In Praise of Wandering and Wondering

In July 2021, the fog cleared. After nearly five years at Hopelab, my mission was near completion –  baking in a more transparent approach to innovation, launching an in-house design group, and tackling challenges facing queer teens. The intensity of the pandemic and the clarity of racial injustice sharpened by George Floyd’s murder, set up a deeper, personal reflection and ultimately led me to make a change. 

I paid deep attention to the “great resignation,” admiring the many who leaped – for discontent, in protest, a “mission accomplished,” or for the sheer joy of a new adventure. Safety in numbers made joining this movement easier. I wrapped up my time on January 1 with two goals: wandering for a bit and wondering for a bit more.

The wander period melted my brain in the best way.  I overemphasized physical work and deemphasized brain work.  Day after day, week after week, my mind began to shift and drift – unburdened by calendars, deadlines, and updates. The shifting was to a calmer and more focused attention.  The drifting was into sparks of creativity and old-fashioned daydreaming, creating a bridge to more and more wondering. 

Wonder is less of a period and more of a state.  Curiosity has intensified. Connection with others is more exciting and meaningful. And I have a new sense of control. Perhaps that is what a good sabbatical, holiday, or vacation should invoke. So here I am just a year after that fog with new sparks and flickers of what might be next.

Goodnight ILN

Summing up the fifteen years of an organization is impossible, as impossible as knowing the ILN is coming to an end. But it is some of our first lessons (way back in 2005) that fuels our elegant, future-forward ending.  The concepts of the innovation lifecycle and creative destruction have taken center stage.  The innovation lifecycle is a simple framework that helps one map which phase the “work” is in: birth, growth, maturity, decline, or death. Creative destruction, on the other hand, is intentional destruction to create more fertile space for new ideas to take hold.  Bringing these two concepts together shifts thinking from “what can I do to prevent decline?” to “what can I clear away to make new space?”. And this is the phase and intention that the ILN has boldly stepped into.  

Before we go deeper into destruction, there are two places I want to take you: Mars and a kelp forest. I am enthralled with everything Mars.  There is just something mysterious and alluring about our red neighbor, and the innovation it takes to understand and visit is astounding. So when the Mars Rovers began transmitting the first images from Mars in 2004,  I was riveted.  Remarkably, those little rovers were designed for a 90-day life, but year after year they just kept going.  Over time, when people asked about the ILN, I would tell them it was like the Mars Rover. You see, the ILN was supposed to be a one-year-long learning collaborative powered by a grant.  Instead, it went on year after year fueled by the passion of its members.   Perhaps I should have realized that when the final Rover conked out in its fifteen-year that it was a bad omen for us.  Nevertheless, the job of this 90-day robot continuing on for fifteen years is simply wonderful.  Goodnight Rover.

A few weeks ago, I watched a heartbreaking and gorgeous documentary called “My Octopus Teacher”. It traces in parallel the videographer’s mental health and his unlikely relationship with an octopus.  At first unsure and tenuous, the two create a bond as the videographer visits the same kelp forest every day for a year. The joy of this friendship, filled with discovery and trust, reminded me of the ILN journey.  At first, everyone was scared to share, but through dinners, wine, and laughter, there was a shift from leary to curious and then on to the joy of discovery. Something I learned from the film: the common octopus lifespan is one year. Day after day, as this octopus and videographer reach out for one another, the bittersweet realization sets in that this too is fleeting and so very precious. Goodnight Octopus.

And so, in the lifecycle of innovation, the ILN now finds itself in the Death Phase.  It would be easy to shy away from the signals of the past four years and simply blame the Pandemic.  Yes, the Pandemic played a significant role, but its most powerful role was offering clarity on the ILN’s end.  The ILN began with committing ourselves to friendship in service of our missions, to sharing freely our know-how in service of innovating faster, and to thriving on the fringe unafraid of being uncomfortable.  Even at the end of year one when the ILN was supposed to end, I could have declared Mission Accomplished. But the universe decided that 14 more years were needed. As the ILN ends in its fifteenth year, space is being made in the most fertile of innovative soils. Goodnight ILN.

The Innovation Learning Network
2005 – 2020


I have nothing against raspberries.  Though in an HBR article from exactly a decade ago, my life temporarily was all about that color.  It explored the democratization of innovation in healthcare and on innovative approaches that drove breakthroughs in thinking and value. Back then, I would jump into my raspberry-colored scrubs to explore hospital environments with nurses, doctors, patients, and other scrubbed-up innovators. Ten years later, those HBR insights from 2010 are still relevant.

Takeaway 1: It’s about humans.

As in 2010, the focal point remains centered on the people who are experiencing the challenge.  And this is both the end-user and the other humans involved. There are pain and joy points for both, and focusing on only one type of actor skews the design. One additional group that I now explicitly include is leaders. They play an essential role throughout the innovation lifecycle, but they are not often thoughtful included. Worse, if they are excluded in the innovation journey or are in the wrong mindset to lead innovation, even the best ideas get thwarted. 

Hopelab’s partnership with the Nurse-Family Partnership (NFP) is a great example. The solution called Goal Mama is powerful because it solves patient and nurse needs. NFP leaders were part of the innovation journey every step of the way.  When the innovation team was divergent, their leaders were exploratory. When the team was preparing for the pilot, their leaders were operational. They matched phase for phase and a great solution came out of that work. 

Takeaway 2: It’s about value. 

If there is no way for your invention to drive value, it is not an innovation. What was not well understood ten years ago (by many of us) was how the business model is very much part of the design too.  In working on Nod with our partner Grit Digital Health, not only did we create a solution that reduced loneliness, we designed it in context to how Grit would get it into its college distribution channel, and thus in the hands of young people.

Takeaway 3: It’s about democratization.

Lew McCreary, the author of that HBR article, made this explicit: “ …by democratizing the methods of innovation, [they] are democratizing health care, giving patients and [caregivers] a louder voice in designing the future.”  In 2010, I was on an innovation, diversity, and inclusion panel.  I focused on what I believed was the inherent diversity/inclusion of human-centered design and talked about how we ensured there was a diverse group of users who were co-creating with us.  Ten years later, I now know that was not enough. Justice and equity must be bedrock design principles for the innovation AND the innovation team – they are inseparable.

In one of my final projects at Kaiser Permanente, our design team focused on improving the transgender-person care experience.  While sharing at a conference that we were about to launch this work, a woman approached me and said, “I am a designer. I am a trans-woman, and I am a KP patient. How can I help?”  Within weeks she was on our team helping kick off this work, contributing to and reviewing the design research plan, and ensuring we were doing our homework BEFORE entering the field. 

And so ten years later, it is still about the humans, about driving real value, and the ideal of innovation democratization. I don’t imagine this will change as I look out to 2030, but I do see a continue deepening and sometimes re-imagining as we solve real problems that real people have and ensure we do so in a just and sustainable way.

Getting to Transformation

Aaron Sklar presenting the WISH Design in Health Care report in Doha – 11/13/2018

At least a few times a year I am asked by a senior healthcare leader, “How can I systematize innovation?”.  And while I’ve been privileged to lead and execute innovation at Kaiser Permanente, Hopelab, and the Innovation Learning Network, never I have been able to articulate as thoroughly as the WISH 2018 Design in Health Care Report.

In early 2018, I joined a group of esteemed design leaders of healthcare to develop a WISH point-of-view on the human-centered health system. We pooled our collective experience to generate nine recommendations in three categories.  And while it was developed for policymakers in government, as I reread the report with fresh eyes this week in Doha, it’s also an excellent starter set for healthcare leaders who are serious about transformation.

Whether your organization is just getting started or needs a transformation tune-up, these nine principles will leapfrog your organization into the future.

Make a visible commitment to human-centeredness

  1. Mandate empathetic design activities
  2. Involve and incentivize patients and the public
  3. Partner with patients to co-design

 Teach design thinking principles to every staff member

  1. Mandate empathetic design research and prototyping training for accredited healthcare professionals
  2. Incorporate human-centered design training for the entire workforce
  3. Facilitate bottom-up problem solving

 Invest in targeted design expertise

  1. Embed design teams in healthcare organizations (and government)
  2. Sponsor design challenges in healthcare
  3. Sponsor a human-centered design community of practice


Read the full report here.

Special thank you to Aaron Sklar who led and organized the committee and the production of this report.




Complementary Missions

Last week (Sept 26) I was part of a Denver StartUp Week panel featuring the collaboration of Hopelab and Grit Digital Health. Expecting 50 attendees, the afternoon sizzled with over five times that. Many questions illuminated a fascination that a startup and a foundation would find common ground to partner. Below is a quasi-recap and additional pondering on this fascination:

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The Power of the Innovation Mindsets

Innovation often has a focus on tools, techniques and approaches. And while these are important building blocks, there are more nuanced ones that accelerate the path to impact. One of these is the innovation mindset.  While we all have a “natural” mindset that is ours and ours alone, while it may be perfect for some parts of the innovation cycle,  it can be detrimental to others.

For example, let’s assume your natural mindset is “operational” – one that is all about rapidly solving problems, optimizing your system, and putting out fires.  Your team is in the earliest phases of an innovation project –  trying to more deeply understand the challenge.  An operational mindset will reduce the divergent and intentional wandering that the team must do in this phase. You, the leader, would be in unintentional conflict because of your natural mindset.

What to do?  With focus and energy, we can temporarily change mindsets to match the phase of work. This is not natural and requires intention. But the leader only needs to hold the unnatural mindset for short periods of time – just long enough to be in sync with the team. One technique I’ve been using is an innovation meditation.  It is designed to be used with a sponsor group, board or other advising body, and can be easily applied at the personal level as well.

It could feel risky to conduct a group meditation to the start of a leadership meeting.  However, what is the risk of having a super-smart group of advisors who are unintentionally advising with the wrong state of mind?

And so, below is the meditation.  As always, I would love to hear your thoughts, comments, or even better, how it went adding in to your leadership practice.


The Innovation Leader’s Mindset Meditation
by Chris McCarthy

Take one deep breath and get comfortable in your meditative pose.  Eyes open or shut, whatever you are most comfortable with. (pause 10 seconds)

Take two more deep, cleansing breaths. (pause 10 seconds)

Breathe naturally, except for the cleansing breaths when indicated…or whenever you feel like.

The Four Leadership Mindsets for Innovation are the strategic, the explorative, the generative and the operational. Each mindset powerful in its own way.

The Strategic – the blue sky, the big picture, seeing beyond the horizon. Take a breath and ponder the sophisticated Strategic mindset. (pause 15 seconds)

The Explorative – the curious, the deepening, the pushing past boundaries, wandering and wondering. Take another breath and ponder the ever inquisitive Explorative mindset. (pause 15 seconds)

The Generative – the crayons, the paper, the scissors and glue. It’s the “what if”s and the “Aha!”s. The desire for alternatives. Take another breath and ponder the playful Generative mindset. (pause 15 seconds)

Ahhh… And finally, the Operational – perhaps the most common and most maligned of the mindsets.  The Devil’s Advocate, the realist, the analyst, the value-maker. Take another breath and ponder the brass-tack Operational Mindset. (pause 15 seconds)

The four mindsets: equal in need, equal in value, but rarely equal in expression.

Consider for a moment what is your natural mindset? (pause 5 seconds)

What mindset do you bring to this moment? (pause 5 seconds)

What mindset should you move to for today’s work? (pause 5 seconds)

Two more deep breaths. (pause 5 seconds)

We will each check-in with: “My mindset today is <fill in the blank>. And I am here and present.”

Open your eyes.

Who wants to go first?


Riding the Curve

It really wasn’t that bad. Not nearly as rough as I predicted. And THAT is a damn good reminder about the nature of change. Planning for it, thinking about it, and worrying about it are the painful parts. Going though it is almost mechanical. And reflecting on it in the past tense is almost always a non-event [yawn].

One year ago, I left behind a 20-year journey through the twisty, beautiful and strange halls of Kaiser Permanente. It was where I found my calling, nurtured my passions, and made a difference in the world. Towards the end, I was on a plateau of doing/making really cool shit.  Those last few years were executed with a tried and true algorithm of cracking tough challenges into high-value solutions.

The truth is, I thought about a change as I approached the plateau, that place where you’re just leaving the curve of acceleration for THE peak –  but why screw around with THAT success?  Eventually the itch to see more – experience more –

Chris and Mike Surfing
My first attempt at catching a wave. My friend Mike Lin fell off and I am about to join him. But oh, what a feeling….

got the best of me, and so I accepted a challenge at the amazing Hopelab.  Those last few months at KP were hard.  Was I making the right choice? Could I repeat or recreate “cracking tough challenges”? Who would I be if not a Kaiser Permanente design leader?

The first few months at Hopelab were strange. It felt like I was on assignment from my old world – trecking to a new city, working with a client, and at some point down the road I’d be going home.  And every day my identity shifted a little here, a little there. A great week, followed by a tough day, then an amazing retreat, and an interpersonal bump, then a beautiful series of strolling meetings, a mini-set back, and a great leap forward.

One year later, I am riding the curve again. I don’t really know when it happened – 4 months, 8 months, 9 months? – but there was that gentle acceleration of thinking, contributing and making that feels like you’re catching a wave.

Yep, riding the curve and loving it.

The Three Pillars

Originally published on the UK Improvement Alliance blog

What would an “innovation learning network” for healthcare look like?  Coming off of two successful years of co-launching an internal innovation group at Kaiser Permanente in 2005, it was time to build and connect to a larger community, and it was clear that to be successful, the network had to be different and valuable. The “value” piece emerged quickly in two of the three Innovation Learning Network pillars:  1) Share innovations across systems and 2) Teach innovation and design technique. These were important, valuable and obvious.

Read more here = >

The Weirdness is Coming

Reprinted from

The sprint is on for the final touches of  “WEIRD PAIRINGS ENGINEERED RANDOM COLLISIONS,” where 80 ILNers and friends will descend on Toronto for three days with our hosts, Saint Elizabeth and MaRS Discovery District.

Coffeehouses/Nursing (ANA), Firemen/Rugs (HealthPartners), Dining/Caregiving (Cincinnati Children’s), and many more will bring the magic from these strange collisions to life. Follow us from Oct 27 – 29 on Twitter:  #ILN15

Whether or not you can join (admittedly, we filled up fast!), we compiled a list of weird articles to get you thinking:

(Some) Takeaways on Innovation Capability Building

It comes down to the human experience, passion and real needs. My three takeaways from an evening conversation between Edward Boudrot of Optum, Adam Dole of Better and myself of KP’s Innovation Consultancy/ILN hosted by Continuum’s Augusta Meill in Boston on June 2.

(See Continuum’s Summary of the event here.)

Impressive was Edward’s exploration of people and empathy at Optum and his Fusion! method. One element is “building passion”, and how the very nature of connecting to the human experience is the call to action for change.  Rapid change from rapid experimentation, causing a shift from old-fashioned product management to the more progressive experience management.  He is pushing on virtuous cycles.  His tip: Be tenacious for the possible.

Adam of Better fills a gap that most of healthcare refuses to adequately address.  For a small fee, Better provides a personal health assistant to help navigate the complexity of getting, receiving and paying for care.  Adam is optimizing the healing/wellness experience. He created a product that addresses a real deep need. I particularly love his singular focus of need and use of design to create a superior service. The first audience question was a concern that this would not be affordable to all. The real question, is why can’t mainstream healthcare deliver this? Until then, Better is here.

I explored how to accelerate innovation and uptake of ideas from a human-centered design lens; uniting design research and minimum specifications. For example, with our nurse shift change innovation, the tools used to discover the need were repackaged so that at each implementation the unit nurses could rapidly (re)discover the need for themselves. Then using minimum specs, they could jumpstart fitting the solution into their environment. It’s a longer upfront cost but tied to longer-term value as the solutions are stickier.

One point of clarification about employee innovation capability building trainings: organizations should not solely rely on this for transformation. It is a piece of the transformation puzzle. It does amp up improvement activities in a big way, and lays the foundation for participating in bigger change efforts.  Paired with other puzzle pieces, like honest-to-goodness design teams, clear strategic direction, and end-to-end idea “mentoring”, the puzzle of innovation capability becomes clearer.

And so the evening ended with far more concordance than expected.  Although, how can you go wrong with the human-experience as your focus, passion as your driver, and real needs as your compass?

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