed PDF documents and to import Blue Button data into HealthVault, respectively.  But we also saw smaller organizations (seven in all) like MedCommons and RememberItNow showcase more narrowly focused apps that deal with important tasks – like getting a second opinion on a radiology image or remembering to take your meds.  Adobe came out on top in the end – and deservedly so as they built a really nice app – but the key takeaway is that they’re just the tip of the iceberg of what could come.  Hats off to the Markle Foundation, CMS and the VA for bringing Blue Button so far along so quickly.

The County Health Rankings challenge drew a number of interesting submissions.  Where we live, work, learn and play dramatically affects our health.  So when you’re choosing a place to live, wouldn’t you want to look up health indicators the way parents look up data on the quality of the schools?  That’s what the challenge winner, Acsys Interactive, makes possible.  They embedded the county health rankings data into their mobile real estate app.  So now when you want to get the scoop on the house for sale you’re driving by, you point your phone at it and get both real estate data and easy access to county health data.  The challenge drew four other submissions, which also included a utility to have the data texted to your phone when you text in a zip code and a tool to help understand asthma risks in a given county.

The Project HealthDesign Developer Challenge was won by Ringful Health, which produced a really slick app for managing chronic pain.  With it, you can use your iPhone to jot down your pain levels and triggers, get feedback on frequent triggers and how effective your medications have been at controlling your pain, and generate reports that you can share with your doctor.  Ringful had been working on this app, but, inspired by the design from Roger Luckmann’s team at UMass, added several new features and then built back end integration with the HealthVault, Google Health and Dossia personal health record services.  Another competitor, CureTogether, extended their site, which helps people track their observations of daily living (ODLs) like sleep, exercise, and food intake, to include lab test data.  A third, and very intriguing, submission came from Fred Trotter, who built an open source utility to track ODLs and store them on Twitter (in a protected account) and then use Grafitter to analyze the data and display patterns.  Fred’s solution is especially interesting because he’s leveraging existing infrastructure and by building an open source tool, he’s inviting others to take it further.

So all in all, I’m quite pleased with how the challenges went.  And it makes me wonder what challenges we should put out next.  Any ideas?

Winning Nudges Announced in "Designing for Better Health" Competition

The winners of the "Designing for Better Health" competition we held with Ashoka’s Changemakers have been announced.  The competition was inspired by the book Nudge, which was written by behavioral economics experts Cass R. Sunstein, J.D. and Richard Thaler, Ph.D.  Nudges are simple pushes that can induce someone to change their behavior.  My favorite entry didn’t win.  If you tracked the competition, it was “Just an Idea.”  This entry suggested a way to help more women conduct their monthly breast self-examination—put a reminder symbol in birth control pill packages on the optimal exam day.  I thought this idea was elegant.

There were 285 entries from 29 countries.  The three winners were all international:

• GOONJ (India) - GOONJ (means “echo”) collects donated cloth and creates clean sanitary pads that it then distributes to women, while at the same time bringing out in the open the taboo subject of menstrual hygiene.

• San Francisco Saludable (Peru) - This unique waste management program nudges people to change their traditional habits to improve their health by producing compost for family gardens. 

• Fundación Boca Sana (Venezuela) - Children are nudged to better oral health because they receive training to act as scholar/promoters who share what they have learned about proper oral hygiene and care with other children, parents and relatives. 

After reading through all of the entries, I came to the conclusion that nudges, as conceived by Thaler and Sunstein, are a subtle concept.  The folks at Changemakers tried hard to explain the concept on the competition site and, to my eyes, they did a good job.  But looking at the entries, a lot of them weren’t even nudge-ish.  In designing the concept of nudges, Thaler and Sunstein were trying to walk a fine political line to come up with an approach to policy that would be acceptable to the right and the left—Libertarian Paternalism, they call it.  One thought as to why a good nudge is hard to find is that it requires a lot of discipline on the part of the designer.  You set up the nudge and then stand back.  If people aren’t nudged to do the right thing, that’s it...you get your answer pretty clearly as to whether it worked.  For people who are driven to solve problems, that may be a very hard stand to take.

That said, there were some wonderful entries and I offer my sincere congratulations to the winners—well done!  Also, I thank Changemakers for their good work and my fellow judges for their efforts.  We’re glad to have sponsored the competition and we hope those who entered, commented and otherwise participated continue to explore the power that well-designed nudges can have in driving better health decisions, behaviors and outcomes.

Keeping an Eye on Prize Philanthropy

McKinsey & Company’s recent report on prize philanthropy is a useful overview of the field. Titled “And the winner is . . .capturing the promise of philanthropic prizes”, the report is available here. Kudos to McKinsey for conducting a broad scan of an important philanthropic tool, and to the John Templeton Foundation for initiating the idea, sponsoring the work and sharing it with the field.

Why is this report useful? It puts prizes in historical perspective and explores the reasons for the recent increase in their use. It combines a review of the scholarly literature with insights gleaned from the leading practitioners in the field. And it develops a set of categories that go beyond the useful, but limited, distinction between recognition prizes and inducement (or incentive) prizes. The report’s six prize archetypes point to important traits that anyone considering using prizes should carefully review.

 

I was particularly interested in this report because RWJF, and the Pioneer Portfolio in particular, has worked with many of the organizations featured in the report. We have worked with Changemakers on a number of competitions, and are continuing to do so. We worked with Hope Lab on the Ruckus Nation competition and with Idea Crossing on its Innovation Challenge for MBA students around the world. And we worked with the X Prize Foundation in its efforts to develop a health prize. These experiences influenced my thinking as I read the report, and prompt two suggestions for future work on prize philanthropy.

 

The first is to work towards a clearer sense of the boundaries of this field. Prize philanthropy, when viewed broadly (as this report did), covers a huge territory. This makes it difficult to distinguish from a whole host of other strategic (goal-oriented) philanthropic approaches. For example, the report lists four important lessons about how to create and deliver effective prizes (p. 35), but none of these lessons is unique to prize philanthropy; they apply to any type of strategic philanthropic activity.

Freakonomics Blog Sparks Debate On "Designing for Better Health" Competition

Major thanks to Steven Levitt of the New York Times Freakonomics blog (and co-author of the book by the same name) for publishing a post on the new Changemakers competition, "Designing for Better Health."  The competition, which seeks innovative "nudges" that can influence people to make healthier choices for themselves or others, has kicked off a really interesting string of comments among Freakonomics blog readers.  Add your perspectives, either there or on the Changemakers competition site.

Announcing our newest Pioneer/Changemakers competition (nudge, nudge...)

People can be so…so…so stubborn. They know the right thing to do—eat servings of fruits and vegetables every day—they just don’t do it. Or they don’t get around to doing it. Or they do it for a little while—exercise for 30 minutes every day—and then they stop doing it. Or their environment creates barriers to doing it.

One way to think about it is that, often, life gets in the way doing the right thing. The kids, the job, the economy (“What the hell? Where did my 401k go??) all compete for time and attention. And sometimes, it’s not life, but the choice itself that gets in the way. Any of you who spent time trying to help an older parent figure out what choice to make under Medicare Part D knows what I mean when I say some choices are just too complicated. When faced with making a complicated choice in real life, many of us end up making choices that aren’t the best ones we could make.

We’ve launched a global competition looking for “nudges,” innovative little pushes – that help people make better decisions regarding their own health and the health of others. The competition is co-sponsored by Ashoka’s Changemakers project and is based on the ideas put forth by Richard Thayler and Cass Sunstein in their book Nudge. Here’s an example of a nudge focusing on wearing motorcycle helmets: instead of making helmet-wearing mandatory, you permit people to ride without a helmet…but only if they qualify for a special helmet-less motorcycle license. To qualify, they’d need to pass a class that improves their riding skills and they’d have to carry an extra amount of insurance. The goal is not to remove someone’s ability to make choices, but, rather to “nudge” them in the direction of the better choice.

If you think you have a good nudge, you can enter the competition here. 

So simple...so stunning...such a struggle

Somebody sent me this image of a handprint featured in this week's New England Journal of Medicine.  So stunning.

 

Why?  The handprint was taken from an ungloved health care worker after performing an abdominal exam on a patient -- the pink area on the left represents MRSA colonies grown from the handprint.  Image B shows a second hand imprint obtained from the worker, after those same hands were treated with alcohol foam.  The resulting culture tested negative for MRSA.  So simple.

And still such a struggle for well-meaning care providers to take the necessary preventive steps.  Arghhh.  Innovations emerging from the Plexus Institute's positive deviance initiatives offer one promising path to a solution.  Last month, they were highlighted in the New York Times "Year in Ideas" for their success in changing processes that enable the right behaviors in hospitals' assault on MRSA infections.

Where might new innovations emerge to break through seemingly intractable problems like this?  Perhaps from the new idea competition  we launched yesterday with Ashoka's Changemakers to find those who are designing effective "nudges" that help people make better health decisions.  Paul Tarini will be writing more about the vision behind this competition, but if you're curious, check it out and join the search for simple but elegant breakthroughs that might prevent the next case of someone checking in to the hospital and winding up with a MRSA autograph stamped on his or her body.

FasterCures, Innocentive Crowd-Source Solutions for Biomarker Research

I mentioned in my post on FasterCures' Mid-Year Top 10 Watch List that they were working on an Innocentive competition to discover breakthroughs in disease research. Yesterday, that competition went live -- FasterCures will award a guaranteed payout of $10,000 for the two most promising ideas that encourage companies to invest and collaborate more in biomarker research and qualification.

Biomarkers are used by medical professionals to determine proper diagnosis, prognosis and the optimal course of treatment for a patient. Widely viewed as a critical technology to personalizing treatment choices and maximizing the impact of medical treatments, biomarkers are key to the biomedical research process and can shave years and millions of dollars from the research and development process.

According to FasterCures President Greg Simon, health care industries have "...little incentive to invest in biomarker research and development and keep the results of their investment in the public domain, where it can do the most good."  Hence the move to crowd-source solutions from the open scientific community that competes in Innocentive's online challenges. Their hope is to eliminate that "first-mover disadvantage" by throwing the search for solutions wide open -- Innocentive's network reaches 160,000 "Solvers" based in 175 countries and cutting across 60+ industry disciplines.

The biomarker challenge is posted in InnoCentive’s Global Health Pavilion, home to competitions that focus on solving some of the world’s biggest health challenges. The entry deadline is November 15, 2008. We'll be interested to see how this approach to discovering breakthrough ideas works for FasterCures.

Why Games Matter: Competition Results

The results of the Why Games Matter competition were announced recently and can be found here. I was lucky enough to be a judge for this competition—here’s what I took away from looking over the field of entries:

• The entries, finalists, and winners show without a doubt the richness of the “games for health” field.
• We had entries (and winners) from all over the world—which demonstrates how interactive video games can be adapted to fit a variety of cultures, geographic locations, and interests.
• We also had entries from different industries and sectors of the economy, and these looked at many different components of health and health care—from HIV/AIDS, to violence prevention, to physical disabilities, to community health, to the transformation of the health care system. We saw that there’s a place for games across all of these.
• Many of the entries included a research component. What a great beginning for the work of Health Games Research, as Abbey Cofskey described for you here.

Save the date for the Change Summit, which will take place at the annual Games for Health Conference on May 8-9, 2008. We’ll be taking another look at the competitors and how they’re doing, and I, for one, can’t wait!