Minimum viable ecosystems

Keeping older people connected, independent and fulfilled in their communities of choice – thriving, not just surviving – is the goal of many innovators, public policy makers, and older people themselves. However, this is a complex challenge and delivering this can be challenging for two main reasons.

First, everyone is different. Whether they’re 25 or 85, people are unique and one-size-fits-all doesn’t work – people need and want different things. Second, there is generally no one motivated individual or organization (other than a family member) dedicated and (financially) responsible for delivering on this goal. In fact, despite moves towards paying for outcome, most health organizations are still rewarded more for people being sick and dependent than healthy and independent.

Could we address these two issues with the creation of a ‘minimum viable ecosystem’? In Silicon Valley parlance, a minimum viable product is a barely functional first step of a product that allows potential customers to provide feedback and ensure the right problem is being addressed. The Airbnb founders did this by putting up a website for to rent out an air bed in their own apartment during a conference, and the Dropbox founders created a simple explainer video, without writing any code. But these were both ‘point solutions’ – a bed for the night, and a file-syncing service, rather than a complex challenge like aging in place. A minimum viable ecosystem therefore could be thought of as the simplest available set of products and services working together that delivers on an agreed outcome, in this case, staying independent or thriving, however, we define it.

Leaving outcomes aside for another post (are we looking to optimize happiness, health or something else and what metrics do we use?), this definition recognizes that there will be i) multiple different players involved and ii) they need to work together.

To identify the multiple players, a simplified version of the age-friendly domains could be used, to cover those sets of things necessary to remain independent: health, housing, human connection, meals, mobility and meaning (see below).

Fig 1: Six domains for thriving in community (adapted from WHO’s age-friendly initiative)

Product and service providers are then engaged (or ‘hired’ in the parlance of Clayton Christensen jobs to be done) to deliver in each of these areas. Until we get to the ability to genuinely deliver personalized services to every individual, we can simplify based on personas, for example splitting the population into four groups, depending on their level of acuity / frailty and tech familiarity. Other dimensions could be chosen (in a congregate setting vs. in the community, strong local family support vs. no support etc) and will depend on the profile of the population.

Fig 2: Four Minimum Viable Ecosystems based on individual personas

Crucially important is that the product and services providers work together, delivering a solution that is more than the sum of its parts, overcoming silos and keeping that person independent. This integration could be thought of in terms of:

• User experience – making sure it’s easy, simple and joined up for the user (e.g. no separate logins / passwords or multiple boxes to plug in)
• Technology – ensuring the services speak to each other and share necessary information / data
• Business model – ensuring that each product / services is paid for and aligned with the larger goal.

So with this Minimum Viable Ecosystem approach could help us get a sense of what we need to do to enable thriving in community: a group of organizations collaborating together in an integrated way that are all aligned behind the needs of a specific persona. It will be interesting to explore case studies in the wild and see what’s working and what more needs to be done to address complex challenges such as thriving in community.

Note: This idea of minimum viable ecosystems came out of a discussion with Bruce Chernof of the SCAN Foundation at a recent Irvine Health Foundation event and will no doubt evolve over time, but I wanted to put something down. I would welcome comments, suggestions and challenges, and in particular real world examples that can make the idea come alive.