Co-creating Value in the Diabetic Foot Care Ecosystem

Abstract

This chapter shows how the overwhelming task of ecosystem design (e.g. the diabetic foot care ecosystem) can be reduced to manageable levels. Diabetic foot ulcer problems are common throughout the world, resulting in major physical and economic consequences for patients, their families, and society. Diabetic foot ulceration and amputation have been estimated to cost the US healthcare system $10.1 billion in 2001. In 2008, ITI Scotland, a publicly funded organisation, announced that it was to spend £7.9 m ($11 m USD) on a Scottish inward investment programme to promote the indigenous development of advanced, novel wound care technologies. Despite the overwhelming patient and health system burden, ITI Scotland (herewith ITI) needed to justify the spend of public money before it could move forward. The chapter describes how ITI approached the challenge by using elements of the Health Ecosystem Value Design in four countries—the UK, US, Germany and India approach to (1) Frame the diabetic foot care ecosystem using similar contexts across the four countries (2) Understand the functioning elements of the ecosystem using practice theory (3) Define the internal structure of the ecosystem to guide problem enquiry, and opportunity discovery and (4) Co-create a variety of value propositions with ecosystem actors that address evidenced opportunities for intervening in the ecosystem. By thinking and seeing more systemically, understanding health problems more deeply, revealing new opportunities with more clarity, and informing value-based research, strategy and programmes with greater foresight, evidence and confidence, the ITI process was able to meet its goals for creating new jobs, attracting inward investment and advancing wound care diagnostic research excellence in Scotland. A new wound care hub in Edinburgh for Scottish enterprise and investment was one of the outcomes.