The double diamond

We believe the best way to make significant improvements to patient health, clinician experience, and care delivery is to experiment quickly at low cost - scaling only once we find high impact solutions. Most successful innovations differ substantially from where they started. Since getting it right the first time is rare, small, quick tests are required before system-wide implementation.

Employing a scientific approach toward creating, evaluating, and implementing new ideas helps us learn faster and at lower cost what works and what doesn’t. The iterative and agile approach we use to apply design thinking to care delivery has four components that alternate between divergent and convergent action. This approach is represented by the double diamond.

A disciplined process for creating new value

Projects at the Acceleration Lab move through four phases of work with the ultimate goal of bringing successful innovations to scale. 

Phase one: it might work 

In phase one, we work to gain a deep understanding of the problem or opportunity space, rapidly test potential solutions, and generate early evidence that we can move the needle. Learning what not to do in phase one is a success as long as we’ve done so quickly and at low cost. Sometimes this is called "failing fast and cheap." Efficiently invalidating hypotheses helps to create a culture of experimentation that enables organizations to succeed.

Phase two: It does work 

In phase two, we move from conducting small experiments to testing at a level of scale that will produce the evidence needed for operational stakeholders to invest in the solution. We also work to articulate a business model that demonstrates a clear return on investment. 

Phase three: How we work 

In phase three, we leverage the knowledge, metrics, and momentum from previous phases to secure funding and support for the solution at scale. Projects graduate when a sustainable infrastructure for the solution is implemented at Penn Medicine. 

Phase four: How others work 

In phase four, we seek to energize and catalyze other health systems to adopt successful innovations.

Innovation Toolkit

The process of innovation is an iterative and conditional one. Where you start, what tools you use, and when you use them will depend greatly on the context of the problem space, who is on your project team, and your access to users and stakeholders. The double diamond framework and the tools highlighted below are a collection of ingredients rather than a linear or rigid recipe for success.

As you move through the innovation process, you will find yourself balancing convergent and divergent thinking and understanding problems and solutions simultaneously. We hope you find this toolkit to be a helpful resource and that you reference it often to help inspire and guide successful innovation.

Contextual inquiry

Seeing what others have missed

Contextual inquiry involves directly observing people in context, asking questions, and developing shared understandings of experience.

Conducting contextual inquiry starts the design process but should be done continuously to help you learn more about the problem, how users and other stakeholders define success, and gather the insight you need to develop and evaluate successful and lasting solutions.

Show me

Instead of relying on a verbal recount of experience, ask users to show you how they use a product or service. What people say they do is often quite different than what they do.

Observing users in action will help you understand the spectrum of experiences users can have with the same product or service.

Surveys, interviews, questionnaires, and focus groups don’t tell you what you need to know. Prompting users to show instead of tell often reveals what others have missed.

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user.

Do the things they are required to do to gain a firsthand experience of the challenges they face. Completing a day in the life exercise will enable you to uncover actionable insights and build empathy for the people you're hoping to help.

The concierge
A concierge provides hands-on, efficient, and proactive services for customers.
Similar to the concept of walking in someone's shoes, a concierge walks alongside someone and helps them get things done.
Acting as a concierge or high-touch helper for a small sample of people will enable you to get deep into the reality of their journey and learn about the barriers they face, because like a real concierge, you'll help them navigate those barriers. You can also test solutions in real time as you explore the problem space in context.
The five whys
Problems in health care are complicated. The five whys will help you drill down to the root cause of a problem so that you don't waste time trying to solve what turns out to be just a symptom of an underlying issue.
To employ the five whys technique, keep asking "Why?" as you encounter problems in the space you're exploring. For example,  "Why is this happening?" or "Why are we experiencing this outcome?"
Five is, of course, just a suggestion. You can use your judgment to determine how many whys are necessary in each specific use case. Extra points: It's also helpful to also ask "Why else?" to dimensionalize multiple reasons for observable results.
The five whys
What's good about that?
In innovation, it's important to fall in love with the problem, not a solution.
Asking "What's good about that?" when considering a proposed direction will prompt your team to consider if there is a solution unintentionally baked into your problem statement.
In the classic Hertz example, the problem definition of "The line moves too slowly" implies the line should move faster. Asking "What would be good about a faster-moving line?" helped focus attention on eliminating wait time so that customers could get to their car more quickly. If the team had anchored on a faster line as a solution, they never would have created Hertz Gold, a solution that has no line at all.


What's good about that?
Eye of the beholder

Ask users to wear a GoPro, keep a diary, or snap photos throughout their day. Artifacts like these will help you understand their first-person perspective.

Eye of the beholder
Related projects: 
Quantitative data review
Gathering and analyzing quantitative data - the "what" is happening - can help inform your understanding of the problem space and enable you to establish benchmarks for evaluating solutions.
Quantitative data review
Related projects: 


Defining opportunities

Sensemaking involves organizing all of the data and insights you gather through contextual inquiry and design experimentation to identify patterns and themes to guide the direction of your design process. Sensemaking frameworks will help you visually organize data, manage complexity, and communicate project direction with stakeholders.

Journey map

A journey map is a visualization of a user's process to accomplish a task. Journey mapping involves plotting user actions onto a timeline.

Details on users' thoughts, emotions, and feedback are then added to the timeline to provide a holistic view of the experience or journey. Journey mapping will help you uncover what's working well in the current state and identify key pain points that need addressing.

You can build a journey map based on several users' observations, creating an archetype user journey, or you can use a template in real time as you conduct individual observations of users.

Download template

A persona is a detailed description of a fictional character who might use a product or service. The characteristics of personas are derived from actual data and insights gathered about a target demographic.
Creating personas can help you understand a users' needs, experiences, behaviors, and goals. Utilizing personas can help ensure that the product being developed caters to the preferences of the target user, not the team designing it.
Related projects: 
Problem octopus

When working on problem definition, you will uncover many interconnected root causes.

To manage this complexity, gain consensus on the problem space, and ultimately scope the project, you can use the problem octopus to organize the problem space visually.

The basic concept is that you start with the head of the octopus, asking, "What is the high-level problem we are trying to solve?".

From there, you can use the five whys to drill down to the next level root causes of that problem definition, building out different tentacles. Continuing to ask "Why?" and "Why else?" will enable you to get to the most granular root causes of the problem.

Download template


Problem octopus
Related projects: 
Assumptions matrix

An assumption is a statement about something that must be true for your solution to work.

When you have defined a solution you'd like to test, ask yourself, "What must be true for this to work?" Once you have a complete list, plot your assumptions on a 2x2 matrix where one axis is how certain you are that your assumption is accurate and the other is how detrimental it will be if it is not.

Mapping assumptions will help you determine what you need to test to de-risk a potential solution. Assumptions that you are uncertain about and that are crucial for your solution to work are your riskiest assumptions.

Download template


Assumptions matrix
Related projects: 
Innovation accounting

When assumptions are identified and design experiments implemented, you must employ a rigorous evaluation of outcomes.

Innovation accounting is a framework for tracking assumptions and experiment outcomes to ensure that you're following an evidence-based approach rather than confirming your own biases.

Download template



Innovation accounting

Intentional divergence

Imagining solutions

After you have defined a problem and a needle to move, it’s time to start thinking about solutions. Leverage the tools below to trick your brain into thinking outside the box. Traditional brainstorming, where participants simply try to come up with as many ideas as possible, is helpful but often reflects existing biases or perceived constraints. Tools designed for intentional divergence can help teams overcome such limitations to develop novel solutions.


The use of analogy is all about asking, "How would others solve this problem?" Sometimes, the solution to a problem already exists in another industry or setting. 

Ask yourself, "How would Amazon, Airbnb, or Warby Parker solve this problem?" If you need to make something go faster, does EZ Pass or Disney Parks offer a useful model? Other times, you might identify elements of multiple solutions that combined could solve your issue.

Shameless plug: Our Accelerators in Health Care Game makes it easy for innovators to leverage the power of analogy and other tools for thinking divergently about solutions.

Frequently, our work involves reimagining processes to achieve better results.
The concept of deletion is about isolating part of a process that is problematic and solving for its absence. Imagine solving for airport security without the security line or collecting tolls without tollbooths.
With this technique, you're not allowed to improve the flawed part of a process. You must delete it and then, making sure you understand what essential benefits it provided, if any, introduce alternative approaches.
Design for delight
Delight is a great concept to utilize when you're striving to create a breakthrough user experience.
Delight expresses a situation in which you've created an experience so compelling and emotionally resonant that people tell others about it, generating active word of mouth. 
Key drivers of delight include positive surprises, including the elimination of work and effort. So, key questions to ask include "What would users not expect in this service?" "How do we want users to feel when using this service?" and "What work can we remove or do on behalf of users?"
Examples of designing for delight include Zappos surprising customers with free overnight shipping on their first order or an Airbnb host creating an itinerary for you based on previously identified interests. 
Design for delight

Human decisions and behaviors are heavily influenced by the environment in which they occur.

A nudge is an intervention that gently steers individuals towards a desired action. Nudges change the way choices are presented, or information is framed without restricting choice - although some nudges do change available offerings to drive behavior change.

To learn more about types of nudges like defaults, active choice, financial and social incentives, and more, visit the Nudge Unit website.


Rapid validation

De-risking assumptions

It's time to put your ideas to the test! Rapid validation allows you to de-risk your assumptions by testing them in the real world. Designing simulations and piloting prototypes - even if they are not sustainable - will help you gather evidence quickly and at low cost in context. This will help support your project's direction and uncover things that don't work before any significant investment is made.  It can also help you generate the evidence needed to secure resources to keep moving forward.   

Vapor test
A vapor test offers a product or service that does not yet exist. Vapor tests will help you answer the question, "Does anyone want this?" and generate credible evidence for demand.
Vapor tests require carefully designed soft landings to protect against poor user experience. An example of a vapor test would be showing a product or service on a website to see how many people express interest by clicking on it.
In this case, a soft landing would involve showing an "out of stock" or "not accepting new clients at this time" message when users click on the offering. 
Vapor test
Fake front end
Piloting a fake front end involves putting a simulated version of a product into the hands of intended users - one that doesn't yet actually perform the intended function - so that you can observe if and how it will be used in context.
A fake front end will help you answer the question, "What will people do with this?"
The first successful mobile device was created by an innovator who carried a block of wood around in his pocket to see when and why he pulled it out to pretend using it, revealing both what to build and how to build it.
Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
High fidelity learning can come from low fidelity deployment.
Mini-pilots will allow you to learn by doing, usually by deploying a fake back end. You might try a new intervention with ten patients over two days in one clinic, using manual processes for what might ultimately be automated.
Running a "pop-up" novel clinic or offering a different path to a handful of patients will enable you to learn what works and what doesn't more quickly. And, limiting the scope can help you gain buy-in from stakeholders to get your solution out into the world with users and test safely.