Ellen Domb, Ph.D.
PQR Group, 190 N. Mountain Ave., Upland, CA 91786 USA
+1(909)949-0857 FAX +1(909)949-2968 ellendomb@compuserve.com
David Corbin
DelCor Interactives International, Inc.
1511-6 E. Valley Parkway, Escondido, CA 92027 USA
800 480 2949 FAX +1(760)480-0249 corb748@aol.com
DelCor Interactives International was founded in 1995 by Dan Delgado and David Corbin.
Dr. Delgado is an optometrist, and Mr. Corbin is an entrepreneur, consultant, and public
speaker. Their first product, Status View™, was available in 1996. Status View is an
education/communication/sales tool for optical professionals, their staff, and their
patients.
By early 1988 DI was selling over $3 million/year of Status View™, and beginning
to introduce new products and systems. They received the Bank of America’s Annual
Business Enterprise Award for Innovation in January, 1998, in an award ceremony in front
of 4500 people, including former Prime Minister Margaret Thatcher, authors Tom Peters,
John Naisbitt, Speaker Newt Gingrich, Nobel Prize Poet Maya Angelou, and commentator Larry
King, among others.
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Figure 1.
Dr. Delgado (seated) and Mr. Corbin (standing) being congratulated by Margaret Thatcher.
She said, "Congratulations on your innovation. I’m hoping to see Status View in
the UK, because patient communication is so critical today." |
DelCor Interactives International is a customer-focused company, and owes its success
to the combination of technical methods used to develop its products and entrepreneurial
experience and intuition that have been used to develop the business.
The product concept for Status View™ started with Dr. Delgado’s experience in
his optometry business. "I wanted to find a way to connect better with my patients, a
way that would ask questions, and at the same time, educate them as to potential solutions
available to them." Analysis of the customer/supplier chain and optical visit flow
chart showed that a complete solution must help the doctor understand the patient’s
needs so that the exam and the prescription can be easily and rapidly customized to the
patient, help the patient understand the technical, health, and fashion options available
in the rapidly changing optical health field, and help the doctor’s staff to provide
the patient with rapid, complete service.
Figure 2.
Flow chart of a typical patient visit. During the exam, the doctor had to find out patient
life-style information and health concerns, educate the patient about options, and
customize and conduct the medical examination, then develop the patient’s
prescription. |
 |
Dr. Delgado started with the "voices" of his own patients and his own staff,
and himself, but knew that if he was to build a business, rather than a personal tool, he
would need to get a broader perspective on the voice of the customer. Local professionals
in his study club made the first contribution to the development of Status View as a
business tool, as well as a technical education tool. Through them, Dr. Delgado and Mr.
Corbin were able to visit a wide variety of practices that were all going through the
stresses caused by the growth of managed care in medicine.
The growth of managed care has caused the doctors to focus much more on the business
side of medical practice, and particularly has caused an emphasis on number of patients
seen per day, while constraining the amount paid for each procedure. At the same time, the
national publicity attendant on the issues of business in medicine has made many patients
question the doctor’s motivations and has endangered or destroyed trust between
doctors and patients. Yet the doctor sees him/herself as a medical practitioner first, and
a seller of services secondarily or not at all. Many of the doctors use extremely
sophisticated equipment as part of their medical work, but some doctors and almost all of
their support staff suffered from various degrees of "technophobia," and
particularly "computerphobia," induced in part by systems that were sold in the
early 1980’s as panaceas for the medical practice, and that took tremendous amounts
of time away from the medical and business sides of the practice.
These observations in the "Gemba" of the optometry and ophthalmology
professionals’ offices lead to some key features of Status View.
Faster patient visit
The patient interviews him/herself
The patient educates him/herself
The interface is easy, intuitive, and can be used by people of all ages and all states
of technical knowledge, with a variety of levels of physical ability.
Prescriptions and reports are prepared automatically
Repetition is eliminated. The staff knows the doctor’s recommendation
as soon as it is completed
More comprehensive patient information collection
The doctor is a professional advisor, not a sales person
The TRIZ concept of the high level innovation coming from the use of resources that are
already in the problem or its environment is demonstrated in this solution. In the
conventional model, the patient was passive. The doctor or the staff assistant told the
patient about preventive medicine, told the patient about surgical options, told the
patient about technical options in the selection of eyeglasses and contact lenses, etc.,
while the patient listened. There was little feedback, little opportunity for the doctor
to judge the patient’s comprehension, and a growing distrust by the patient of the
atmosphere of being "sold" something. The neglected resource was the
patient’s ability to learn at his own speed and his own level of comprehension. The
breakthrough concept at the foundation of DII’s Status View is that the customer
teaches himself, while providing necessary information to the doctor and staff. Three of
the 40 TRIZ problem solving principles (Ref. 1, 2,3) are part of this solution concept:
- Merging: Make operations contiguous or parallel; bring them together in time.
The patient interviews himself while the doctor and staff see other patients
- Segmentation: Divide and object or process into parts
Separate the education and life-style interview from the technical exam
Separate the "selling" of features and benefits of various product options from
the medical advisory function of the doctor.
- Local Quality: Make each part of an object function in conditions most suitable
for its operation.
The patient educates himself at his own pace, at the level of detail that interests him.
The TRIZ Technology Forecasting methodology can also be seen at work here. The
evolution of all technical systems follows the "S" curve, according to the TRIZ
research on the world patent collection (References 4, 5, 6, 7). As shown in Figure 2, the
functional capability increases over time, from birth to maturity. TRIZ is unique in its
emphasis on functional capability, not secondary results such as sales or market share.
Figure 3. The "S" curve for product improvement.
A significant overlap between TRIZ and QFD comes with the analysis of the mechanism for
the rapid improvement in functional capability in the Growth phase of the concept. Once
the product has left the development phase, and is in the hands of real customers, then
the customers discover new applications, improvement opportunities, failure modes to be
overcome, additional applications, etc. Likewise, the developers are able to merge the
data from many customers and improve the product in ways that no individual customer may
have anticipated.
In the TRIZ analysis, two other curves, for level of innovation and number of
innovation, accompany the "S" curve, as shown in Figure 4.
Figure 4. The family of curves that show the progress of an innovation.
Status View has followed these forecasts, and has used them to anticipate needed
changes.
For example, recognizing the need to get the Voice of the Customer outside the local
area, both Corbin and Delgado were certified to provide continuing education to doctors,
and gave talks at state and national conventions of optical professional societies for a
year, simultaneously beginning the sales of Status View, but also gathering the voices of
the non-customers so that they could modify Status View to include the needs of broad
cross-sections of the customer community. In terms of the curves of figure 4, the small
number of high level innovations (the customer educates himself in parallel with other
activity in the doctor’s office) was followed by a large number of lower level
innovations to improve the utility, speed, and acceptance of the product by the patients
and the staff.
For example, the initial concept was seen as "self-training" for the doctor
and the doctor’s staff. This uses the TRIZ concept of Principle 25, Self-service, in
that as the people use the product, it teaches them what they need to know to use it
better and more thoroughly. But, in practice, the level of "technophobia" was so
high, that another form of training was needed. For the prototype installations, Corbin
and Delgado provided personal guidance which has evolved into a training system with
classroom work in a simulated doctor’s office at DelCor headquarters, a video
training system, and a set of handbooks. Numerous other refinements in the way that Status
View is actually used in practice were created as a result of feedback from the
system’s users. The doctors’ staff members have been very influential in this
phase, since they are most sensitive to the use of the doctor’s time, the
patient’s time, and their own time. The current flow chart for a Status View
implementation is shown in Figure 5.
| Figure 5. Flow chart of a patient visit with Status View.
The doctor reads the report on the patient’s perceptions of needs before beginning
the exam, so that she/he can tailor the exam and the patient education to the
patient’s specific needs. The prescription forms prepared by Status View include
information on patient preferences from the interview, so that the doctor only needs to
add the clinical information. |
 |
Another significant TRIZ research finding (Ref. 5) is that innovation is frequently the
result of using science developed in one field to accomplish significant change in another
field. Delgado and Corbin used this principle in two especially significant ways:
- They selected and customized a touch-screen input device, to keep the interview process
"friendly" to the non-computer-using, non-keyboard using patient.
- Status View does not just use a simple set of programmed questions. The question
sequencing and logic branching were developed using methods from Gestalt therapy,
Ericksonian Hypnosis, Neuro-Linguistic Programming, and other behavioral sciences.
Market validation of the Status View concept began immediately, and was seen at 2
levels.
- Patients purchase an average of $50 additional products/services at each appointment.
This has been so well documented that DelCor now offers a complete refund if the practice
does not get $35/vist additional purchases in the first year of use.
- Sales of the system have gone from 0 to over $3 million in less than 2 years.
Now that Status View is in the rapid growth phase, additional opportunities to add
functional capabilities are compounding. DII has applied the TRIZ principle of the use of
feedback, principle 23, and the principle of the continuity of useful action, principle 20
in several unique ways:
- After the doctor has used the system for a group of patients, the collected data are
transmitted to DelCor, where trend analysis is done, and marketing advice is transmitted
back to the doctor based on the specific findings from her/his patients
- The state of health of the system can be monitored, and software can be upgraded during
non-use hours. (This "improvement" went through several iterations. DII learned
that it was important not to surprise doctors or their staff with changes. Even small
changes required training for the user to know what to do. Most surprising to the
programmers was that fixing bugs required training—the customer had learned to work
around the bug, so when the bug went away, the customer needed to learn to work without
the work-around.)
- The questions in the Status View interview can be modified if local circumstances show
the need, to put more or less emphasis specific areas of education. For example, a
geriatric community, an industrial medical practice, and a soccer-crazed youth community
need different information on eye safety.
Conclusion:
Listening to the voice of the customer, recognizing the multiplicity of customers and
their multiplicity of needs, and using many skills of innovation to create a system of
service to satisfy those needs has taken DelCor from concept to business success in under
3 years. They will continue to expand their use of QFD and TRIZ practices as they move
into additional applications of Status View and additional products and services for their
customers.
References:
- E. Domb. "Tutorial on Contradictions." July, 1997, The TRIZ Journal
http://www.triz-journal.com and "QFD and TRIZ/TIPS" in the Proceedings of the 3d
International QFD Symposium, Linkoping, Sweden, 1997.
- D. Hooper, K. Aaron, H. Dale, E. Domb. "TRIZ in School District
Administration" Feb. 1998, The TRIZ Journal http://www.triz-journal.com
- G. Altshuller, 40 Principles: TRIZ Keys to Technical Innovation, with
drawings by Uri Fedoseev, and additional material by Lev Shulyak. Technical Innovation
Center, Worcester, MA 01605 USA. Russian version published in 1974, English version in
1998.
- E. Domb, K. Tate, R. King. TRIZ: An Approach to Systematic Innovation.
Methuen, MA, USA. GOAL/QPC, 1997. service@GOAL.com
- G. Altshuller. Creativity as an Exact Science. Translated by Anthony
Williams. NY. Gordon & Breach Science Publishers, 1988.
- J. Kowalick. "Technology Forecasting for Breakthrough Designs" November, 1996,
The TRIZ Journal http://www.triz-journal.com
- E. Domb. "Technology Forecasting for the Future of the Air Bag." Proceedings
of the Automotive Industry Summit on the Application of TRIZ to the Future of the
Airbag." Service@triz-journal.com
