Born in a pandemic: How do you re-imagine maternal health during COVID-19 outbreak?

Saul Kaplan and his team at the Business Innovation Factory are tackling their most important project ever: Transforming the maternal health experience for the most under-served population.
Written by Vala Afshar, Contributing Writer

Saul Kaplan is the founder and chief catalyst of the Business Innovation Factory (BIF) and author of The Business Model Innovation Factory: How to Stay Relevant when the World Is Changing. Kaplan regularly writes about healthcare transformation, human-centric design, and purposeful disruptive innovation. 

Kaplan started BIF in 2005 with a mission to enable business model innovation. BIF makes transformational change safer and easier to manage for institutional leaders by helping them explore, test, and commercialize next practices and new business models. Before BIF, Kaplan served as the executive director of the Rhode Island Economic Development Corporation and as the executive counselor to the Governor on Economic and Community Development. 

Prior to his state leadership role, Kaplan served as a senior strategy partner in Accenture's Health and Life-Science practice and worked broadly throughout the pharmaceutical, medical products, and biotechnology industry. Kaplan also spent eight years working for the Pharmaceutical Division of Eli Lilly and Company. As a marketing plans manager, Kaplan assisted in developing the launch strategy and successful introduction of Prozac into the US market. 


Saul Kaplan is the founder and chief catalyst of the Business Innovation Factory (BIF) and author of The Business Model Innovation Factory: How to Stay Relevant when the World Is Changing.

Stephanie Ewens

Today, Kaplan and his team are working on perhaps the most important project in their company's history. BIF has delivered 70 business transformational projects in the past 15 years, but none is as important to Kaplan than his current project: Delivering better maternal health outcomes. Kaplan and I have guided several large-scale Salesforce enterprise customer trailblazers in the higher education, healthcare, and government sectors. Kaplan is an expert innovator, big thinker and even a bigger doer, and a mentor. I have had the fortune to lean into Kaplan when faced with complex and system-wide tactical, operational and strategic guidance.  I asked Kaplan to share his story about his company's journey to completely transform the maternal health experience, which some would argue was severely challenged before the COVID-19 pandemic, and leadership lessons for any leader having to transform their organization in the midst of this terrible crisis. 


Saul Kaplan is a family man, community builder and a purposeful connector. He believes that everyone you meet know more about something than you do. He advocates for random collisions and the power of a beginner's  mindset. 

Purposeful Transformation 

How many times have we heard leaders use the expression 'burning platform' in their failed efforts to get us to change? Leaders incessantly call for transformation and the best we seem to be capable of are tweaks to the way our stubborn mindsets, industrial-era institutions, and social systems work today. All of that has changed overnight as together, we face the mother of all burning platforms, COVID-19. Transformation is our only choice in this crisis. 

There is no shortage of urgent problems screaming for transformative solutions amidst the COVID-19 crisis. It's easy to be overwhelmed by the breadth and immediacy of all the life-changing and life-threatening risks around us. What if, after we ensured the safety of ourselves and our families, we leveraged our personal privilege to take action today to help those less privileged around us in our local communities? As if our call-to-action isn't dramatic enough, we need to do it all remotely while hunkered down in our homes. 

Fifteen years ago Kaplan founded the non-profit Business Innovation Factory (BIF), in Providence, Rhode Island, with the mission of making transformation safer and easier to manage in healthcare, education and social services. After 70 amazing business model design projects across the country, 15 inspiring Collaborative Innovation Summits, catalyzing a network connecting thousands of human-centered innovation junkies and developing the superpowers of human-centered design, rapid real-world prototyping, and storytelling/engagement, it wasn't until COVID-19 hit that Kaplan began to understand how transformation really works.  

Kaplan and his team had already decided to pivot at BIF before the crisis, taking their own medicine, to transform a 15-year business model from depending on sponsored projects to self-initiating our own projects based on design challenges that they're passionate about and committed to seeing all the way through their design process (Shift, Design, Prototype, Commercialize) to increase the social impact and to help more people. BIF went from being consultants and designers to being social entrepreneurs. Sounds easier than it is! The word pivot trivializes the emotions of transformation. For BIF it is equal parts exhilarating and terrifying as they pulled the rug out from under how they had worked together and defined success for a long time.

US Maternal Health Crisis Before Coronavirus  

Kaplan and BIF decided their pivot would focus on healthcare, where they have the most experience, and while brainstorming many possible opportunity spaces, they kept hearing about the maternal health crisis facing women in America. Learning that women in the US are more likely to die in childbirth than any other high-income nation in the world made BIF and Kaplan angry and they quickly mobilized putting their BIF superpowers to work to design a new women-centered model to address this heart-wrenching and unacceptable crisis. 


US maternal health statistics before COVID-19.

Kaplan's anger became an obsession as BIF discovered that Black and Latina women in the US face a significantly greater risk of experiencing a life-threatening event or even death. They asked ourselves: How can that be? As they dug even deeper into the research they learned that the racial disparity in maternal health outcomes is a preventable problem. Established science tells us that by enabling self-empowerment and personal wellbeing we can reduce the risk of poor maternal health outcomes in America. 


Maternal health is a social issue, a racial issue, and an economic issue.

Business Innovation Factory

"At BIF we believe in solving the hardest problems first, so we unbundled and leveraged everything we've learned over 15 years about imagining and designing human-centered business models and unleashing personal agency to improve learning and wellbeing outcomes. We didn't start with the question, how can we improve today's healthcare system... We started with the question: 'Can we imagine a new model in service of empowering women at the core to improve their own personal maternal health and wellbeing?' ", said Kaplan.

The conceptual design process resulted in LunaYou, a maternal wellbeing program to empower women with access to a wellbeing coach, and to the information, skills and social connections to improve her wellbeing, all by remote access. 


LunaYou: A maternal wellbeing program designed for you (mothers).

With the conceptual model in hand, BIF was ready to take the idea off of the whiteboard and into the real world and to build a working prototype of LunaYou, hiring their first Wellbeing Coach and developing a low-fidelity app to enable women to visualize a real-time flow of her own self-reported maternal wellbeing information for seven indicators including blood pressure, steps, sleep, personal empowerment, stress levels, social support, and everyday equity.  Kaplan and his team planned to prototype the model starting at a small scale (25 women) in their home state of Rhode Island before developing a plan to commercialize LunaYou nationally. BIF had just started recruiting and enrolling the first women for our LunaYou prototype and then overnight everything changed when COVID-19 hit. 

US Maternal Health Crisis After Coronavirus Hit

Kaplan estimate that about 950,000 women will give birth in the US in the next 90 days right in the midst of the COVID-19 crisis (2,500 in Rhode Island) with about half of them covered by Medicaid, putting them at even higher risk of experiencing a life-threatening complication. As soon as the crisis hit BIF, started hearing questions from women, a lot of questions, as COVID-19 began to dominate the airwaves. Every day as the crisis intensifies pregnant women are getting increasingly worried about their chances of experiencing a safe pregnancy and delivery. 

Women are hearing stories about hospitals across the US restricting access to the delivery room, forcing them to give birth alone. Prenatal office visits and birth classes are being canceled. Rising anxiety and stress levels are through the roof. Women, we're talking to, especially women on Medicaid with higher-risk pregnancies, are beyond frightened right now. It makes us cry to hear their anguish. 

In response to the crisis BIF immediately reimagined its prototype assumptions and plan. Kaplan knew they needed to wrap a circle of support around as many pregnant women as they could, now. Kaplan also knew that any plans for in-person convenings and group meetings were out. Everything had to be delivered on-line. BIF decided to expand the scale of our prototype in Rhode Island from the 25 women they had planned to enroll to offering free online wellbeing support to every pregnant woman in Rhode Island covered by Medicaid (about 1,250 with a due date in the next 90 days) since they face the greatest maternal health risk during the COVID-19 crisis.   

"Our pre-COVID-19 plan was to complete the prototype this year, capture learnings and then build out the scalable version of LunaYou so we would be ready to commercialize nationally to all women in 2021. In response to coronavirus we've begun aggressively planning for scale now and are in discussions with potential partners to help develop and fund the next version of our LunaYou platform which is on our critical path to launch nationally," said Kaplan. 

While the COVID-19 crisis is still in its early stages, BIF is already supporting women remotely and is motivated to scale as quickly as resources and capabilities allow. "Our team is exhausted but we all feel as if we're rising to the crisis as long as we are helping as many women as we can every day, starting in our own community. I'm sure our assumptions will change many more times before the crisis is over and we will continue to learn and adapt on the same log scale as the coronavirus," Kaplan. 

Transformation Lessons Learned From the COVID-19 Crisis 

We're all on a steep learning curve about what it really means to go from tweaks to transformation during the COVID-19 crisis. It's still early but here are Kaplan's 15 leadership lessons for any leader having to transform their organization in the midst of this terrible crisis.

  1. We can all be innovators in a crisis. 
  2. Unleashing personal agency is the new imperative. 
  3. It's not an innovation until it solves a problem in the real world. 
  4. Stop waiting for leaders to act. Make personal networks more purposeful. 
  5. The best solutions emerge bottom-up, not top-down 
  6. Work and live-out-loud. Stories heal and enable the emotional connections needed to transform.
  7. Methodologies and protocols are merely guides. Flexibility and adaptability are essential in a crisis. 
  8. Innovation isn't always about inventing something new. It's about flexibly recombining what we already have. 
  9. Less thinking, more doing. Try more stuff. Experiment every day. 
  10. Don't start by asking, who pays? Lead with value creation and the money will follow.
  11. You can't analyze your way to transformation, it's a generative act 
  12. Empathy and genuine human emotional connection is possible on-line 
  13. Catalyze something bigger than yourself. Help someone less privileged. 
  14. Unbundle superpowers from the straight-jacket of how things worked before the crisis
  15. Digital transformation can and must be equitable and inclusive. It's up to us. 

We are experiencing a crisis unlike anything we can relate to or make sense of. It is disrupting everything and everybody. People are hurting all around us. Small acts of kindness make an enormous difference. If you know a woman who is pregnant now, reach out to her just to ask her how she is doing. Pregnancy isn't a disease and wellbeing really matters. We can all help. 

This article was co-authored by Saul Kaplan. You can learn more about Saul Kaplan, BIF, and support for LunaYou here.

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