November 2, 2011
20 Ways to Protect and Nurture Design

Lorna Ross is the design manager at Mayo Clinic’s Center for Innovation. She gave an insight into running a small design team within a very large organization (one dominated by clinicians and physicians, to boot) at the recent Design at Scale conference. She concluded with 11 ways she thinks about protecting and nurturing design, culled from a longer list of 20 ideas. She shared that longer list with me, and I in turn share it with you here. It contains some gems applicable in disciplines way beyond design:

  1. Move beyond needing to be understood. Focus on being valued.
  2. Do not react to every situation. By allowing the dynamics to play out there is deeper learning. Designers self regulate through experience.
  3. There is a thin line between being understood and being irrelevant. (If busy people have to validate you they will opt to ignore you instead and move on.)
  4. Get your team comfortable with discomfort.
  5. You may want to direct the work but your team may need you more as a decoy. Go where the need is greatest.
  6. Make every team member feel empowered, trusted, respected…. and accountable.
  7. Communicate zero tolerance for liabilities. One dysfunctional person can bring down your whole team, and you.
  8. Never make excuses for your team. You will be seen as biased.
  9. Make difficult and unpopular decisions with the same confidence and conviction that you make the easy ones.
  10. Do not get too wrapped up in being liked by your team. They need you less as a friend and more as a leader.
  11. Examine your own prejudices.
  12. Scare everyone you hire. Carefully design the most effective interview process to really know who you are bringing onto your team.
  13. Pay close attention to feedback and always be seen to value it.
  14. Choose your battles. Know what you can affect and what you cannot.
  15. The almost toxic levels of adrenaline needed to function in “hostile” or chaotic environments can tip a team into :battle mode” where there can be considerable collateral damage.  It is your job to watch for this and interrupt it very carefully.
  16. In a conservative culture, passion, determination and conviction can often be perceived as arrogance. Humility is a skill that you and your team need to master.
  17. Value integrity and honest above everything else. Trust amongst the group is critical.
  18. Learn to function without praise or validation. Not because you don’t deserve it but because it may never come. Determine and declare your own success metrics.
  19. Never wait to be surprised by feedback. Seek it out.
  20. Never gossip. It’s a luxury you cannot afford.

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(Notes: 39)
  
Filed under: Lorna Ross Mayo Clinic Center for Innovation innovation design protect nurture Design at Scale DMI 
September 21, 2011
"We spend $5 trillion dollars every year on a system that is devoted to diagnosing and fixing."

—

Dr Alex Jadad runs the Center for Global eHealth Innovation in Toronto, an organization that’s explicitly designed to prototype experiments in healthcare. Jadad spoke at the just-wrapped BIF7 conference in Providence (a series of highlights to follow) and spoke of his sadness at realizing that he had forgotten the doctor’s mission: “to cure sometimes, to alleviate often, to console always.” As Jadad pursued his career in medicine, he got sidetracked by a laser focus on curing, diagnosing or attempting to fix. He had “forgotten about alleviating or consoling” and now his entire body of work is refocused on improving health and wellness. This focus echoed an idea Dr Jay Parkinson outlined at the recent Mayo Clinic Transform conference, one he wrote up on his own blog. Parkinson’s question:

Can the few natural born leader doctors lead us into a sustainable system that profits off health, not sickness?

I find it encouraging that charismatic types such as Jadad and Parkinson are asking these questions. Now I wonder who’s really listening — and who’s helping to figure out the answers.

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(Notes: 7)
  
Filed under: healthcare BIF7 Alex Jadad Jay Parkinson innovation systems design wellness Mayo Clinic Transform 
September 16, 2011
Paul Grundy: The Innovation Imperative of Healthcare

Paul Grundy, director of healthcare transformation at IBM gave possibly the most important presentation at Mayo Clinic’s Transform conference, contrasted as it was by the supreme illegibility of his slides, which were so difficult to digest as he ran through his talk. Understated yet baldly matter of fact about the depths of the challenge facing those running the American health care system, Grundy was blunt and to-the-point, emphasizing that the main issues that payers and consumers need to address are inevitable, not political. “We really have an innovation imperative,” said Grundy, as he outlined the sorry state of the industry. Without adult supervision, coordination of care or integration of services, costs have skyrocketed. Fixing this is no longer simply an issue of benefits; it’s a business imperative.

(Note: Mayo Clinic has posted unedited video of the talks on its Transform website. Grundy’s is here, and well worth watching.)

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(Notes: 35)
  
Filed under: Paul Grundy IBM healthcare innovation Mayo Clinic Transform business design 
September 15, 2011
"Along the way it seems like someone overlooked the notion that a medical procedure is a most emotional thing to go through as human being. Devices are devoid of emotion. They’re scary. They have no look on their face. When you encounter an MRI or a mammography device, it doesn’t tell you you’re going to be ok or make you feel good about what may happen. It makes you wonder ‘am I going to die now?’ We wonder: why is that? Aren’t we in charge? Folks in design and our brothers and sisters in engineering should guide the direction these devices take."

— Bob Schwartz, general manager of global design at GE Healthcare, speaking at the recent Transform conference at Mayo Clinic and extolling the benefits of thoughtful design for healthcare products. Schwartz rounded off the session (a joint presentation with GE CMO, Beth Comstock) recounting the story of a little girl who emerged from being scanned in one of GE’s redesigned machines to ask her mother: “can I do it again?” Great.

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(Notes: 40)
  
Filed under: healthcare innovatio GE Bob Schwartz Beth Comstock Mayo Clinic Transform medical device design 
September 15, 2011
Presumption vs Product

Allan Chochinov of Core77 gave a great presentation at Mayo Clinic’s Transform conference. Funny and insightful, he showed some of his former students’ work, focusing on the gap between the “presumption of design” and the eventual result. The framing really worked (and not just as a plug for his new course at SVA, Products of Design, of which I should add I’m a proud faculty member.) 

As Chochinov described, design is at a crucial point in its evolution. He showed a number of ideas that skirt the line between good and evil, forcing us to question what we need, want and expect from our physical world. For instance, he showed the Belkin headphone splitter, which allows up to five people to plug in their headphones to the same music device. Fantastic, right? Or, perhaps this misses the deeper idea that when two people share the same pair of headphones, they’re sharing more than the chance to listen to the same piece of music. In innovating to fix this problem, the designers have unwittingly broken the ritual.

The “presumption of design” and the “product of design” are not always one and the same, and designers have to be sophisticated and savvy to understand, appreciate and act on the difference. And acting, of course, might end up being doing nothing at all. As Chochinov reminded us, just because you have a good idea doesn’t actually mean it has to be made into a commercial product.

Chochinov wrapped up by making a point he’s been making for some time, but it’s one that bears repeating. “Designers think they’re in the artifact business, but they’re not,” he said. “They’re in the consequence business.” Beautifully put.

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(Notes: 4)
  
Filed under: Allan Chochinov Products of Design product design design Mayo Clinic Transform SVA consequence artifact 
September 14, 2011

Rebecca Onie runs Health Leads (formerly known as Project Health, as she refers to in this video, shot when she won a MacArthur Fellowship in 2009).

Based on the insight of one Dr Jack Geiger, who prescribed food for patients suffering from malnutrition, Onie started her own version of that initiative in 1996. As she told the audience at Mayo Clinic’s Transform conference, she’d been working in a Boston hospital when she realized that the staff there were operating a “Don’t Ask Don’t Tell” policy. They were doing their best for their patients in the short time they got to see them, but the real problems were often social, not medical. Health Leads allows doctors to write prescriptions for unmet needs such as housing, food, or heating, forms that patients then take to the Health Leads desk at the clinic in order to work with staff to get the needs filled. 1000 volunteers currently work with nearly 10,000 patients on the east coast. 

At Transform, Onie was clear that for her, this work isn’t about being glamorous or high profile; it’s about getting stuff done. “There’s no systematic transformative change without the grueling and sometimes incredibly tedious work of getting things done,” she said. Her entire approach to Health Leads has been about rolling up her sleeves and getting on and trying to make an impact. “We’re looking to change the experience of delivery and healthcare,” she said, outlining the big challenge as she sees it: “How do we ensure that these innovations in fact yield transformation?”

At one point, Onie told a story of a creative clinic director figuring out that in order to get people to pay attention to the Health Leads prescription sheets internally, they should pin them directly to billing notices. I commented that this was a great example of the importance of finding a champion for innovation, for discovering someone willing to take a chance, to do something different and to make change happen organically. Onie agreed, and then added that she wants to push this even further. For her, it’s not merely a question of finding champions, but educating and nurturing them. That, she said, is why Health Leads specifically targets undergraduate college students as its volunteers. This way, by the time the graduates enter the professional workforce, they’ll have been steeped in the social ideas of the program, and be more willing and able to continue to push for systemic change throughout their careers. It’s the slow and steady approach to radical transformation.

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(Notes: 5)
  
Filed under: Rebecca Onie Health Leads Jack Geiger innovation healthcare Transform Mayo Clinic volunteer systems design change experience 
September 14, 2011

“Chronic disease management is a team sport.” So said Dr Sanjeev Arora at this week’s Transform conference, hosted by the Mayo Clinic in Rochester, Minnesota. Arora is an liver specialist by training, though a sideline in community healthcare has now become more than a day job. In 2002, he founded Project ECHO [Extension for Community Healthcare Outcomes] in an attempt to handle the very real problems suffered by those diagnosed with hepatitis C in New Mexico. Frustrated that he wasn’t able to do enough within his own clinic (there was an eight month waiting list while many of those with the disease were unable to travel for the many visits necessary for treatment, Arora started ECHO as an attempt to mobilize a network around a disease.

The video above gives the gist of how the program works. At Transform, Arora outlined the importance of collaboration to the new practice. Every Wednesday afternoon, a team of specialists, including doctors, nurses, nurse practitioners and the like call in from wherever they’re located to take part in a video conference. Together, they’ll co-manage the care of up to 15 patients in the course of the call. In his talk, Arora spoke the language of business, of the need to standardize best practices and channel the processes of the most streamlined organizations. Yet, he added, expert clinicians need to implement a quality that’s not necessarily a factor on Toyota’s production line: wisdom. “What makes this different from manufacturing is that every patient is different,” he said.

As Arora mentions in the video, there are now ECHO projects for diseases other than hepatitis C, though he’s also aware of the complex issues that surround trying to scale the program too aggressively. “Don’t start ECHOs for 200 diseases,” he said at Transform. “Just a few diseases account for morbidity and mortality. Do it for those.”

8:06pm  |   URL: http://tmblr.co/ZLv7dx9XCy6X
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(Notes: 18)
  
Filed under: Sanjeev Arora ECHO New Mexico healthcare Transform innovation community Mayo Clinic process standards video conference network collaboration manufacturing