Innovation And Design Thinking Insights

Acknowledgements: This article is based on the YouTube recording of Professor Stefanos Zenios’s presentation at YPrime’s annual Innovation Network Gathering, where he presents design thinking as a disciplined process for innovation, with particular emphasis on healthcare and clinical trial design.

Link: https://www.youtube.com/watch?v=1vOjzRhU0Ms

Summary

Innovation is often framed around breakthrough science or disruptive technology. Professor Stefanos Zenios reframes it with sharp simplicity:

Innovation is not an event. Innovation is a process - a design process.

And especially in healthcare, innovation demands disciplined rigor, not reckless speed.

Leading Stanford’s Biodesign Innovation and Startup Garage courses, professor Zenios has watched hundreds of teams turn unmet needs into market-ready ventures - including iRhythm and DoorDash. His lessons are grounded in real operational practice, not theory alone.

This article summarizes key themes and principles he teaches and the operational insights he shared in his talk on improving clinical trial design through design thinking.

1. Innovation Begins With Unmet Needs - Not Ideas

Professor Zenios starts with a core principle:

Innovation emerges from identifying unmet needs - not from brainstorming solutions.

In the Biodesign program:

• Fellows spend 3 months embedded in Stanford Hospital to identify unmet medical needs.

• They immerse themselves in the clinical environment and observe clinicians, staff, workflows, frustrations, and failures

• Then, they organize their observations to frame problems and the unmet needs, before they begin ideating and proposing solutions.

This process emphasizes immersion, observation, and organizing insights before proposing solutions.

2. Move Deliberately and Fix Things (Especially in Healthcare)

He contrasts healthcare innovation with Silicon Valley culture:

“Do not move fast and break things.”

Healthcare innovators must adhere to the two criteria:

1. Make things better

2. Do not make things worse

So innovation becomes an exercise in precision: Move slowly at the beginning so you can move faster later.

3. Case Study: DoorDash - The Power of 65 Interviews

DoorDash emerged from disciplined observation and data collection - not a clever idea.

The team:

• Conducted 10 interviews → no insight

• 20 interviews → nothing

• 65 interviews → breakthrough

At interview #65, a bakery owner revealed she turned down 20 orders per week due to lack of delivery capacity.

This story reframed the problem.

The team then:

• Became Domino’s drivers to understand consumer-friendly delivery.

• Became FedEx drivers to observe routing optimization.

• Leveraged Uber for understanding distributed supply.

The insight was simple:

Combine Uber, FedEx, and Domino’s and create a delivery service for small restaurants.

They tested the model in class, raised funding, and eventually built a company with a ~$30B market cap.

Note (Link to Professor Zenios’ Research): While not discussed explicitly in this lecture, the DoorDash example aligns with what Professor Zenios formalizes in his research as “Precedents Thinking,” which examines how decision-makers adapt proven structures from existing organizations to design new ventures.

Operational lesson: Before you build, immerse. Before you decide, observe.

4. Case Study: iRhythm - Reinventing a 40-Year-Old Device

The Holter monitor - bulky, wired, inconvenient - had barely changed in 40 years.

Patients often abandoned it after a day. False negatives were common.

The Biodesign team:

• Condensed the electronics into a patch-sized form factor

• Used new materials so the patch could stay on even during showers

• Simplified distribution by mailing patches directly to patients

• Allowed patients to mail them back for analysis

They tested in class, raised funds, went public, and now the device is used by hundreds of thousands of patients.

Design lesson: Innovation is removing friction across the entire user journey.

5. The Design Thinking Framework

Prof. Zenios’s design thinking is not creative intuition - it is structural discipline.

He describes a process that includes:

1. Immerse with empathy - Engage deeply in the user's environment.

2. Organize observations - Convert raw data into patterns.

3. Develop a point of view - Define a sharp problem statement.

4. Ideate solutions - Generate options grounded in real needs.

5. Prototype early and iteratively - Build low-resolution prototypes and test quickly.

This is how founders operate under uncertainty.

6. Innovation Is Not an Event - It Is a Design Process

Prof. Zenios emphasizes:

“Innovation is a process. Strong design processes induce creative accidents that create beauty.”

The mindset includes:

• Bias for action

• Confidence to engage strangers

• Comfort with ambiguity

• Openness to wonder

• Willingness to test assumptions early

• Discipline to iterate

My learning: These behaviors reduce uncertainty and help teams learn faster under ambiguity.

7. Why Healthcare Requires a Different Innovation Lens

For innovation to succeed in healthcare, it must meet four criteria:

1. Usability - Patients, caregivers, clinicians must navigate it easily

2. Feasibility - Technology must work reliably

3. Viability - Economics must make sense

4. Approvability - Regulators must have a clear path to approval

But as clinical care becomes more complex:

• Patients navigate difficult ecosystems

• Care teams face operational overload

• Payers demand measurable value

Usability and viability now matter as much as feasibility and regulatory approval.

This highlights the importance of usability and adoption in healthcare innovation.

8. A Clinical Trial Case Study - When Design Thinking Arrives Too Late

Prof. Zenios shares a real Phase II trial that struggled due to poor initial design:

• Patients in coma → informed consent impossible

• Hepatologists and ER physicians did not coordinate

• Trial required three evaluations per day → staffing impossible

• Enrollment stalled

• Stock tanked

• The protocol was too burdensome operationally

  
  

Eventually, the company adjusted:

• Moved trial sites to community hospitals where clinicians collaborated

• Reduced evaluations from 3 per day to 2 per day

• Scheduled evaluations at shift start/end so the same nurse performed them

• Simplified workflow burden

  
  

Enrollment improved but the company lost a year, and the stock never recovered.

Prof. Zenios’ message: Avoid learning under fire. Move slowly at the beginning.

9. Battle-Testing Protocols: Borrowing Lessons From Broadway

Before a Broadway show is rehearsed, it undergoes workshops:

• Breaking the script into small parts

• Testing with audiences

• Refining interaction and flow

Prof. Zenios suggests clinical trials should do the same:

1. Run protocol workshops with patient actors (Just like medical students train with standardized patients)

2. Use a “fake IRB” A feedback board, not an approval board.

3. Prototype the user journey Map friction before launching the real trial.

He emphasizes:

• It is far cheaper to fix a workshop than a real trial.

• Far cheaper than losing stock value.

• Far safer than exposing patients to flawed protocols.

  
  

10. Becoming a Better Innovator in Healthcare - My Learnings

Professor Zenios’ playbook which I understand:

1. Bias for action - Overcome hesitation early.

2. Start small - Test in micro-contexts.

3. Observe and interview - Engage real users, not assumptions.

4. Prototype quickly - Early failure prevents late disaster.

5. Learn and adapt - Refinement is the engine of progress.

   
   

When the process becomes habitual, innovation becomes reliable.

Reflection (Interpretation beyond the lecture)

Professor Zenios’ lecture reframes design thinking as a discipline of:

• Empathy

• Structure

• Prototyping

• Iteration

• Operational realism

  
  

The message is clear:

Innovation succeeds when it respects complexity and designs deliberately.

Innovation should be:

• Not speed, but precision

• Not chaos, but structure

• Not hope, but process - design process

• Not reckless disruption, but empathetic engineering