Designing Ecosystems in Health Understanding

Understanding any health issue is complicated enough, in how a doctor works through the alternatives as a “pattern recognition” when someone sick seeks help.  The diagnostic process is a complex transition process that begins with the patient’s personal illness history to achieve a result that can be categorized so solutions can then be applied.

A patient consulting the doctor about his symptoms starts an intricate process that may label him, classify his illness, indicate certain specific treatments in preference to others, and put him in a prognostic category.

The outcome of the process is regarded as essential for effective treatment by both patient and doctor(1). It is seen as “the clustering of signs and their development over time is, in narrative theory, defined as the plot, with this plot, eventually becoming the diagnosis.

Taking health systems higher into whole health systems

When you take health systems higher, into a design of a whole health system, the complexity becomes a magnitude of order to sort out that is way up there, in a different league. We struggle to find ways to capture whole health systems, perhaps until now.

There are so many gaps in our health system, to the point we are often just plugging parts thinking they are improving the system.  Actually, the opposite is often true, we produce a ‘knock-on’ effect that depreciates the system to make it less effective progressively over time or in surprising sudden fashion. This progressive decline comes partly from not understanding the complete Health Ecosystem you are in. We need to think about designing Health Systems in Ecosystem ways.

It is argued our health systems are failing as they do not address the “whole” health ecosystem, as we only tend to treat part of the system. The doctor is looking to cure the immediate issue, applying solutions that are often grouped as generative but in his judgment applicable to your need.

The question we all face there are significant gaps as the system really is one-sided, it is looking for speedy outcomes, and to limit the cost. This is a solution-providers need but is it coving the patient’s side by delivering value in one that offers affective capacity. Affective here refers to the underlying affective experience of feeling, emotion, or mood, both in its physical and mental capacity to influence and produce lasting change but also to provide a better health system focused on outcomes that work for the system providers and the patients’ perspectives delivering value to both.

Recently I was invited to preview some really pioneering work of Chris Lawer with his “Health Ecosystem Value Design 2.0”

Chris presented to a small group of invitees his work over many years accumulating into this new process and set of workshop templates to address whole health ecosystems.

This is highly topical, relevant and directly related to the need for deeper questioning across so many health systems across the globe. Of course, today, no system is designed for such a pandemic of the magnitude we are facing with CORVID-19  but we certainly need to connect and relate to health systems, build better understandings of how they function and where are all the essential connecting points are to manage health differently than the present ways. Looking at the issues from an ecosystem approach really makes sound sense.

The aim of Chris’s work is to thinking differently, from the individual person to the collective body (ecosystem) to capture, evaluate the actual realm of possibilities by seeing this complete ecosystem. The dynamics need to be really appreciated, as an ecosystem is never stagnant, it needs to be recognized as a living ‘thing’ to detect differences, detecting progress or slippage, plotting progress and transitions. These are always in dynamic tensions and need to be recognized as such.

Clearly, Chris’s work is extensive and very detailed, it has to be.

It is far too detailed for simply a post, so I thought I would provide a short snapshot. Those wanting to understand and apply radically different solutions to their part of the allying health systems around the world can contact Chris himself ( details are given below).

The case study he used went through was based on the work he conducted in 2019 and still ongoing. Here is the problem page that he set about to understand and then begin to frame new options that have the potential to radically alter Chronic Pain (this example shown below). The knowledge gained is certainly not just in Northern Ireland, the base for his study, but for chronic pain solutions worldwide, as he has built a way to map the complete ecosystem of Chronic Pain.

Chris sets about to build the model of Northern Irelands pain experience and the multiple affect factors  (base of study) of all involved actors; patients, health providers to then guide systematic inquiry, learning, design, and affect.

Within the methodology, it captures the forces at play, the events themselves, the durations across multiple perspectives, the encounters), the practices, the places these are undertaken (hospitals, clinics, mobile visits, surgeries). Most importantly, the effects, especially the negative ones (quilt, greed, discomfort, fear, shame, grief, etc., etc.) in the different perspectives of all those involved. It is structured, systematic and validated approach.

I really relate to this frame as it summarizes the aspects that determine the dynamics within any ecosystem if you think about it.

Chris works through ten different templates to discover and valid novel paths to a new ecosystem transition through this approach. It is clearly a very systematic inquiry to arrive at the potential alternatives in the Value Creation options. It considers all parties, practices, and encounters to build this complete picture with emersion with different parties involved in the discovery and validation through workshops, discussions, interviews, and physical validation.

The end results are showing the divergence of opinion, practice, and approaches and so identifies the significant gaps in the system from multiple perspectives. The decisions that can then be taken in investments in transitions are made with a deep understanding of the connected whole. Any emerging phases understand the diverse affective capabilities to build progressively towards a better Ecosystem, in this example, for dealing with Chronic Pain, across Northern Ireland.

Chris, within these designs and solutions, offers critical measurement criteria to build out to judge the value creation in this ecosystem design. Those measurements address the whole system and very radical over the existing ones based on a different health ecosystem capacity dynamic, in recognizing capabilities and learning methods to make this transition.

His complete sequence of the method is shown here:

The solutions offered are a real “sense-making” purpose that accounts for all involved in the health system, from patient to the solution providers and all the associated parties (helpers, family, doctors, practitioners, etc.).

You can call it a solution that has a definite “sense of place” within the broader Ecosystem, it becomes holistic and not fragmented as it is so ofter today in its parts having a separate design applied to that specific part.

I do feel this is a fascinating work from Chris and Umio.

It is pioneering in the much-needed Ecosystem approach that can be applied across all of the health systems with the depth of experience Chris has built up, in the design and approach from his Version 2.- the Health Ecosystem Value design 2.0 framework.

To finish in his own words, this is what he is offering:


Health Ecosystem Value Design® (HEVD) embodies a novel philosophy of ecosystem, emergent, relational, and affective value thinking to advance the health and social (care) sciences.

The framework goes far beyond the dominant biomedical, reductionist view of health as baseline functioning and end-state absence of disease. Instead, HEVD adopts a broader socio-ecological view of health as an individual, group, community, and place-based capacities and powers of acting in the pursuit of valued affects producing positive experiences with life.

Valued Affects supports a novel perspective of human-centered value and its creation-assessment. They challenge the transactional disease-centered exchange-economic outcomes model, along with the symbolic medical/clinical order and method of individualist-centered (patient) health behavior thinking.

HEVD reveals deep “thick explanations” of health, social, and related phenomena to surface new possibilities, design novel transitions, and realize sustained ecosystem-level transformation.

Anyone interested to learn more or engage Chris should visit his website and/or contact him, it is truly pioneering.

Tel: (UK) +44 (0)1295 724 539
Mob: +44(0)7717 435 785



1) The diagnostic process in general practice: Anders Baerheim’s paper




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