How We Approach Scaling Innovation

“How do we use our limited but flexible resources to help innovations reach scale?”

At the intersection of the Swiss, French, and German borders lies Basel. I was there to give a keynote presentation on The Rockefeller Foundation’s approach to innovation, impact, and scale at the Novartis Foundation’s 2014 symposium, Sustainable Healthcare Interventions: from Blueprint to Lasting Impact. The intersections of borders was a good metaphor for the amazing intersection of ideas that occurred at this symposium.

After Dr. Ann Aerts kicked things off with a fascinating overview of the Novartis Foundation’s work, I shared a few perspectives, beginning with the four basic stages of our innovation strategy:

• First, we identify a big problem and work to reframe it in a way that introduces new ideas and sparks new thinking.
• Next, we take a step back to look at the big picture through a broad lens. Who are all the actors involved with a problematic situation, how are they influencing it, what are the barriers to change, and where might be there be momentum that we could harness—we call this taking a systems view. This helps us address the root causes of the problem, not just the symptoms.
• Armed with that perspective, we then look for tools, approaches, and innovations that could be helpful. Some will be new, many will already exist and be used for a different purpose. We hope to recombine ideas to stimulate a new solution that is greater than the sum of its parts.
• Finally, when working on complex social problems, we need to be flexible when we implement. We manage our work through emergent strategies, which means that we start with a plan but allow it to change. This is particularly important to allow local communities to contribute their knowledge, participate in its implementation, and take ownership once our role is over.

But, of course, no discussion of innovation is complete without reckoning with the social sector’s biggest question: how do we use our limited but flexible resources to help innovations reach scale? When people talk about venture philanthropy—it’s not just about taking the highest risks on the most unproven ideas. It’s doing so with a plan for the best ideas to scale up and have the most impact.

For us at The Rockefeller Foundation, scale means partnerships. When we plan for how to use our unique assets—our brand, convening power, networks, and flexible funding—we think about how it can help catalyze others to contribute their unique assets as well.

Just one important example of this approach to innovation is the Foundation’s current exploration into the health challenges faced by informal workers, who comprise more than 60 percent of the global workforce.

We started by reframing the problem. We’re not asking “how can we get informal workers into existing health systems”. Rather, we’re asking “how can we build on the unique assets and capabilities of informal workers to improve their health“. This requires some deep understanding of informal workers and those who provide health services to them:

• For example, in Sierra Leone, health providers tend to be cooperative rather than competitive with referrals up and down the spectrum.
• This causes informal workers to combine different providers—a local clinic, for example, plus a traditional healer—to maximize their chances of recovery. This makes it difficult for them to identify “what worked” and inform future health care choices.
• We also learned that men tend to blame health issues on their vices—this leads to shame, which keeps them from seeking treatment. For example, we heard from a pedicab driver in Manila who blamed his respiratory problems on smoking rather than constantly breathing vehicle exhaust. How might we design a health intervention with that perception in mind?
• And perhaps most powerfully, access to mobile devices is exploding in Africa and Asia. As with so many other social problems, technology is opening up all sorts of windows to provide health solutions.

Each of these pieces of knowledge will directly inform how we craft a potential intervention—and which preexisting actors and innovations we can bring together to scale up a solution. We’re still at a relatively early stage in this exploration—and therefore still very much open to new partnerships!—but we feel confident that our early work, first to reframe the problem, and now to look at it from a systems perspective, will help us serve as a bridge between these workers and the global community that is only beginning to understand their plight.

Harjatin Singh. Photo credit: The Novartis Foundation

After my talk, we heard from innovators doing great work in a wide range of areas:

• Dr. Hassan Mshinda spoke of an innovative incubator that provides entrepreneur opportunities in ICT for university and college graduates.
• Dr. Krishna Udayakumar spoke of success factors in scaling up innovations in health care, namely enabling people to be co-producers in their own health care.
• Dr. Isaac Adams talked about innovations in telemedicine in Ghana.
• Prof. Senga Pemba discussed eLearning modules and the evolution of TTCIH into a social enterprise.
• Dr. Maria Teresa (Teng) Dioko spoke of an advanced sensing system for leprosy.
• Finally, three students, Harjatin Singh, Ishan Kothari, and Arpit Sabherwal, described a fascinating “jugaad-a-thon” where they quickly developed a new smartphone app to help with the advanced detection of leprosy.

It was encouraging to hear from so many voices—traditional and untraditional—weighing in on this critical question of innovation to scale in the health sector.

The question before us is is an important one: how do we move beyond pilots and integrate innovations into existing systems to reach scale?

I heard from many at the symposium on this critical question—I’d be curious to hear your thoughts in the comments below to help refine our own approach.