As a part of the InnovationLearningNetwork.Org InPerson Meeting in Los Angles this week, attendees split into a dozen groups and were set loose to hunt for insight and inspiration. My team and I found it at the Getty Museum exploring the evolving museum industry and its future. It was remarkable how similar its challenges are to healthcare…and how much we can learn from their experience. Nik Honeysett, its Administrator gave us the 101.
First of all, the industry changed “overnight”. For centuries, highly skilled curators would collect and interpret. And the public had only one option; go to the museum to see it. Then with little warning, the public got a voice via the internet. And the paradigm began a monumental shift: the public wanted new ways to see the collections, they wanted to talk about it, and they wanted to help influence it. The museums were not prepared for this voice, nor have most learned yet how to harness it fully; but they are learning.
Nik shared a story of a Canadian museum of fine art that attempted to crowdsource an exhibit. The public submitted and voted for a hockey exhibition – not exactly what the museum had in mind; or even in the genre of fine art. Although this was shared as crowdsourcing gone wrong, I can easily image a twist where the museum could have commissioned a series of oil paintings of hockey scenes; dragging in a whole new audience into their world.
Next technology seeped into the museums. Most often it was a random employee who just happened to know how to flip on a PC, they were the first museum technologists. Interestingly, museums were the first to bring touchscreens and hyperlinks to the public in 80’s. Not so bad for being homegrown. Recently there has been a shift to bring in trained technologist, but at the expense of “sullying” the inner museum world with those who did not rise through the ranks. Finally, new and interesting business models began to emerge. As most museums are not-for-profit, and have similar missions, rather than competing, they focused on cooperating. Deals like two venues for the price of one began to emerge. “Retail museums” began to appear as popup stores in downtown areas . And unique combinations like museum and DJs began providing new experiences for new crowds.
And so healthcare is not as unique as it perceives, and has much it can learn by simply going out into the world. I am certain that the other eleven groups found an equal amount of insight and knowledge in their LA exploration. Meanwhile, go to the museum; the inspiration is curated for you.
There is a mantra that I’ve been hearing: “No data without stories, and no stories without data.” At first blush, this sounds awesome. It honors the art of storytelling; elevating it to the powerful level of data. And it also helps the storyteller fully grasp the power of data; their stories now pack a powerful data-driven punch.
However those of us who live in the world of innovation, this mantra can be crippling. There often is little to no data to pair with the stories we discover. And many stories in the early phases of innovation work are just anecdotes. As the innovator accumulates knowledge and more anecdotes, opportunity areas start to emerge; and from opportunity, innovation springs.
And that is the conundrum. In a data driven world, the simple anecdote is looked down upon, but often is where the richest untapped insight exists.
“No stories without data, and no data without stories” is a great rule of thumb. But it is not a law. For the vast majority of what business does, this rule of thumb will keep us safe. But for the innovator, the company rule breaker, the anecdote is a mightly lens to view the system cracks and failings.
So this blog is dedicated to the lowly and often maligned innovator tool: the anecdote.
Use it well.
Use it wisely.
Normally, at this time of year, my organization the Innovation Learning Network compiles a “best of” from the previous 365 days. This year, we decided to try something radically different – having members of our network contribute articles and artwork that reflect our 2012 themes: play and spread.
The result is a completely new look and feel.
Please enjoy and share widely.
I am thrilled to announce our book’s release. You can order it here:
From Chapter 1 of “Innovation with Information Technology in Healthcare” by Lyle Berkowitz and Chris McCarthy:
“Let’s face it, most of our healthcare clinical processes are so last century. However, a revolution is brewing. More and more providers are slipping into the Twenty-First Century quietly and without fanfare. They are figuring out how to deliver care that is not only medically superior, but is operationally modern as well. And they are creating stories which are helping to awaken our spirits and move the rest of us forward. And this is good news for everyone!
These stories range from a rural healthcare system leveraging telemedicine strategies to an academic medical center using EHR decision support tools in a novel way. They span from a small clinic using a new type of home monitoring device to one of the largest healthcare organizations in the world trying new and exciting ways to manage and relate to their patients. What these organizations have in common is their relentless pursuit of making healthcare delivery better for patients and providers alike. They are defining a new type of health system, where technologies are seamless and delivering perfect care is easier and more cost-effective than the alternative.
Most of the innovations in this book are not revolutionary nor radical. In fact, they are expected and obvious in many ways. Consumers in other industries have demanded far more than they have of healthcare. Imagine if a bank told a customer that it would take a few weeks to see a bank balance. Imagine if an airline wouldn’t let you book your own flights. Imagine if there was no way to compare car features or prices.
We in healthcare have just moved beyond the start line, and have a long way to go. Fortunately, healthcare organizations which are already innovating in this space are setting the pace and moving in the right direction, towards their own “Healing Edge”. And hopefully this book will help you get there too!”
I’m on a Virgin Train barreling out of Coventry towards London, and I am tired.
But more tired.
We’ve just finished the fourth and final day of the InnovationLearningNetwork.org (ILN) InPerson Meeting. It is a bi-annual gathering of leaders and innovators who explore design and innovation in healthcare. And its magical.
This, the fifteen gathering in seven years, meeting’s purpose was to explore spread, scale and sustainability (S3) of innovation. It’s a topic I’ve avoided…purposely. Healthcare leaders and designers new to healthcare had enough to deal with trying to understand how to be explorers, ideators, and prototypers.
With enough experience under our belts, we opened the spigot of the S3, with insight from the UK’s Institute for Innovation & Improvement (our host), the Institute for Healthcare Improvement (our friend), and Kaiser Permanente’s Innovation Consultancy (my other love). Through several workshops, it made clear what is nearly self evident about the S3:
These insights give me great joy as a thinking person. They give me great pain as a designer and leader. It means that in 2012 our jobs are much harder and more exciting. If you like complex system, this is eureka. For most, it’s heartburn.
The NHS shared a model of energy from Loehr and Schwartz. It blew me away, and crystalized a new power view of the Innovation Learning Network. The model suggests basic energies of change: Intellectual, Physical, Emotional, and Spiritual. You can guess where most business leaders lead their business lives. And you can also guess where innovators/designers live theirs. For me the ILN is a recharger for all four energies, but with an extra boost of emotional/spiritual.
And so, I am tired. I am charged. I am changed. I am pulling into London. I am signing off.
Keep Calm and Innovate On.
I love improv. I love it for the laughs, for the nuance, for the unexpected, for the discovery. As much as standardization makes our lives easier on a grand scale, improv is the one constant that makes life simpler moment-to-moment. The classic “workaround” is usually when an improv unintentionally becomes a standard. Workarounds are neither good or bad, they are simply coping mechanisms.
The most celebrated improviser is the chef. He is continuously enhancing his recipes, pushing his knowledge, and testing new methods, all with the explicit goal: to make it taste good. Which takes me to my newly wrecked childhood memory.
By far my favorite dish growing up was my dad’s Braciole: cheese and garlic rolled into thinly sliced steak, tied into a roll, and simmered in tomato sauce until the meat nearly falls apart. (my mouth is already watering). Decades of these delicious rolled morsels dot my memory.
On a recent visit home, I encountered a bit of blasphemy. My dad no longer rolled his Braciole; he made them into envelopes. How is this possible? Braciole MUST be rolled. His simple answer, “The meat browns more easily as a flat envelope. And I don’t have to tie the rolls which is a lot of work. I just put two and only two toothpicks to hold the envelope shut. When they are done cooking, I know to pull out two and only two toothpicks from each one.”
I didn’t like his answer. He was screwing with my delicate childhood memories. But what his answer reveals is the truism: simple wins over complex. Workarounds are simply trying to find the path of least resistance from A to B. It doesn’t matter if you are a doctor, mechanic, engineer or chef; accomplishing our tasks with less pain (and more joy) is what we’re all shooting for. So, with a big sigh, I must confess I love the envelopes too.
lightly salt and pepper,
lay six slices of garlic,
spread 2 tablespoons of cheese, a sprinkle of oregano and parsley.
Fold the each steak into an envelope, and secure it shut with two toothpicks (scroll to bottom to see video). Contents of the steak should be sealed in. In a hot pan with olive oil, quickly sear the steaks on each side (about 90 seconds a side).
Enjoy with side of pasta, salad and a good red Italian table wine.
HOW TO MAKE AN ENVELOPE:
I’ve had the strangest experience returning to my hometown Springfield Massachusetts. I have not been back here for more than a couple of days at a time usually around the holidays. However this trip I settled in for a full three weeks, and have noticed some odd behaviors emerging in the general population.
1) people cross the street anywhere, anytime. There seems to little to no fear of cars, and sometimes mothers are pushing baby carriages directly into four-lane traffic. Rarely are crosswalks used, and crossing lights used even less.
2) many people are choosing not to use sidewalks, but instead are walking in the roads, sometimes in the middle
3) drivers no longer pay attention to lines on the road; they have become meaningless
And this got me thinking about design, behaviors and culture. The design of the roads, traffics and sidewalks work because culture and behaviors cooperate with the design elements to make the whole system flow. Without culture and behaviors, the design elements are simply silly remnants of the past. I pushed the crossing light button to cross a major thoroughfare, and was laughed at by two pedestrians who darted through the traffic. I felt really silly.
When I visited Vietnam a few years ago, I marveled at the organic-ness of city traffic. Thousands of mopeds, car and pedestrians zoomed and darted in SEEMING chaos. More time there revealed the elegance of the known behaviors. There are social contracts that safely move a pedestrian across the street. If you don’t know the norm, you can get hurt and hurt others. In fact, my partner did just that by hesitating while walking across the road.
Back to Springfield: there seems to be two different cultural and behavioral systems in clash, and all with the same design elements – the old rules-based and new free-flow. The real danger is that different operating systems are driving these different systems. I follow the traffic lines. I am less concerned that others will “disregard” them. I am surprised when I almost crash.
And now back to design: how many systems in the environments that we live and work are in flux or outdated? How many designs are simply relics that make less sense in today’s world? How can we ensure that we are paying attention to and design for these changes? For surely, culture and behaviors are not static.
I know a lot of pissed off drivers and walkers in Springfield Massachusetts. I don’t know what the answer is, but I do know the clash between the different operating systems is really dangerous. People are pissed. People are dying.
This blog is usually about design; today its about family. My Aunt Ruth passed on Sunday, and i was honored by being asked to give her eulogy. With this honor came the burden of asking questions about her life to those who loved her deeply – her siblings, her children, and her grandchildren. Although painful at times, their stories were simply full of joy. I wanted a place for the stories to live beyond the service, this blog seemed the perfect place for family and friends to access them anytime, anywhere.
Click here for the audio recording ==> Audio of Eulogy for Ruth Ferrera
Image – the deepest ocean blue shag carpet, the Golden velvet wallpaper, the golden candlesticks sconces and the Chandelier.
Well this was simply the fanciest place I knew growing up, and if it wasn’t for that I’d and rest of you would never have been exposed to “good taste”. Auntie Ruth was indeed elegant. Classy. And in my eyes the closest thing to royalty that this family had.
When she was a kid, along with her sisters Anne and Susan, they would wear their white bucks, and their green and yellow Holy Name band uniforms….marching in parades. This one time in a competition aunt Ann marched the band along with Ruth and Susan not in a simple straight line past the viewing booth, but in a moment of panic instead made several strange and precarious turns zigging and zagging the band across the road much to the amusement of onlookers. As Auntie Sue wacked her symbol and Auntie Ruth beat her drum, and the band played on.
Well, leaving her drums behind, Auntie Ruth found her way into Modeling. She was discovered while working at Friendly’s as a waitress…and even ran for Miss Springfield! She came in fourth.
Now running for Miss Springfield, steps us back to that “royalty” that I mentioned earlier. There are certain gifts that royals must possess in order to royal it up: they need a deep love of God, they need a fierce love of family, they need the ability to tell a good story and finally they need just a touch of Zany.
So lets go deeper!
1) A Deep Love of God: Christ was and is simply present for Auntie Ruth: all the way from the pictures on her walls through the pages of her bible. And even as a nightlight in her bathroom glowing safe passage to the toilet.
Pastor Geno, Harlo White and Benny Hinn guided her spiritual walk with Christ, but her grandson Jordan was her study partner going to prayer meetings and listen to tapes. When I asked Jordan his favorite memory of his grandma, without hesitation he said studying the bible with her.
With Auntie Ruth, the breath of the Holy Spirit was simply one laugh or smile away….AND sometimes in several Halleluiahs in tongues I dare not speak.
When she was given her prognosis, she exclaimed “I’m not afraid! I know where I’m going! But do you know where you’re going?!” pointing to a startled room of clinicians. She was fearless in death, and was so ready see the face of Jesus.
2) A Fierce Love of Family: Her grandbabies adored her, and she adored them. From putting on graduations for her “Littlest Angels”, to making the best toast – little Jacob says the secret was using Italian bread -, to being a real speed demon in the car according to Alliyah.
Mia told me her favorite memory was grandma teaching them the turkey song, and last night Mia and Michael not only sang it for me but danced it as well.
I learned that Joshua proudly showed his grandma his driver’s permit in the hospital a few weeks ago. The problem is Grandma had been teaching him to drive long time ago. Now that’s illegal AND that’s love!
Finally Johnny shared that his favorite memory was his grandma clowning around with her new wig on her birthday. I can just imagine the light of her smile and twinkle of her eyes during these shenanigans.
She loved all the games, all the recitals and all the plays. Even though she didn’t know the rules, who was competing, or what the play was about. It didn’t matter. Her little ones were in it, and therefore it was GOOD.
And she loved her Reggie. Everyone needs a handyman and Reggie was hers. Fixing her car and home, he kept her running.
3) The Ability to Tell Stories: now really? Is there anyone who can tell stories better than Auntie Ruth? Now lets be clear. Stories are not depositions. They are lively half-truths brought to life with rolling eyes, raised eyebrows, big smiles, different voices, all punctuated by some really intense hand gesturing. Telling stories about being touched by the Holy Spirit or about her Rufus, Baby, Blue and Belle…all were equally riveting, and like any storyteller, she never told it the same way twice.
4) A Touch of Zany: From her obsessiveness with a clean and proper house, to her infectious cackle of a laugh, its her touch of zaniness that brought smiles to our faces. Remember the time John John decided to sneak up on his mom for a good scare while she was vacuuming? Little did he know that Auntie Ruth has a degree in the vacuum cleaner weaponry, and beat the crap out of him.
Or that time she thought it was a good idea to nap while Auntie Ellen was cutting her hair? Auntie Ellen just kept jabbering and cutting and cutting and cutting..and cutting…and cutting…. Well when Auntie Ruth woke and looked into the mirror she was lost in “oh oh oh oh my goodness”.
Or “Baaaaaaby! Granma’s Baaaaaby!” You know that time she went hunting for her cat “baby” all over the neighborhood, finally found it several houses away, scooped it up, carrying it home…only to find HER cat curled up in her house sleeping. Needless to say, the “mistaken identity” cat in her arms was none to pleased being dragged into a stranger’s house.
And sadly she too was plagued with the Stebbins affliction of that “occasional trip.” Remember her tumbled over the hassock [ottoman] at Grandma’s? You know, when she belly flopped right into the kitchen in front of everybody?
My guess is that our Royal Auntie Ruth, on having passed from this world, lost all her elegant composer and did an Olympic 100-meter dash for the Pearly Gates, tripped and belly flopped right into Heaven. Pure joy!
John will miss the mom who is simply proud of him.
Gina will miss the quiet mom-daughter conversations on life and family.
Julie (aka Mouth) will miss those reassuring gentle moments when her mom would simply rock with her.
As much as we are going to miss Aunt Ruth, AND WE ARE GONNA MISS HER, we need to remember where and who she is with. I know she is laughing it up with Auntie Charlotte, Uncle David and Aunt Ann, and Gram and Gramps. I mean, come on, she just belly flopped into heaven!
Now back when I was 10 years old living on East Alvord Street, my mom was on vacation in Puerto Rico, and my dad the fireman was called into work. It was only 6pm, but to me it was the middle of the night. I started to hear spooky noises all over the house, and freaked out. In tears and clutching the phone I called Auntie Ruthie. “I’m all alone!”, I cried. Not five minutes had passed when she swooped in, bolted in to the house, and hugged me saying “Christopher, You are never alone! Aunty Ruthie is right here!”.
Well Auntie Ruthie, right back at you. You were never alone, and with Jesus you will never be alone again.
Zambia @ Safari Camp / 4 July @ 8pm: “its called what?!?!” The two fellow travelers, who also happend to be doctors, were in agreement that if I go SCUBA diving in Lake Malawi that I should seek treatment for a water parasite called schistosomiasis.
Zambia @ Airport / 5 July @ 10am: Using m.kp.org * on my SmartPhone, I email my doctor about the Lake Malawi parasite concern.
Malawi @ Airport / 5 July @ 3pm: Again using, m.kp.org I receive the following note back from my doctor: “I will discuss with my infectious disease specialist and get back to you. Be safe but have loads of fun! And take lots of pictures.”
Malawi @ Lake Malawi / 6 July @ 3pm: Kicking back having a cocktail by the lake and reading Abraham Lincoln: Vampire Hunter on my iPad, I notice that I received another email from my doctor: “A prescription for Praziquantel will be mailed to you. Have a safe trip home.”
Malawi @ Lake Malawi 30 feet below the surface / 7 July @ 10am: I am enjoying the most amazing freshwater SCUBA dive of my life. My dad has been raising fish from this lake for 30 years, and this is a once in a lifetime chance to swim through what looks like my dad’s fish tank…but a billion times bigger.
San Francisco @ home / 10 July @ 2pm: I’ve just arrived home, and sitting in the mailbox is the prescription.
The above is true, amazing, and what the world of healthcare should be. Its seems so unreal the I was able to receive care by MY doctor based in San Francisco while I am on safari in Zambia, and that the care was coordinated, timely and precise. I can only imagine that in a few short years that this will be the standard. But right now I am basking in the awe that what many innovators have been dreaming about for decades literally manifested this past Fourth of July. Now that is independence!
A few years back the Innovation Learning Network explored the wide world of telemedicine. The premise was to explore how one might be able to receive care anywhere, anytime by people who knew you. We brought that exploration together into a nice booklet called CareAnywhere. For most, CareAnywhere was an “imagine if” exercise. Well, I’ve just had my first REAL CareAnywhere…
….and it is everything I thought it would be.
*NOTE: m.kp.org is designed for SmartPhones. Use kp.org when using a computer.
Choice is a good thing. But it is rare that alternatives are ever fully explored. I think it has something to do with the speed at which we are expected to get to the answer. Time is money and the clock is ticking. How could I ever explore alternatives?
The power of the alternative is not really in the choice, but in the formulation. For whatever alternative is chosen is it because the other alternatives have made it the strongest. We know why we chose it. We know why we passed on the others. And we made a calculated risk that THIS is the one.
Its why in brainstorming we release the guardrails, going for quantity so that we have a pile to choose from. Its why in prototyping, we develop the most promising alternatives in parallel so that as some fade, others continue on the journey. And its why in PDSA that many tests are planned so that well developed solutions may emerge. Placing all the eggs in one basket is simply poor practice.
So this blog celebrates the alternatives; the conscience push to have several pathways to choose from, and then REALLY choosing the smartest one.
NOTE: you might be scratching your head wondering how the heck did he get on the “alternative” tangent? Well, I just finished reading “Thirteen Days” by Robert F. Kennedy. It is the story of alternative development in the extreme…and I just couldn’t help but see the connection to the world of innovation. It’s a great read.