#ILN12: Emotionally Charged

The Spread, Scale and Sustain Edition

I’m on a Virgin Train barreling out of Coventry towards London, and I am tired.

And charged.

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.

Until now.

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:

  1. Its HARD and a LOT of work.
  2. There are no silver bullets
  3. There are no perfect methods
  4. Its not binary; you can’t just turn it on
  5. It should be a design element that is designed for from the beginning
  6. Its really about shared purpose
  7. Its really about the human experience.

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.

Bob’s Braciole (Or How Improv Wrecked A Childhood Memory)

My Dad serving his famous Braciole

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.

Bob’s Braciole


  • Flank steak or top round or bottom round (sliced 1/8 to 3/16 inch think)
  • Salt and pepper to taste
  • Thinly sliced garlic
  • Bread crumbs
  • Grated Pecorino Romano cheese
  • Dash of Oregano
  • Dash of Parsley,

Lay each steak out on wax paper,

lightly salt and pepper,

lay six slices of garlic,

spread a 1 tablespoon of breadcrumbs,

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).

Submerse the steaks in tomato sauce and simmer for 4 hours. Or place into a crockpot and cook on low for 8 hours.   Remove steaks from sauce and remove all the toothpicks.

Enjoy with side of pasta, salad and a good red Italian table wine.






Pissed Off Operating Systems: The Clash of Culture and Behavior

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.

Eulogy for Ruth M Ferrera (1941 – 2012)

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

The Sweet and Elegant Auntie Ruth (center) with daughters Julie (left) and Gina (right).

Ruth’s Eulogy

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.

CareAnywhere: an African Adventure

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.

A Live Google Session

I woke up Sunday morning, Mother’s Day, feeling off…very off. My throat was razor-blade sore and feeling achy. It also happened to be the day of my soon-to-be Godson’s Christening. Somehow I made it through the ceremony, but at the party afterwards it started to get worse. Now I have to tell you, at the party there were five moms from age 41 to 73; a Polish mom, a Belarusian mom, a French mom, a Polish-Russian mom, and an Anglo  mom. No joke.

“Chris you don’t look so good.” said the Anglo mom.

“I know.  Its my throat, and I feel awful.” I immediately felt five sets of eyes on me. My words had activated the mom-emergency-response-system. Looking at each mom, you could see the calculations being conducted, centuries of passed wisdom being accessed, and just a little bit of posturing.

“You maast shqueeze frrresh lemon wit equal shut-gar, and drrrik everrry hour,” said the Polish mom.

The Belarusian mom cut in, “No no no. You must cut lemons, dip in honey, and eat them.” This actually had to be translated by the Polish-Russian mom as she only spoke Russian.  Watching her explain this remedy was a bit disconcerting as she kept pointing at me and chopping.

“Gargle every 15 minutes with Listerine.  It’ll kill everything.  I swear by it!” said the French mom.

“Tea with lemon and honey.” said the Anglo mom.

On the plus side I received five remedies in two minutes flat. The downside was that I had five set of eyes all waiting for me to choose my “medicine”, potentially declaring one mom the winner. I slowly backed out of the kitchen, and crawled into the guest bed for a snooze.  I would not be taking sides at the moment.

As I was falling asleep I starting thinking that what I had just experienced was Google in action the last several thousands years. A small group of moms sharing, comparing and competing with remedies to keep their families and friends safe. And to be honest, this old fashioned “Google” was so much warmer than the online version.

And it reminds me that healing is a “touch experience”.  As we shoot for high tech solutions to keep us healthy through our tablets and smartphones, as drugs are mailed to our homes, and we conduct office visits by email, that part of the healing is another person putting a hand on your forehead, offering a gentle smile, and telling you its gonna be ok.

Which did I finally choose? The tea with lemon and honey of course.  For that was my mom who offered it up.

Insights 2011 – a recap of all things ILN

Each year, my organization the Innovation Learning Network compiles a “best of” from the previous 365 days. I am thrilled to share this work with you. Highlights include:

  • gamification
  • analogous observation
  • care in 2031
  • a few cool tools for research and group interactions

The PDF is free (and green!); however if you would like a hard copy, you may order it here.


The Paradox of Innovation and Structure

As innovation and design continue to move to the forefront of leaders agendas, the topic of who are the innovators and how do we find and develop them is becoming more and more important. Even more important is the exploration of the organizational structures put in place to foster and sustain them. And here is where the paradox starts to kick in; books, magazines, talks and anecdotes show us that organizational structures often stifle innovation and creativity. At TEDxBerkeley yesterday, several speakers indirectly pointed to this:

  • Carl Bass CEO of Autodesk believes that innovation is the result of individuals….it’s the individuals who break the rules. And create new ones.
  • Tapan Parikh of UC-Berkeley explained that the most innovative ideas came from “the people that no one wanted to talk to, the weird ones…on the edge doing their own thing.”
  • Tiffany Shlain, filmmaker, said it best “innovators need moxie.” For those of you who don’t remember, moxie means “courage and aggressiveness; nerve.” (from Dictionary.com)

Combing these three perspectives: An individual on the edge, doing his or her own thing with moxie. Yes….that’s a great definition for an innovator. The trouble is that that this kind of person doesn’t fit most organizational structures. So if this is the paradox, then we need paradoxical structures. Structures that open up, rather than contain. Approaches that liberate, rather than corral. Direction that is intentionally wide and blurry, rather than unintentionally narrow and clear.

These paradoxical structures of course would not fit well for an entire organization (I have no proof, maybe it would!) but for the creatives, the innovators, and the moxi-fied weirds big organizations could be their home.

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