Scaling, Spreading - Ning

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Supplies” or “Gremlin” under the category “Fictional Characters.” What I love about this game is that it rewar
annual mashup of all things ®

Insights Vol.7

Scaling, Spreading, Play & Art

From the big healthcare challenges of scale, spread & sustainability, to the lighter side of design and art

Table of Contents

Photo Credit: Tim Rawson

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Message From the Director A friendly welcome to our 7th volume of ILN Insights.

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About the ILN The people and organizations that make it all possible.

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The Art of the ILN A visual interpretation of the year’s innovation themes by ILN artists.

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How (Some) Board Games Can Help Us Be (More) Innovative It’s time to dust off those brainteasing board games and grab a colleague because research shows that investing a little time “playing” before brainstorming, can pay dividends later. By Barry Kudrowitz

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A Simple Innovation Story See how Kaiser Permanente and CIMIT collaborated to spread a “just in time” innovation for an annual innovation challenge.

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Collaborative Pilot Aims to Help Innovator, Implementer and User A multi-organization innovation project that is yielding invaluable, practical feeback and tips for collaborators. By Margaret Laws

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Going Big in Healthcare An innovation without impact is really just an idea (and likely a waste of resources). The true value of an innovation lies in the ability to scale, spread and ultimately sustain a newly operationalized innovation. These three healthcare organizations have proven time and again, their ability to do just that.

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Cultural Probes Gaining a fresh look at a stale topic. By Mary Katica & Laura Janisse

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Integrating Design Thinking and Medicine Improving outcomes and HIV screening rates for women veterans through design. By Havens, Bailey, Geppert & Gregory

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From Dry to Dynamic Introducing a little playfulness to help sharing nurse research and innovation more effective. By Jodeena M. Kepnich

By Carleen Hawn

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Experiencing Innovation Kaiser Permanente’s Leading Innovation Game The power of immersive, collaborative play helps illustrate the complexity of the innovation lifecycle.

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Seven Visual Insights of Social Determinants Examining health through a visual lens helps to illuminate bigger, underlying social issues. This visual exploration helps us to “see the forest for the trees.” By Ted Eytan, MD

By Deanna Konrath

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Creating Care Coordination Teams Out of Spare Parts Sometimes all you need is a pain point, and some existing pieces to do great things. By Lyle Berkowitz

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Silos to Stories When you’re looking to spread innovation and strengthen ties across a system, it’s amazing how far a digital facelift and some powerful stories can get you. By Beth Gibbs

Insights Vol. 7  3 

Message from the Director

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elcome to the all new ILN Insights. When we first released the original Insights back in 2007 it was a simple (and massive) PowerPoint deck. A few years later we moved to the super cool, super hip visual booklets. And again, a few years later, we decided to really change it up. The new style is more magazine-like with bigger pages, and more member-driven content. And we tapped into the artistry of the ILN by having ILNers contribute art pieces that reflect our 2012 themes. And so, in the spirit of prototyping, we hope you enjoy this next iteration. Aside from developing this new format, a whole lot more went down in 2012: The ILN evolved. We added our associated Safety Net organizations into the ILN. And to date we have seven of these important organizations under our umbrella. We are sure that they will add new challenges for us to tackle, and will expand our view of what innovation is. The ILN grew. We added five new organizations: Center for Health Design, Military Health System, Michigan Health Hospital Association, MedStar, Carolinas Healthcare, and Banner Health. And we had one very special partnership with the Institute for Healthcare Improvement (IHI). The ILN played. In May, we convened at Henry Ford Health System in Detroit to explore the intersection of design and play. The masterful Barry Kudrowitz helped us understand the direct connection between being playful and the creativeness of ideas. The ILN spread. In October, we convened at the National Health Service (NHS) in Coventry, England where the NHS, IHI, and Kaiser Permanente led a deep exploration of spread, scale and sustainability for innovation. The year ahead of us promises to be exciting and turbulent. If ever there was a time that innovation and design are needed, it’s now. And I am so grateful that you are on this journey with us. Yours in innovation,

Chris McCarthy Director, ILN

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Photo Credit: Eric Santos

Insights Vol. 7  5 

About the ILN

Photo Credit: Ted Eytan

We’re seven years old with all the playfulness, curiosity and creativity that goes along with the age.

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he Innovation Learning Network (ILN) brings together the most innovative healthcare organizations to share promising solutions across our systems, to explore and evolve the methods of innovation, and to foster collaborative friendships among our many and talented people.

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The Innovation Learning Network

About the ILN

members 2012-2013

BOSTON HE ALTH CARE for the HOMELESS PROGRAM

Health Plan Alliance A Health Ministry of the United Methodist Church Kansas West Conference

Health plans, hospitals and physicians working together

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About the ILN

Our Members

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ogether, we challenge the myth of the “lonely innovator ” and the “lone genius.” We see the enormity of challenges faced by healthcare and know that such complexity cannot be tackled by one organization. We are a self-organized, international network of nurses, doctors, hospital administrators, technologists, designers and “misbehavers.” We rely on the gusto, leadership and passion of our members to help drive the network towards its purpose of sharing and spreading innovation. Here are a handful of the people who help guide and organize the ILN in an “official” capacity.

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About the ILN

Governance Board Members of the Governance Board are not only ILN sponsors, but also take on the added responsibility of guiding, nurturing and developing ILN strategy and direction. They meet throughout the year with the ILN team to pick their brain, stretch their thinking, and offer valuable insight.

Sponsors Sponsors are champions of change, innovation and design in their organizations. They tackle healthcare transformation and utilize the ILN both as a platform and a sounding board to support and augment their own organization’s innovation initiatives.

Network Weavers Network Weavers are the hubs of our network. By pairing up their vast connections and techniques like smartnetworking, Weavers help to facilitate the flow of information between their organization and the ILN. They scan the horizon for transformational designs and create connections that optimize knowledge transfer across systems.

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Article Title

“Pi In The Sky”

Art b y: B en Davis (aka I shky)

World’s largest ephemeral installation appeared above the San Francisco Bay Area on Sept. 12, 2012. Ben shared his art with the ILN during a sharing session earlier in the year. Learn more here: http://ishky.com/pi

The ArT of the ILN Photo Credit: Bradley Bozarth

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Article Title

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ince the ILN started in 2007, we’ve celebrated the creativity of the innovator through Virtual Thursdays, Galleries of Innovation, design sessions and BrownBags. We’ve told you to create inspiring environments to do your work. We’ve told you to draw your ideas instead of just talking about them. And so we push ourselves even further down the artist’s path. In an open invitation, we asked our peers to create works that represent play or spread, our themes for the year. We were not disappointed. The art featured throughout Insights Volume 7 creates just the right ambience for the magazine. We hope you will consider it just as you consider the written word.

Insights Vol. 7  11 

Photo credit: Tim Rawson

How board games can help us innovative be 12  Insights Vol. 7

Move over “family game night.” It’s time to dust off those brain-teasing board games and grab a colleague because research shows that investing a little time “playing” before brainstorming, can pay dividends later. By Ba r ry Ku d row itz

How (Some) Board Games Can Help Us Be (More) Innovative

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familiar with this concept, it is a nonlinear way of organizing, visualizing, and/or generating ideas.6 A mind map typically takes the form of a diagram involving words and graphics that branch out radially from a central concept. In this case, the central concept is a toaster and the player is making associations around it such as bread, kitchen, breakfast, heating, etc. The creative challenge for Player 1 is to broaden his mind map to find closely associated words that are not the ones on the card. Taboo Meanwhile, Player 2 is engaging in a The game Taboo is about getting your very different creative process: convergent partner to say a certain keyword without thinking. Player 2 is hearing a string of using a list of words that are commonly seemingly unrelated words and phrases associated with it. For example, Player 1 (such as “food pops out of it,” “don’t would try to get Player 2 to say the word put it in the bathtub,” and “it browns “toaster” without using the words “bread,” items”) and is trying to find the word that “appliance,” and “heat.” connects them all. Although Player 2 is At first glance, you might not see how this not aware of this, she is taking part in a variation of a classic test of creativity called the Remote Associates Test (RAT). The RAT involves finding a connective link between a set of three seemingly unrelated words that have a mutually remote association.7 An example of a set of words could be: tap rain floor. The challenge is to find a word that Figure 1. A basic mind map for a toaster showing how thoughts can diverge around a central concept. can be paired with any is creative, but it actually hits on some major of these three words in the set. For this creative thought processes. Player 1, in this given example, the word “dance” is an case, is engaging in divergent thinking. This appropriate solution as in “tap dance,” person is trying to envision everything that “rain dance,” and “dance floor.” can possibly be related to toasters; he is making a mind map. For those who are not lay allows us to escape reality for a short time. It is a safe bubble in which we pretend, imagine, and create. It allows us to say and do things that we don’t typically say and do. It’s no wonder that many studies have found that playing makes people more creative. 1, 2, 3, 4, 5, 6 Below I analyze a few popular board games to demonstrate how their game play encourages innovative thinking.

Illustrations by Barry Kurdowitz

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How (Some) Board Games Can Help Us Be (More) Innovative

Apples to Apples The game of Apples to Apples is about choosing a noun from a set of noun cards that best describes an adjective chosen by another player. For example Player 1 could be holding a hand of noun cards that includes things like “beauty pageant,” “the World’s fair,” and “Frankenstein’s monster.” If Player 2 turns over an adjective card that read “scary,” Player 1 would then choose a noun Figure 2. The remoteness of an association plays a role in the perception of creativity and humor. A very close association will be obvious and thus not creative or humorous. A very distant association will be confusing. A creative or humorous response will card from his set that he typically have a non-obvious connection that is neither too distant nor too obvious to the audience, which results in an “Aha!” or believes Player 2 would “Haha!” moment. It is possible for a very distant/no connection association to illicit humor. This could be a result of expecting a resolution and not finding one or finding humor in nonsense. find most appropriately described as “scary.” conclusions about Player 2 based on The heart of this whatever small observations he can game is the ability to empathize with make such as prior conversations, her other people. For those in the design personality, her dress, or her responses industry, you may already be aware of in the game. Is she the type of person how important empathy is for creating that would be against beauty pageants? successful products and services. Is she interested in classic horror Designers have to understand their literature? Is she afraid of large crowds? potential users; they need to tap into “For This game also involves a skillset the emotional and physical needs and where creativity and humor overlap: desires of their target audience. This something to the ability to quickly find connections typically involves extensive ethnographic be creative between seemingly unrelated things. In research and observation. In the case the realm of innovation this is called of Apples to Apples, players who know or funny, it the Associative Theory of Creativity each other well have a vast knowledge 7 needs to be of each other’s preferences and opinions. , in the realm of comedy this is called 8 the Incongruity Theory of Humor . The game gets more challenging when For something to be creative or funny, it unexpected the players are not well acquainted. needs to be unexpected but still make In the aforementioned example, but still make sense, in other words the association has where Player 2 reveals the “scary” sense..." to be distant enough to be non-obvious adjective card, Player 1 must draw

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How (Some) Board Games Can Help Us Be (More) Innovative

still appropriate for the given categories. If any but not so distant that it is confusing. In this two players have written the same response to a example, when looking at a hand of noun cards, Player 1 is searching for any connections between category, those responses are invalidated. In an idea generation session, the first ideas we these nouns and the word “scary.” In addition to trying to empathize with Player 2, Player 1 is think of for a given prompt/problem are typically likely trying to find a connection that is not too going to be the same ideas everyone thinks of distant, but also not too obvious. A noun card that first, and thus not novel nor creative. If you says “horror movies” might be too obvious of a ask a group of people to associate on the word play and therefore not creative, while a noun card “green” the majority of people will say “grass”.10 Scattergories discourages players from writing like “pigeons” might be too distantly associated and therefore confusing. A noun like “Spice Girls” “elephant” or “eagle” for “Animals that start with the letter E.” Instead the game pushes players or “dirty diaper” may have moderate levels of association with “scary” to be deemed creative to think of the less common, more novel “egret,” and/or humorous. “emu,” and “earthworm.” In Scattergories the player with the most unique responses is the winner. It turns out that in the real world, the people with the most unique Scattergories In the game of Scattergories players are given a time limit and a random letter of the alphabet and must come up with unique examples of items beginning with that letter that fit into a set of given categories. For example, if the letter for the round was “G,” Player 1 could write “Glue stick” under the category “School Supplies” or “Gremlin” under the category “Fictional Characters.” What I love about this game is that it rewards two important elements of creative thinking: quantity and novelty. Many researchers define creativity as a combination of novelty and a secondary quality measure such as usefulness or appropriateness.7, 9 Novelty and Appropriateness are exactly how to score points in Scattergories. To win, players try to have the most responses that are Figure 3. This is a visualization of the popularity of “animals that start with E” as represented by a Google search webpage result count. The head of the graph are likely the common responses that most people think of first. novel to the group, but are also The “long tail” is populated by a long series of less common items, which represents the more novel, creative responses.

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How (Some) Board Games Can Help Us Be (More) Innovative

responses are also winners. In my research, I have found that the ability to quickly come up with many ideas, is strongly correlated (r2=.82) with having many creative ideas.11 There are some speculations on why this might be. One theory is that people who are coming up with many ideas are bounding through the common thoughts allowing them to move on to the less common ones. Another theory is that people who come up with lots of ideas are less inhibited in their thought process and therefore the ideas they come up with are going to be less restrained. A final thought is that people who are good at making associations are going to come up with lots of ideas as well as lots of non-obvious associations. In any case, having lots of idea alternatives to choose from is bonus. As Emile Chartier said “nothing is more dangerous than an idea when it is the only one you have.” E.B. White quoted “Humor can be dissected, as a frog can, but the thing dies in the process and the innards are discouraging to any but the pure scientific mind.”12 I hope that I have not killed your love of these classic games, but rather inspired you to play them again with a new perspective. Note These games (Taboo, Apples to Apples and Scattergories) have all received the Mensa Select award, which is given each year to five board games that are “original, challenging, and well designed.”

“Nothing is more dangerous than an idea when it is the only one you have."

References 1. Dansky, J.L. and Silverman. I.W., Effects of Play on Associative Fluency in Preschool-Aged Children. Developmental Psychology, 1973. 9(1): p. 38-43. 2. Lieberman, J.N., Playfulness: Its Relationship to Imagination and Creativity. 1977: Academic Press Inc. 3. Isen, A.M., K.A. Daubman, and G.P. Nowicki, Positive Affect Facilitates Creative Problem-Solving. Journal of Personality and Social Psychology, 1987. 52(6): p. 1122-1131. 4. Berretta, S. and G. Privette, Influence of Play on Creative-Thinking. Perceptual and Motor Skills, 1990. 71(2): p. 659-666. 5. Russ, S., Affect and Creativity: the Role of Affect and Play in the Creative Process. 1993, Hillsdale, NJ: Lawrence Erlbaum Associates. Wyver SR and Spence SH. 1999. Play and divergent problem solving: Evidence supporting a reciprocal relationship. Early Education and Development, 10(4): 419 – 444 6. Buzan, T. and B. Buzan, The mind map book : how to use radiant thinking to maximize your brain’s untapped potential. 1993, New York: Plume. 320 p. 7. Mednick, S.A., The associative basis of the creative process. Psychol Rev, 1962. 69: p. 220-32. 8. Keith-Spiegel, P., Early Conceptions of Humor: Varieties and Issues, in The Psychology of Humor, J.H. Goldstein and P.E. McGhee, Editors. 1972, Academic Press: New York. p. 4-39. 9. Dean, D.L., et al., Identifying quality, novel, and creative ideas: Constructs and scales for idea evaluation. Journal of the Association for Information Systems, 2006. 7(10): p. 646-698. 10. Johnson, S. (2010) Where Good Ideas Come From: The Natural History of Innovation. Riverhead Books. 11. Kudrowitz, Barry and Wallace, David. “Assessing the Quality of Ideas from Prolific, Early Stage Product Ideation.” Journal of Engineering Design: Special Issue on Design Creativity. Jan 2012.  In Press 12. White, E.B. and K.S.A. White, A subtreasury of American humor. 1941, New York,: CowardMcCann. xxxii p., 2 l., 3-814 p.

Barry Kudrowitz, Ph.D. Prof. Product Design University of Minnesota Minneapolis, Minnesota, USA

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ILN ART

“Play, You Can”

Art b y Rho nd a Mo ntalvo

This piece entitled “Play, You Can” was inspired by the creativity that comes from “Canstruction,” a philanthropic art movement to raise awareness and funds to feed the hungry. I was eager to try it for myself. The results pleased me and I am thrilled that I can share. Once the piece was complete and photographed, I donated the food to our local food bank.

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Article Title

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SIMPLE INNOVATION STORY

This is a story of “proudly found elsewhere,” and a great collaboration that feels like playing, while developing a powerful tool that will facilitate innovation. It is also a story of how powerful the ILN can be, connecting groups with great synergies and highlighting the potential for collaboration. And, through collaboration, we have the potential to create something better than if it had been done alone. In a last-minute development, we’ve even had a bit of innovation spread (far earlier than anticipated).

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Launched by Kaiser Permanente's Information Technology group in 2008 to provide a space and resources for experimentation with health IT. Internal Kaiser Permanente employees and physicians are eligible to apply for funding and support to test out their innovative IT ideas. While we accept ideas from all disciplines, in 2011, the Fund began hosting Innovation Challenges, focusing innovators on top strategic opportunities for the organization.

Article Title

Kaiser Permanente & CIMIT CoLab meet: the power of social networking coupled with a powerful idea management platform.

Kaiser Permanente & CoLab determine that a product could be ready for testing within three months; just in time for the Kaiser Permanente Innovation Fund Challenge.

CoLab, “We’ve done a comparison CIMIT’s functionality with Kaiser Permanente’s requirements... Looks like they will just need a few customizations... we think we can make it happen.”

Wow, those past three months have flown by! Weekly meetings have helped prepare CoLab for Kaiser Permanente’s use. We are ready to go live with the pilot. We won’t need full integration with IdeaBook (KP internal social media platform) and folks may have some trouble with registering but it shouldn’t be too daunting. We are building out the workflows for each stage as we get there.

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Kaiser Permanente:

A non-profit consortium of Boston's leading teaching hospitals and universities, CIMIT fosters interdisciplinary collaboration among world-class experts in translational research, medicine, science and engineering, in concert with industry, foundations and government, to rapidly improve patient care.

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Collaborative Pilot Aims to Help Innovator, Implementer and User A multi-organization innovation project that is yielding invaluable, practical feedback and tips for collaborators. By Ma rga r et Laws

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Collaborative Pilot Aims to Help Innovator, Implementer and User

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"there is a real shortage of practical feedback for innovators who need to test their solutions, and for delivery systems that want to become launch pads for innovation."

ately it’s impossible to read the news without seeing a story about innovation in healthcare. At the same time, there is a real shortage of practical feedback for innovators who need to test their solutions, and for delivery systems that want to become launch pads for innovation. Dignity Health, the nation’s fifth-largest hospital system, and Asthmapolis, a health care innovator, are helping to fill this gap with an unusual collaboration. Dignity’s Woodland Healthcare campus and Mercy Medical Group in Sacramento are currently hosting a pilot of the Asthmapolis sensor system. The health system’s aim is to help adults and children with asthma to better manage their disease (see below). Photo Credit: Rebecca Nguyen

The Asthmapolis sensor, attached to a metered dose inhaler, works with a mobile phone app to record when the inhaler is used. The purpose is to improve patients’ awareness of triggers, patterns in symptoms, and current level of disease control. The sensor data also gives physicians the ability to quickly identify how patients are doing and take steps to help them get their asthma under control.

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Collaborative Pilot Aims to Help Innovator, Implementer and User

Following are some early insights from the collaborative pilot:

By understanding the full context of the challenge, one can more precisely design/choose a solution., and the chances go up that your design/choice will be more right.

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It’s All About the Problem. Pilots are designed to determine if a product or intervention solves a real problem, so the pilot should occur where a real problem exists. The Asthma and Allergy Foundation of America (AAFA) rates the Sacramento area as one of the most challenging cities to live with asthma, with worse than average air quality. So it is not surprising that Dignity Health found many patients in their service area did not have their asthma under control and traditional approaches to selfmanagement weren’t working. Dignity leaders spent time developing a deep understanding of the drivers and barriers to solving this complex problem. After a careful scan of product and processbased approaches, they decided to pilot the Asthmapolis sensor system. From the very beginning, Dignity has valued the Asthmapolis system and agreed to become a customer should the pilot succeed.

Choose Strong Strategic Partners. To understand how an innovation might be funded, commercialized, adopted, and eventually scaled requires the right constellation of partners. The Asthmapolis pilot benefits from the collaboration of three strategic partners taking distinct roles: • Implementation – Dignity Health integrated the Asthmapolis pilot into their comprehensive, integrated clinical care model. • Innovation - Asthmapolis provided the solution and technical information about the product. • Support and research – The California HealthCare Foundation provided grant funding to the pilot as well as an independent evaluator who will assess the success of pilot and communicate findings to the field.

Collaborative Pilot Aims to Help Innovator, Implementer and User

Agree On What Success Will Look Like. It’s important to develop a clear understanding of the elements that define success for a pilot. Dignity’s integrated clinical care model seeks to improve the lives of patients with chronic disease by reducing cost, expanding access, and improving quality of care – three goals that helped define success for the pilot.

"To understand how an innovation might be funded, commercialized, adopted, and eventually scaled requires the right constellation of partners."

Make the Bench as Deep and Wide as You Need.

Consider life after the pilot. The Asthmapolis pilot is designed as a controlled study that will produce publishable results from a rigorous economic evaluation of the technology. This means others will benefit from the experiment and its insights. In addition, the pilot could lead to the uptake of Asthmapolis technology throughout the Dignity system and shape the way it evaluates innovations in the future.

Successful pilots rely on teamwork, but it’s important to gather the right people from the start and to allow the group to evolve as needs change. So far, the Asthmapolis pilot has involved a wide range of participants from Dignity, including lead physician project investigators at each facility, a project coordinator, and an IT manager. Dignity’s corporate finance and legal departments have also been called upon, as have communication and regulatory experts at both the regional and local levels.

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Collaborative Pilot Aims to Help Innovator, Implementer and User

Don’t let this happen to you. When world-renowned violinist Joshua Bell played in a D.C. subway station, swarms of busy commuters just didn’t notice. Like them, your colleagues won’t instantly perceive the importance of your pilot and therefore won’t automatically give it the attention it must have to succeed. You need to tell people why they should care, which typically means pointing out what’s in it for them. The Asthmapolis pilot at Dignity Health paid a great deal of attention to promoting the benefits of participation. This has been the key to recruiting both patients and providers. Since these two groups have different educational needs, the team was careful to develop materials unique to each audience.

"It's generally better to be disciplined with your priorities and flexible with your schedule - rather than the reverse.

And finally… All pilots face many hurdles along the way. When something has to give, it’s generally better to be disciplined with your priorities and flexible with your schedule – rather than the reverse. Despite the challenges, managing a pilot is exciting and critical work. Without this first “learning” step in any ambitious endeavor, a slight miscalculation in strategy can be amplified later on when the stakes are higher. The lessons that emerge from a well-defined and carefully run pilot may well lead to significant successes down the road—not just for the specific initiative at hand, but for the organization to enhance its credentials and expertise as a launching pad for innovation.

Margaret Laws, MPP Dir. Innovations for the Underserved Program California HealthCare Foundation Oakland, California, USA

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ILN ART

“Connecting the Dots” Art b y D e anna H arve y

Connecting the Dots was inspired by the question: When we use food to reward staff for jobs well-done, how do we help them connect the dots about why they are receiving the food? So often, leaders order food and have it delivered to reward staff. However, there is no communication about why the food is being delivered, what is being recognized. By putting the picture on the cake, we help staff to connect the dots between the job well-done and the reward.

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BIG Going

in Healthcare

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Illustration by Tim Rawson

An innovation without impact is really just an idea. The true value of an innovation lies in the ability to scale, spread and ultimately sustain a newly operationalized innovation. These three healthcare organizations have proven time and again, their ability to do just that. By Ca r leen H aw n

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Going Big in Healthcare

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Although their motivations are similar making health care delivery dramatically more cost-efficient while preserving or improving quality - their strategies differ markedly.

ltimately, for an innovation to succeed, it must scale. That is the platform on which three major health care organizations, Partners HealthCare, Mayo Clinic, and Kaiser Permanente, have built their innovation programs. Although their motivations are similar—making health care delivery dramatically more cost-efficient while preserving or improving quality— their strategies differ markedly. Their stories illustrate several routes to remarkable successes, but also many challenges discovered the hard way. All of the companies have found that few innovations survive in the marketplace. Even ones that make it through pilot testing may not succeed outside the carefully controlled environment of the testing phase. To raise the chances of bringing a steady stream of technical advances, process improvements, and business model innovations successfully through the pipeline, these companies have put considerable resources into creating and maintaining an infrastructure specific to the requirements of continuous innovation. A key principle adhered to by all of these institutions is that preparing an innovation for scale is not a distinct task to be undertaken after an idea has been successfully piloted. Instead, potential scalability must be assessed at the very beginning of the process, as a determinant of whether the innovation will be pursued in the first place. Here are thumbnail sketches of the innovation work at each of the organizations.

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Going Big in Healthcare

Photo Credit: J. Kiely Jr. / Lightchaser Photography & Consulting

The Center’s Message Connect platform allows clinicians and their practices to send customized messages to patients.

The Center’s Connected Cardiac Care program provides remote monitoring services for heart failure patients at risk for hospitalization.

Embedding the Customer at Partners HealthCare Partners HealthCare, a nonprofit consortium with 12 hospitals and clinics in the Boston area, set up its Center for Connected Health in 1995. Its purpose is to promote technology-enabled innovations to create behavior change, generate efficiencies and improve the quality of patient care. The Center focuses on finding innovations that empower patients and providers to transform care. Many of their programs address wellness and chronic disease management, such as heart failure, hypertension, and diabetes— all ripe for IT innovation using new kinds of remote monitoring tools. The Center has created several successful programs, currently being implemented in Partners HealthCare’s provider network, applying technology to improve patient health.

Based on the Center’s technology platform, a personalized health technology company was launched, offering products that incorporate personalized goal setting, health journey maps with gaming dynamics, timely biometric feedback and interactive digital coaching. The Center initially tested the technology in a clinical trial, partnering with a local company, to test a remote monitoring program for 400 workers with hypertension who volunteered to try it out. The results were impressive enough that the solution was developed into a company that is thriving on its own. This experience solidified the Center’s model for innovation: 1. Embed the customer in the project from the very beginning. 2. Conduct research studies in ‘real world’ and remote patient settings, to create and validate connected health solutions that will move healthcare forward to be more.

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Going Big in Healthcare

It's all about the fit at Mayo Clinic Mayo Clinic of Rochester, Minnesota, has been innovating since its inception in 1889. It now has 70 clinics and hospitals in three states, with 56,000 employees serving more than 1 million patients each year. Mayo has built the capacity for innovation into its structure. It has at least four distinct operating units dedicated to converting its creativity into new tools, processes, and businesses. The newest of these is Mayo’s Office of Business Development, which receives dozens of business ideas on a weekly basis. About 10 percent warrant a thorough examination and about two result in the development of a business plan for

commercialization. The Business Development discipline has four stages: Stage 1: The “fit” stage. Projects are vetted for their alignment with Mayo’s mission and likelihood of success—the 8-Point Test: Does the project align with Mayo’s core values and strategic plans? • Does it add value to the Mayo brand? • Does it leverage core resources and capabilities? • Does it provide a competitive advantage? • Can Mayo mitigate the risks of failure? • Will it deliver good financial returns? • Will it deliver good educational returns? • Is it scalable? Stage 2: The business planning stage. A business case and financial model are drafted and put to a review board for approval. Stage 3: The execution stage. A strategy is formulated for delivering the innovation to market. Stage 4: The performance stage. A project pilot that is established is maintained, and then prepared for replication in other markets. Even then, there can be surprises, a Mayo executive warned. “The failure happens almost always during the hand-off….Much of the knowledge for how a project works or fits into a big picture has not been expressed or understood, so ‘project memory’ gets lost.”

Photo Courtesy of the Mayo Clinic

Going Big in Healthcare

Step-wise Innovating at Kaiser Permanente Kaiser Permanente is the largest integrated health care organization in the country, with a for-profit medical group, a nonprofit health plan, and a nonprofit hospital system with 37 medical centers. Kaiser Permanente’s large infrastructure enables it to test and attempt to scale almost any innovation within the safety of its own organizations. It maintains a number of operating units dedicated to identifying and testing innovations. The Innovation and Advanced Technologies division—focused on IT ideas— harnesses employee creativity. The division has its own capital fund, the Innovation Fund for Technology, which it uses to make seed investments in ideas proposed by employees. The funds examines some 150 proposals annually, Above: Innovation team describing pre-gamification tool workflow to assess pediatric patients using paper-based tools. Below: Screenshot from Kaiser Permanente-developed, Dr. Hero game depicting clinician interaction with a patient.

funding about 12%. Ideas must pass a four-point test: 1. Expert vetting. The board consults subject matter experts within Kaiser Permanente to assess the merit of the idea. 2. Commercial scan. The board conducts a “commercial scan” to determine if Kaiser Permanente can purchase a product or service similar to the proposed project in the open market. 3. Resource review. The board reviews whether the proposed tool or service latently exists in any of Kaiser Permanente’s existing resources. 4. Novelty test. Is the idea really new? The board does an internal review of similar innovation projects that are already underway elsewhere inside Kaiser Permanente. An internal network, called IdeaBook, enables employees to “crowd source” information. Once a successful innovation is established within a hospital, it may scale to a region or to several regions. …

More on Scaling-Up This is just a taste of the lessons learned from the Partners, Mayo, and Kaiser Permanente initiatives to embed innovation in their operational DNA. Much more can be found at: http://www.chcf.org/scaleinnovation

Carleen Hawn Photos Courtesy of Kaiser Permanente Innovation and Advanced Technology

Founder Healthspottr.com San Francisco, California, USA

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Experiencing Innovation Kaiser Permanente's Leading Innovation Game The power of immersive, collaborative play helps illustrate the complexity of the innovation lifecycle. By D ea n n a Ko n rath

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Photo Credit: Manny Darden

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wo hours into brainstorming “innovation retreat” ideas, we had our first ‘aha’ moment: could we create an immersive experience exploring the innovation cycle before embarking on an innovation project? Understanding the full innovation life cycle has been a complaint we were hearing from leaders, innovators and implementers alike. Innovators are asking why no one understands how their ideas can make an impact. At the same time, leaders cannot figure out why ideas that have been successfully prototyped are not spreading fast enough, or at all. We wanted to design an immersive experience that would be engaging and shift the conversation we were hearing — shifting from “I don’t know how” to “how might we?”

Immersion: The state of being deeply engaged or involved; absorption. How did we get the idea of creating an immersive experience? By stealing and building off another idea! One of our fellow brainstormers had participated in a poverty immersion exercise, and they raved about taking on a persona and experiencing for two hours, a day in the life of someone struggling with everyday poverty issues. Participants, regardless of role or leadership

level in the organization, truly immersed themselves in that persona’s experience. This created deeper empathy and resulted in more strategic conversations about better supporting the persona’s needs. And so began our journey to design something that would allow leaders and innovators to step into a persona and experience what it’s really like to move through the innovation lifecycle – from initiation through ideation, prototyping, operationalizing, even spread – and discuss

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“I was initially skeptical that a 90 minute session would lend to their learning. By games end, participants were engaged and more informed of the life cycle of the innovation process than before. I was most impressed in watching that transformation and delighted to field requests for more exposure.” - Sally Butler Organization Effectiveness Game Facilitator, Kaiser Permanente

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“It was engaging and a fun way to understand the questions, issues and concerns to have in mind when implementing a new change or innovation. There was a lot of laughter trying to figure out the game and act out our assigned personas.” - Kristene Cristobal Director, Clinical & Operational Improvement Center for Health System Performance, Care Management Institute Kaiser Permanente

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Case Stories Labor Management Partnership

In Kaiser Permanente-Northern California, the Labor Management Partnership held a game day for their employees to experience innovation and work in partnership to advance their innovation. By influencing their “sponsors,” they practiced that fine art of negotiating for needed resources and support. Based on the success of this day, for the next round, some of the content of the game will be adapted to better reflect this audience’s frame of reference. Takeaway: The game can be adjusted to meet different needs. Modify the content or how the game is facilitated to make it most relevant to your team’s situation. Focus on the elements that will be of most benefit, in this case influencing sponsorship.

Performance Management Institute

Used by Kaiser Permanente’s Performance Management Institute, the Innovation Game has been used twice for their Advanced Institute sessions. This is a deeper Performance Improvement training for Improvement Advisor graduates of the Improvement Institute, and is used during their four-hour Change Management sessions as part of their certification. Takeaway: Including the game into a larger learning program can reinforce skill building and desired behaviors, in this case, recognizing impact of innovation and change on people.

Finance Leadership Challenge

The leadership of Kaiser Permanente’s Finance team came together to play the Leading Innovation® Game as a way to cultivate their understanding of the future of the organization through innovation. Takeaway: Integrating the game into a leadership forum opens the conversation about how leaders can create and support an environment that is open to innovation, risk taking and change.

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operationalizing, even spread – and discuss more strategically what to do differently. Ultimately, we iterated our way into a fully contained immersive board game that helps leaders, innovators and teams experience the challenges of successfully leading innovation and change. You could say that we “gamified” the innovation lifecycle. And by creating a safe space to explore and examine innovation from different points of view through collaborative “play,” teams are able to generate more meaningful insights, take smarter risks, and test out different strategies. How does the game create that immersive experience for participants? Imagine you are at a team offsite or a project kick-off, sitting with six other colleagues you may or may not know. You open up the Leading Innovation® Game box and pull out the different game components. Your first step as a team is to select a persona and introduce your “personified” self to the team. You might be the project manager, the healthcare provider, the innovator, the patient or another role. It is important to select a persona different from your day-to-day work life. You will walk in your persona’s shoes for the remainder of the game, and advocate for their values and beliefs. You are now ready to plan as a team, which means you get to negotiate, debate, plea and cajole for what you believe you will need to be successful. As a team you will review your Innovation Challenge,

Experiencing Innovation: Kaiser Permanente’s Leading Innovation Game

How has the game been used? The overall timeframe to complete these elements of the game is roughly 60-90 minutes depending on how deep the teams wish to go and how much time is allocated. Teams can customize the game to better fit the context of the work or roles they play — this includes the challenge that a real world they solve to, the persona roles, even scenario that requires the reality check cards themselves. your team to design and But once play is complete, the team implement innovative solutions. debrief is critical to making this With limited time and resources experience real. This can be 30 to 90 (as with real life), in teams, you will minutes, open format based on the debate, prioritize, debate again team’s challenges or formalized to and finally select which Innovation support a particular goal. Strategy Cards to incorporate Since initially prototyping the game into your plan, knowing you will at the 2011 Innovation Retreat, we not be able to include all elements. have continued to spread and gather Partner Cards are then selected, stories on how the game is being requiring tough choices for creating utilized in a variety of ways. The an extended project team — those “Case Stories” section to the left critical partners and stakeholders highlights a few of those successes. that allow you to navigate through Applying gamification to the the challenges ahead. innovation lifecycle has created more powerful and engaging ways What comes after playing the for leaders, innovators and teams to game? understand the innovation lifecycle Now you are ready to play out and navigate its ups and downs. The your innovation: As your team power of collaborative play continues moves through the innovation to pave the way for increased lifecycle phases from initiation self-reflection and team insights through spread, Reality Check needed drive innovation at Kaiser Cards are drawn that impact your Permanente. innovation’s success (sometimes with positive, negative or neutral consequences). And along the way you will need to pause for Sponsor stops to review your team’s Status Report and reflect on challenges, progress and plan for action.

“We wanted to design an immersive experience that would be engaging and change the conversation we were hearing, shifting from “I don’t know how” to “how might we?”

Deanna Konrath Innovation Design Manager, Garfield Innovation Center Kaiser Permanente San Leandro, California, USA

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Creating Care Coordination Teams out of

SPARE Part s

Sometimes all you need is a pain point, and some existing pieces to do great things. By Lyle B er kow itz, M D Photo Credit: Thinkstock Images / Photos.com

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t started with increasing complaints from our doctors that they were getting paged a few times a week by radiology: “Your patient is here for an MRI, and we need an order - can you fax it?” Our docs were saying “I don’t have time for this, and I know I handed the patient the order when he was here last week… why couldn’t he remember to bring it in?” To fix this problem, we focused on the often overlooked mission - making life easier for physicians. Happily, what we wound up with was a system that not only decreased the workload on docs, but also improved the experience for patients, elevated the quality of care, increased revenue for the hospital and saved money for patients all at the same time!

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Creating Care Coordination Teams out of Spare Parts

In 2006, Chicago-based, Northwestern Memorial Physicians Group (NMPG) started the process of fixing a long-term problem around ordering radiology tests. The process created for radiology orders would soon expand to cardiology tests and other orders, as well as consult requests. Combining these together allowed us to set up the infrastructure for a more robust care coordination that handles around 3000 orders and consults every month for a group of under 100 physicians. The iterative approach taken, which moved us from an early concept to a realistic system, is a good example of the Plan-Do-Study-Act method so commonly used in these types of projects. Over the course of a

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Baseline

A physician hand-wrote an order on a prescription pad and handed it to the patient so they could call to make the appointment. They additionally had to remember to call the referral team to get authorization and bring the paper form to the test with them as their official order.

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Iteration Three

To ensure proper referral authorization, the offices started faxing the order form to both the NMPG referral department, which obtained prior authorization for testing from payers, and to the hospital scheduling department, which called the patient to schedule the test.

year, our ideas were tested and evolved as outlined below: However, for this care coordination system to succeed, we needed to get physicians to want to use it. Because we made it part of their EMR (electronic medical record) system and because it took away a pain point (getting called by Radiology), there was an easy story to sell. However, consistent education (e.g. emails) and monitoring of usage were still needed. Some doctors picked it up right away, others with low volume scores had to be reminded multiple times. Fortunately, by starting with a high volume and high pain point issue, adoption was easier than if we started with a low volume or low-impact problems.

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Iteration one

Created five different forms based on test type (e.g. CT, MRI, U/S, Plain Film, Other). Physician filled out these forms then had office staff fax the form directly to the hospital, where the radiology scheduling team contacted the patient to schedule the test. Patients were told they still had to call the referral department themselves, but no longer needed to have a paper order when they went for their test.

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Iteration four

The referral department realized they could obtain authorization and then THEY could fax the order to the hospital themselves. So the office staff started only faxing the form once - to the referral department. The referral team would then write out the authorization information on the form and fax it to the hospital scheduling department, who would then call the patient.

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It's important to make sure early attempts are as tangible as possible for discussion, engagement and measurement purposes. remember: fail early to succeed sooner.

Iteration two

NMPG developed a single order form which included all types of tests on a single page to make it easier for physicians and the office to track and use. The physician would fill out this single form, choose the test requested, and the office would still fax to the hospital, but the patient still had to contact the referral department.

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Iteration Five

The ordering physician pulls up the radiology ordering message in the EMR, fills out the requested fields (e.g. reason for test, timing of test), and sends to the referral department. After receiving the message referral teams obtain authorization from the payor and send to the hospital via an EMR fax function. The hospital scheduling department agreed to accept this form, which was electronically authorized version of the form.

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Creating Care Coordination Teams out of Spare Parts Once the radiology ordering solution was completed and in working order, NMPG and Northwestern Memorial Hospital (NMH) realized they could use the same system for other hospital studies, such as cardiology tests (e.g. ECHO, stress exams, holter monitors), and a variety of others (e.g. doppler, pulmonary function tests). We additionally expanded to using the system for referrals to various specialists on campus. Because the infrastructure was in place and because physicians were already comfortable and happy with the radiology ordering system, they readily accepted the expansion of options. The result was a consistent increase in system usage. Currently, the system is used regularly by almost 100 primary care physicians to generate the following monthly volumes: 600 radiology, 1000 mammograms, 350 other types of tests, and 1200 consult requests. We then evolved further by developing the concept of pathways, which applied a “checklist” approach to new clinical conditions, such as a new diagnoses (e.g. cancer, diabetes, hypertension)

or a new finding (e.g. abnormal labs or radiology findings). When using these “Pathway” messages, a doctor would be provided a group of tests, consults, education and follow-up activities all within one template. For example, the Hematuria Pathway was for a new diagnosis of hematuria (blood in the urine). A single message would include orders for a CT scan of the kidneys, a Urology visit after the CT scan, and a one month chart review to ensure completion of everything. Research on this pathway found that a patient would complete everything more quickly, more completely, and cheaper as compared to the status quo. Of importance is to note that this whole care coordination process and team had to be created and sustained with no new budget. We did this by making sure the orders, consults and pathway messages were all very specific, so that the care coordinators did not have to have any special clinical skills to follow the messages being sent to them. In our case, we converted our “referral team” into our “care coordination team” as we found they had the perfect

set of skills needed for this role. First, they knew how to obtain referral authorizations. Second, they were adept at using the EMR for both messaging and data retrieval. Third, they were very comfortable and facile in talking to patients and physicians. Finally, they understood and appreciated the concept of following a structured checklist. These skills made the transition from a basic referral team to a full-fledged care coordination team a seamless transition. In other words, even though the care coordinators were mainly non-clinicians, they could succeed in this type of role because the checklists only required them to follow clear protocols, not make clinical judgments. And while this initially meant the system was “cost-neutral,” we eventually found that we created a significant ROI for our hospital, since we were able to reduce “retro-authorizations” for hospital tests as seen in figure 1. Retroauthorizations means that the team has to contact the insurance company to get special approval if a patient had a test without first getting insurance authorization.

PDSA in Healthcare Originally created by Walter A. Shewhart, the “Shewhart Cycle” was later adapted by Dr. W. Edwards Deming, who is largely considered the “Father of Quality Management”. Deming’s Plan, Do, Study, Act cycle allows you to more safely test out changes (innovations/improvements) on a small scale to measure the impact before larger implementation of a new process or program. Because of these small cycles of learning and less risky trialing, healthcare organizations around the world are embracing this method for change. Visit IHI.org to learn more.

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Creating Care Coordination Teams out of Spare Parts

# of RETRO-Authorizations As one would imagine, this involves extra time for both care coordinators and physicians, and in the end, they are often denied, making for angry patients and/ or a hospital that does not get paid. Since our care coordination system ensured authorizations were completed before the patient set up their tests, the number of retro-authorizations went from over twenty-five a month to under one a month within two years of going live with the initial pilot. The result was that we saved time for our care coordinators and physicians, made patients happier, and increased revenue for the hospital. Everybody wins!

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Figure 1

Spreading the Love: Expanding to Other Practices By proving we can leverage the economies of scale already created by NMPG to serve other medical groups affiliated with our hospital, we believe we will help improve quality and efficiency for all patients we serve. We additionally have found that this new system is self-sustaining in our current “volume-based” reimbursement models, but should thrive even further in future “value-based” reimbursement models, such as accountable care organizations (ACOs). Like many innovations, our care coordination system came from humble origins. What began as

“The result was that we saved time for our care coordinators and physicians, made patients happier, and increased revenue for the hospital.”

a way to transmit a single radiology order evolved into a robust care coordination system which improves efficiency, quality and financial reimbursement across a wide spectrum of care activities. By making sure it solved a physician pain point and by keeping the system easy to use and selfsustainable, we expanded and spread the system across our organizations.

Lyle Berkowitz, MD Assoc. Chief Medical Officer of Innovation Northwestern Memorial Hospital Chicago, Illinois, USA

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Article Title

ILN ART

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“Art Cars”

Art by G eo rge S imo ns

These “art cars” evolve from European Grand Prix racing cars early in the 1900’s. In this example, a 1936 Bugatti Type C. The cars are as much about art as reproduction with liberal interpretation expected; have to be handmade by the owner/driver providing high levels of excitement at 40 MPH and wondering if this thing will indeed stay together; and have to adhere to group guidelines of weight and cost. For the most part, the only purchased components are the motor and wheels and tires. All else is concocted by the owner. Twelve of these cars exist with eight more in the works.

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Article Title

CULTURAL

probes GAINING A FRESH LOOK AT A STALE TOPIC by Mary Katica & Laura Janisse

It was 2 p.m. when we arrived on the fourth floor Medical-Surgical unit. We couldn’t wait to meet Ken*, the

less than two hours to complete, while other kits are designed to live with participants for longer periods of time, sometimes up to a few weeks. Through interpretation and creativity, cultural probes put participants in a position of being active influencers versus passive experiencers. For research teams, they evoke new ways of connecting to participants.

Unique in comparison to traditional “research for design” methods (observations, interviews, etc), cultural probes are a design-driven research technique used to conduct “research through design.” They consist of four to six activities that prompt participants to express their feelings and thoughts about a specific topic. William Gaver, a design professor at the University of London, and his colleagues created the Cultural Probes research technique in 1997 when exploring new interaction techniques and approaches to gain inspiration and knowledge for design projects. Gaver, with a background in experimental psychology, wanted to move from hard science to a position of placing interpretation at the heart of design. Tuuli Mattelmaki, who focused her doctoral dissertation on Cultural Probes, believes there are four key reasons to use cultural probes as a research tool: 1) to get inspired, 2) to gain information, 3) to trigger participation, and 4) to provoke conversation.

Our team uses a diverse mix of research methods in our projects. Some methods, such as observations, interviews and videography, tell us a lot about what people say and do. While other methods, such as cultural probes, tell us a lot about how people think and feel. In a recent project on workplace safety, we decided to use cultural probes as one of our main research tools. We started brainstorming potential activities for RNs, nurses aides, and frontline staff members. As activity ideas emerged, we prototyped them using various form factors and tested them in order to see how people reacted. We know from past experiences that designing activities that are playful, encourage activity, and do not feel intimidating is key. Getting early feedback on the activities helped push the design and ideas further, narrowing down the final set of ideas. After multiple iterations, we ended up with four workplace safety focused activities for our probe kits:

Medical-Surgical RN who designed the intricate six-page pop-up book - the last thing we expected to receive from him. So, what on earth triggered Ken to make a pop-up book? Our cultural probe did.

Included in the kits are supplies, such as colored markers, construction paper, glue, scissors, stickers, camera, audio recorders, and notebooks. Most kits are designed to take

*Ken is a pseudonym, created to protect the identify of the research participant.

1. Safety Top Tracks This activity, designed in the form of a CD case, asked participants to identify two songs they felt best described and represented how they felt about workplace safety.

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A RN proudly stands by her artwork.

“This [probe kit] was fun, and different, I liked it!” A page from Ken’s pop-up book.

2. Hank Magazine Guest Contributor Designed to look like Kaiser Permanente’s frontline staff magazine, this activity invited the participant to create a magazine spread that highlighted their safety story. 3. My body feels, I feel, I think about A worksheet where the participant was asked to fill in a figure of a person with associated questions such as: How do they feel? What do they think about? How does their body feel in regards to safety? 4. Tips of Wisdom A card-set for the participant to write their top three tips around workplace safety to a colleague who was assuming their role. The activities were designed to be engaging to participants and help them reflect upon and respond to our research questions. We packaged the activities into a clear box along with creative supplies (colored markers, stickers, speech bubble stickers, colored paper, foam letters, scissors, tape, and glue sticks) and instructions for how to complete

Workplace Safety cultural probe activity set

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the kit and each activity. In total, we made 20 cultural probe kits for the 20 participants. They were oriented to the activities (either by our team or their managers) and encouraged to complete the kits within one week at home, away from work distractions. Thirty-minute follow-up interviews were scheduled with each participant so that they could walk us through what they had created, and answer some of our follow-up questions. It is now 2:10 p.m. and we are sitting in the unit break room, the space Ken had suggested we meet. We held his completed probe kit on our lap, which included his now-famous pop-up book. He turned in his completed kit to the unit manager a few days earlier, who then in turn passed it to us. We had yet to actually meet Ken. Suddenly, the break room door opened and in walked a short, dark-haired man. He took a seat and quietly introduced himself to us. He was so soft spoken that we asked his name again to confirm it was Ken. It was. He wasn’t anything like we had imagined. We assumed by the expressive, colorful and direct nature of his completed probe activities, he would be a direct reflection of that – confidently articulate, eccentric and straightforward. We pulled out the pop-up book and asked, “Ken, can you tell us about your pop-up?” Without saying a word, Ken gave a big smile and nodded yes. Over the course of the next 30 minutes, Ken walked us through his activities from the kit. He was very shy in nature and it seemed hard for him to make eye contact with us during our time together. Despite his quiet

and reserved nature we learned a lot from Ken and his probe kit activities. Cultural probe kits offer participants safe alternative ways to communicate their thoughts and feelings. And as we saw with Ken, he not only preferred to, but also found it easier to communicate his feelings about workplace safety through the activities versus our in-person conversation. The probe kit gave him the ability to fully (and safely) express himself.

Benefits to using Cultural Probes:

Cultural Probes help researchers to understand more quickly how people think and feel, providing deep insight and inspiration to the project at hand. For Ken, it was clear that the cultural probe helped him communicate in more comfortable ways. For other participants, it may be just a complementary communication style. As researchers, we find cultural probes to be a beneficial technique for the following reasons: Participants move from being passive experiencers to active influencers. You can learn a lot when you put yourself in someone else’s shoes. The “Hank Magazine Guest Contributor” activity gave participants the opportunity to share what they felt the organization should focus on when it came to workplace safety. Although some responses were anchored in safety policies and procedures, many responses were focused on recognizing staff’s efforts around safety. Alternative communication modes

Article Title provoke conversation and sharing of thoughts that otherwise might be missed. How people talked about safety and how they expressed it were different. When we talked to participants about workplace safety, they talked about policies and best practices. However, when we asked participants to share how they felt through the “My body feels, I feel, I think about” activity, they shared more emotionally rooted thoughts – for example, feeling “strong,” “disappointed,” “tired,” and “helps everyone.” Participants have time to connect with and respond to questions being asked. The workplace safety pop-up book, which was a participant’s response to the “Hank Magazine Guest Contributor” activity, is a great example of what time and space can enable. Because the kit is designed to be mobile and participants are encouraged to take the activities home to complete, participants are often more thoughtful in how they respond to the questions being explored. Various types of data can be collected. Because participants are given various ways to communicate, the design team is able to collect a diverse range of information: from a piece of writing, to a visual illustration, to a sound or audio clip. The “Safety Top Tracks” activity resulted in a playlist of song tracks participants identified that reflected how they felt about workplace safety– “Jesus Take the Wheel” and “We are Family” are two tracks from this work. They trigger creativity. Both for the design team as well as for the participants, cultural probes evoke creative freedom. They allow teams to push the boundaries of how to seek out participation, information, and inspiration on research projects. For participants, cultural probes give them the opportunity to respond in creative ways that feel new and engaging.

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Be creative and playful

for trying out Cultural Probes

Designing activities with a playful tone helps participants engage. Here are some ideas: a) Ask questions using metaphors, b) Use various form factors: digital, non-digital, etc, c) Avoid jargon, write in simple terms, and d) Use lots of colors and materials.

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Iteration is key when designing probe activities! It’s typical to start off with a bunch of ideas but end up finalizing only a handful of them. Try to follow this these guidelines: a) Brainstorm 10 activity ideas, b) Go through 3 rounds of iterations for testing/refining, and c) Settle on the 4-6 activities you feel will be most engaging to participants.

Protecting participants’ identity helps them feel comfortable and safe when completing the activities. How to protect them: a) Create a pseudonym to replace their name, b)Tell participants their identity will not be linked back to anything they create (their roles might be, but not their name).

7 Tips

Iterate, iterate, iterate

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Protect your participants

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Provide a supplies

Review with participants

Stock the kit full with various creative tools for participants to use when filling out the activities. It’s important to enable creativity! Try to include some basics: colored markers, paper, stickers, glue, and scissors. Other ideas might include a disposable camera or a journal.

Take time to review the kit, activities, and directions with participants before they start. This ensures the participant understands the nature of the kit and what is expected of them. It also helps that you set the tone. Tip: This could be done over the phone or in-person.

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Conversations you have with participants after they complete their kit is incredibly valuable. As you recruit or arrange for distribution of cultural probe kits, ensure that you also schedule a follow up debrief session. Tip: Best to do this in person, but over the phone or using a webcam can work too.

The artifacts collected from the probe kits are incredibly insightful. Sharing them with others in the organization can be quite powerful, as it’s a new way of understanding and relating to the topic at hand. Try to incorporate the artifacts into presentations and deliverables.

Schedule debrief sessions

Let the artifacts live on

Nurse aides sharing their activities with the team.

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Integrating Design Thinking & Medicine

Design Thinking

Magic

Medicine

Improving Outcomes and Program Sustainability for Women Veterans and HIV Screening By Kayt H av en s, M D / Co r n elia Ba i ley, M D M / A ma n da G eppert, M PH, M D M / J u d ith G r eg o ry, Ph D

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Integrating Design Thinking & Medicine

Why Does "Design Thinking" work so well in Healthcare? Photo Credit: Hans Van der Beele / Photos.com

Background Human immunodeficiency virus (HIV) treatment and detection has changed dramatically over the past 30 years. Today treatment is hopeful. A person infected today and who begins treatment with usually one pill per day can expect to have a normal life. Armed with this amazing new outlook it was our goal to make HIV testing a normal part of routine exams. So when the VA’s rate of testing for women veterans was noted to be lower than for men we saw a great opportunity. And so we began a “design thinking journey.” Let’s look at the women who make up our American veterans. Currently 8% of veterans in the United States are women (2 million). This includes (besides WW2) 7500 women who served in Southeast Asia 1965-75 and over 40,000 women deployed during Operation Desert Shield and Desert Storm 1990-91. Our present active duty military women make 17% of the forces serving in recent wars. In the women’s health clinic at the Zablocki Milwaukee VA we see women of all ages who have served our country in these various capacities.

Design Thinking explicitly approaches challenges from the human experience. It relies on more fully understanding what people feel, think, say and do. Through this understanding, good ideas emerge. The ideas are novel, valuable, and sticky because they are grounded on what people need. For healthcare, this is a powerful approach. With all its complexity, healthcare is the most human of endeavors, and using an approach that celebrates this complexity, yet yearns for simplicity is a far better fit than those methods that try to filter out the complexity.

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Integrating Design Thinking & Medicine

Project Overview The Zablocki Milwaukee VA Women’s health team in collaboration with the IIT Institute of Design team (consisting of two graduate students and several faculty) developed a study to increase HIV testing among women veterans. Upon review of the literature there were three questions, that guided our research: How can we improve testing? We have learned through various studies that the answer is simple. Just ask. Valdiserri1 in a 2010 Internet survey (myHealthevet) found that 73% of veterans were “very likely to get the test if a provider recommended it. However, only 9% of patients had been offered HIV screening in the prior 12 months. Of those offered, 91% had the test performed.”

The Zablocki women’s health clinical PACT (Patient Aligned Care Team) continued to educate themselves about HIV testing and treatment outcomes. Milwaukee AIDS advocates were invited to PACT team meetings to enhance education around the impact of HIV in the community. Every PACT team member from the pharmacist to LPN to front desk assistant was prepared to answer additional questions from patients according to their disciplines. Positive poster messages were added to every LPN office. Setting the Stage for Change: Normalizing HIV testing

The Zablocki Women’s Health PACT (which includes the MD, NP, RN, LPN, social worker, PharmD and medical secretary) undertook a pilot study aimed at testing all women in the clinic who had not been previously tested within a year period. The primary intervention was simple. The LPN on her initial intake visit asked each woman “Do you want an HIV test today?” which is known as the “LPN How do we know who is at risk? Although there are known risk factors, providers ask.” The LPN script was written in accordance with can’t usually know, nor does the patient in most the 2009 Wisconsin HIV Act #209. Oral consent was circumstances. In 2006, Adimora2 found that in obtained and documented. HIV prevention education a North Carolina study 27% of women with HIV as well as condoms were offered. Each woman had infection had no discernible high-risk behavior. the right to decide and advance any questions to the Thus a woman’s risk may be related to her appropriate PACT team member. In addition, the HIV VA lifetime reminder was partner’s behavior and not her own. activated in the electronic medical record at the Zablocki VA in September 2011. This reminder Why should we increase screening? In the Morbidity and Morality Weekly Report was not seen by the provider prior to the “LPN ask” 20063 several rationales were given for screening during this four-month period. As it was not possible all sexually active women yearly. The reliability to discern which intervention may have triggered the and cost effectiveness of testing if the prevalence test request, this report includes the “LPN ask” and is >than 0.1% is significant. HIV if detected early the reminder in the representative data. The last four can be treated effectively as a chronic disease. months of data represents the HIV lifetime reminder Many medical experts now believe that if a 30 only, as the “LPN ask” pilot was concluded December year old has treated HIV she can live close to a 31, 2011. During a 12-month span of time 397 women with normal life span, longer than a counterpart who is obese and smokes a pack per day for the same unknown HIV status were tested in the outpatient women’s health clinic during their routine visits. period of time. When the woman was asked without judgment or questioning if she would like an HIV test during her intake interview by the LPN the testing increased significantly.

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Integrating Design Thinking & Medicine

Percent of Previously Untested Women Veterans Tested in Each Intervention Period Reminder & LPN Offer

% Tested

.4

The Role of Design Research The PACT team was fortunate to have several design researchers on board to understand the context for the change.

.3 .2 .1 0

Reminder Only Before Intervention

Intervention Period Figure 1

You can see from Figure 1 the four-month intervention period, which reflects the change in the number of HIV tests, actually completed when the “LPN ask” occurred during the intake interview. The blood was also drawn immediately once verbal consent was obtained. Although we note the reminder in this chart, its impact during the four month LPN intervention was minimal.

Problem Reframe (September 2011)

The initial research pilot program with the “LPN Ask” was off to a productive start. The initial strategy used to increase testing among women was driven by a traditional public education outreach model that included a postcard sent to patients offering an incentive to the first 200 patients, as well as local media coverage, to encourage testing. And, correspondingly, LPNs had been approved to obtain consent in anticipation of increased testing due to the outreach effort. However, shortly after initiation, during expert interviews and subsequent literature review, the design team realized that in order to increase testing for women in the long term the problem should be reframed from the question “how do we increase testing?” to “how do we normalize testing for HIV?”

Design Research Sept. - Dec. 2011

Video Prototyped Feb. 2012

Problem Reframed Sept. 2011

Video Complete Mar. 2012

Synthesis Dec. 2011

Pilot Planned Aug. 2011

In-Clinic Pilot Sept. - Dec. 2011

The In-Clinic Pilot timeline (green) and Design Research timeline (yellow) ran in parallel in Fall 2011 and converged in December.

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Integrating Design Thinking & Medicine

Design research (analysis and synthesis; September – December 2011)

By engaging design research methods, the patient journey was explored from multiple perspectives and audiences. Barriers to screening were identified through • One on one interviews with medical providers • Interviews with women veteran employees • PACT team workshops that explored issues relating to stigmas of HIV testing, and potential process changes to improve behaviors leading to increased testing. The use of design methods was instrumental in helping frontline staff identify systems level pain points and problems. For instance, the co-creation of the patient journey fostered group discussion and co-learning and led to a shared understanding of the journey from beginning to end. The workshop format created a welldefined moment for the team to synthesize and crystallize learnings as a team and turn them into an actionable solution; in this case, it was a simple process change in workflow. The LPN began to ask each patient who came in for her initial labs and vitals. In this way, design methods not only helped create effective solutions they helped to build and strengthen the team. Team members felt heard, developing empathy for one another. Overall, innovation ownership was created.

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PACT team workshop and patient journey exercise.

Sustaining the Change: Sharing the Story

By December, the four-month pilot was completed. The Institute of Design team and the women’s health director from the VA continued to work together to develop a communication strategy to diffuse project findings about a relatively simple and effective process change. The target audience was other PACT teams in the VA nationally. The goal was to plant the seed in multiple minds and have the learners do as little work as possible to understand the message. Synthesizing four-months of clinical observation, the Institute of Design graduate students storyboarded and created low fidelity prototypes. They outlined the major points with a rough draft script and post-its. Then the students used an Android smartphone and YouTube to make a quick version of the video for handoff. The rough video provided the bridge to a professional studio who developed the prototype into a beautiful six-minute

Integrating Design Thinking & Medicine

The design research wrote an initial script, storyboarded using post-its, and created a first draft of the movie using a smartphone and YouTube.

animated video. Daily re-iterations occurred until the scripts and illustrations matched the energy and clarity from Stills from the final “Make the Test Normal!” video. the original low-fidelity prototype. Since its completion, the video has been placed on the national HIV VA site. The story and video was presented to VA national champions throughout the entire country for implementation by other PACT teams. Conclusion

The Zablocki Milwaukee VA Women’s health team in collaboration with the IIT Institute of Design team sought to increase HIV testing among women veterans. Together they identified a relatively simple process change in workflow. This process change ensures that patients are consistently offered the test, an important factor for women who may be infected with HIV but have no discernible high-risk behavior. Early detection of HIV means effective treatment as a chronic disease. The integration of design methods and medicine not only led to the creation of an impactful solution but also to a short, simple and compelling way to disseminate findings with other VA medical providers.

Watch “Make the Test Normal!” at http://www.hiv.va.gov/products/video-maketest-normal.asp

References 1. Valdiserri R, Nazi K, McInnes D. Need to Improve Routine HIV Testing of US Veterans in Care: results of an Internet Survey. J Common Health. 2010; 35:215-219 2. Adimora A, Schoenbach, Martison F. Heterosexually Transmitted HIV infection among African Americans in North Carolina. JAIDS 2006;41:615-623 3. MMWR. 2006 55 (RR14); 1-17

Kayt Havens, MD

Amanda Geppert, MDM

Cornelia Bailey, MDM

Judith Gregory, PhD

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Dry c i m a Dy n lness to little playfu a g in c u nd d Intro research a e rs u n g in r tive. help sha more effec n o ti a v o n in ich By J o d e e n

Photo Credit: Tim Rawson

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a M. Kem p

n

W

ith so many new ideas hitting the nursing units every year, it’s a wonder (and amazing) how nurses incorporate all this new information. Knowledge from research, process improvement, or changes in practice all require good, effective communication. We knew there had to be a better way than the old-fashioned live presentations. So, at Alegent Health we created an Innovation and Research Day and held it during Nurse’s Week on May 9, 2012. The event was a fun way to showcase the creativity of our nursing staff.

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From Dry to Dynamic

Through creativity and ingenuity, the nurses rolled up their sleeves to submit the “dry” abstract and “fun” posters. For some, this was their first attempt at writing an abstract. For others, it gave them a chance to mentor their colleagues. There were three goals we had in mind as we designed the day. First, we wanted to decrease the fears of presenting to an audience. When staff present internally, they step outside their comfort zone, in a safe environment. Second, we wanted to build confidence in the staff ’s ability to write abstracts; a necessary skill in order to submit to local, state or national conferences. Third, we wanted to eliminate silo and competitive behavior.

“Love all the enthusiasm about research!” Kayleen Joyce MS, CCRC Operation Dir. of System Research Fifty-five abstracts were received and compiled into a booklet. The ideas came to life in poster boards, allowing nurses to utilize creativity and teamwork in presenting their work. Innovation and Research Day was a great avenue to share their successes by promoting nurse accomplishments. It sparked teamwork between units, campuses and entities by sharing best

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practices so other nurses could try new ideas on their own units. No gathering of nurse is complete without a celebration! Nine nurses, nominated by their peers received new nursing awards including: Advanced Practice, Exemplary Professional Practice, Legacy, Lifelong Learner, Nursing Achievement, Outstanding Preceptor and Transformational Leadership. The evening finished with a commissioning ceremony where nurses pledged their commitment to the nursing profession. Overall it was a huge success; so much so, that Alegent Health has committed to making this an annual event. Our recipe for success was to take nurse passion, creativity and teamwork to make new knowledge effective and fun. Three Lessons Learned: 1. Create a simple and clear structure for the process, and consider coaching people through it. 2. Enforce deadlines. It makes your and their lives easier. 3. Keep it fun. This is meant to be a celebration!

From Dry to Dynamic

With all the appreciation and congratulations about the successful program, we knew that we had made an impact. However we really knew we were on to something when we received the following feedback from Chris Hoebelheinrich, BA, MSN, RN, a Clinical Instructional Designer at Alegent Health:

“Yesterday was incredible. I had just a good feeling coming out of there and proud that I’m an Alegent Nurse. The posters and program were exceptional. Looking forward to next year, I will definitely have another poster!” Pat Stevens, RN Alegent, Mercy Surgical Services

Jodeena M. Kepnich, MSN, RN, CNML

I just wanted to take a minute to send you all a quick note to thank you for such a wonderful event, the Innovation and Research Day. Besides being a highly successful event, it was personally gratifying for me, as a nurse. I am honored to be included in the unique group called Alegent Health nurses! In my area of nursing, I have been “behind the scenes” of many large events. Sometimes the build-up is so great; there is a little feeling of let down when it is over. Please know that your efforts were not lost on this nurse! Today was one of those days where I felt a little drained by the challenges of my work—we all have ‘em. But as I entered the Right Track tonight, at once I felt my “batteries” begin to re-charge. The energy in that room was so uplifting tonight! Thanks for making this event a showcase of nursing innovation and a way to honor those among us who are doing great things on the “ground level.” I was so impressed to see what my nursing colleagues are doing to improve the lives of patients and their fellow nurses. And while each of the nurses honored tonight has achieved great things, I must tell you that I also felt honored: Honored to be a nurse, but more importantly an Alegent Nurse.

Advance Nurse Administrator Alegent Creighton Health Omaha, Nebraska, USA

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7

Visual Insights on Social Determinants

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Examining health through a different lens helps to uncover bigger, underlying social issues that can’t be solved by the latest app or device alone. This visual exploration helps us to “see the forest for the trees” as it relates to health in the Metro Washington D.C. area. Sto ry & Ph otos By Ted Eyta n, M D

W

e are relying too much on modifying a person’s individual choices to improve health. The social determinants of health can loosely be defined as how the circumstances in which people develop and live affect their mental and physical well-being and life expectancy, and have been characterized as the causes of the causes of health (or ill health)1

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Seven Visual Insights on Social Determinants

1

Many citizens, few health professionals

If you look visually at a health system, like this example based on Kaiser Permanente, you can see that we are out-personned. There aren’t enough people working in health care to reach every person we serve to guide their daily choices. People and organizations outside of health care are needed.

0.18 Million Staff

0.05 Million Nurses

9.0 Million Patient Members

0.017 Million MDs

The Actions of a relativley small staff/Nurse/Physician group will need to be amplified through individual, care delivery, and population approaches.

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Seven Visual Insights on Social Determinants

People aren’t hoping that we’ll improve their health care experience; they are hoping that we improve their ability to live a long healthy life. The groundbreaking Marmot Review in 2010 depicted big differences in life expectancy and disability-free life expectancy among the best-off and worst-off neighborhoods in England. The graph above (licensed under the Open Government License v1.0)2 is full of information that shows that people who are socially deprived will not (a) get to a certain age and (b) if they get to that age, are unlikely to get there without a disability. We don’t usually measure this in United States health care today.

What we are working to improve, should matter to people.

2

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Seven Visual Insights on Social Determinants

3

MOST HEALTHY

patients

staff

LEAST HEALTHY # OF PEOPLE 62  Insights Vol. 7

Use images, not words

The difference between the most healthy and the least healthy people describes the health inequality in a population. Society is better off when there is a smaller difference in this range. We can show the spread via the disability-free life expectancy metric, using smooth bars. Their height is equal to the disparity between the healthiest and the least healthy. The gray bar shows the spread for or own staff – their health inequality matters, too. And images are the most powerful way to demonstrate this.

Seven Visual Insights on Social Determinants

The Future We Want MOST HEALTHY

MOST HEALTHY

staff

patients patients

The Future That Scares us

staff

MOST HEALTHY

INTERVENTIONS

LEAST HEALTHY

MOST HEALTHY

patients

staff

LEAST HEALTHY # OF PEOPLE

patients staff

INTERVENTIONS

# OF PEOPLE

LEAST HEALTHY

LEAST HEALTHY # OF PEOPLE

# OF PEOPLE

There are two alternate futures. The future we want is the one where everyone is healthier. There is less of a disparity between the most healthy and the least healthy. Our staff shows even greater health gains, leading our members. The future that scares us is the one where the most advantaged are much healthier, the least advantaged are only a little healthier, and our staff is no healthier than the people they are serving.

4

Two alternate futures

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Seven Visual Insights on Social Determinants

5 emphasis on individual

A total health approach

“These serious health inequalities do not arise by chance, and they cannot be attributed simply to genetic makeup, ‘bad’, unhealthy behaviour, or difficulties in access to medical care, important as those factors may be.”2 This image describes the interventions that are focused on individual choices – this could be a calorie counting app or a game that promotes competition among friends. If 100% of our effort is applied to these interventions, we won’t reduce health disparities.

On the other hand, a Total Health approach, based on the social ecological model first advanced nearly 30 years ago, addresses the family, community, and societal environment that shapes individual behavior choices. There’s some investment at every level, as the image below depicts.

Individual & Family

Home, School & Work

Neighborhood & Community Society

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Seven Visual Insights on Social Determinants MOST HEALTHY

MOST HEALTHY

staff

patients patients

staff

Total Health Approach

Individual & Family

Home, School & Work

Neighborhood & Community Society

LEAST HEALTHY

LEAST HEALTHY # OF PEOPLE

TODAY: 2013

# OF PEOPLE

TOMORROW: 2020

Using the visual thinking approach, this is the one image that includes the Who/What and How of behavior change and social determinants to improve health. If we spend the right amount of time at the individual level as well as the societal level, people at all levels of the health gradient will improve their health, and the gap between them will decrease. We will model the improvement in our own workforce.

The tomorrow we want

6

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Seven Visual Insights on Social Determinants

7

The tomorrow we don’t want

If we invest poorly, and do what seems easiest, we’ll get the outcome we don’t want. The most advantaged, who didn’t need as much help in the first place, will get healthier. The least advantaged may or may not get healthier. Our workforce will not achieve greater health gains. Our costs, and more importantly their costs (money, time, lives) will not be manageable. That will make all of us unhappy.

MOST HEALTHY

MOST HEALTHY

patients

patients staff

staff

emphasis on individual

LEAST HEALTHY

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LEAST HEALTHY # OF PEOPLE

# OF PEOPLE

TODAY: 2013

TOMORROW: 2020

Seven Visual Insights on Social Determinants

However, we are not trying to fix an image. We’re trying to fix real social problems like obesity and crime represented in the images to the right (data and images from present day, Washington, DC, USA) • We need to understand the role of health care in improving health; we cannot do it alone • We need to have a measurable goal in mind – not just pounds lost or blood pressure lowered, but longer, healthier life, and less inequality between the most healthy and the least healthy When we talk about innovating in health, we need to think beyond individual interventions – this is in the scope of health care and a health care Innovation Learning Network. The ambition is to create the conditions for people to take control over their own lives. If the conditions of daily life are favourable, and more equitably distributed, then they will have more control over their lives in ways that will influence their and their families’ health and health behaviours.2

Visualization of crime in Washington, DC, with the biggest cutouts being homicide, the smallest assault.

References 1. Royal College of Physicians, How doctors can close the gap: Tackling the social determinants of health through culture change, advocacy and education. 2010. 2. Marmot M. The Marmot Review: Strategic Review of Health Inequalities in England post-2010. 3. Garner T, Trombatore D, Raza U. Obesity in the District of Columbia. Washington, DC; 2010. 4. Eytan, T. Quantified Community: Visualizing the Health and Illness of Washington DC Through Open Data and Art. www.tedeytan.com. 2012

Ted Eytan, MD Physician Dir., Center for Total Health Kaiser Permanente Washington D.C., USA

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Photo Credit: Michael Stowe / Photos.com

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Silos to Stories When you’re looking to spread innovation and strengthen ties across a system, it’s amazing how far a digital facelift and some powerful stories can get you. By B eth G i b bs, M S, R N

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Silos to Stories

Photo Credit: Tim Rawson

E

ach year the Center for Nursing at Alegent Health in Omaha, Nebraska, produces a report of nursing activities and achievements. In previous years, the report highlighted activities that occurred at each location and had a message from each nursing leader, from each hospital. This method of reporting gave the appearance that each facility worked independently of the others and gave it a silo feeling. Through a new communication design, Alegent helped engage its audience through stories and created a sense of unity in nursing across the organization. In the old design, each campus’s nursing leader had a

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“ ...a new communication design, Alegent helped engage its audience through stories and created a sense of unity in nursing across the organization.”

message to summarize the year. Nursing accomplishments and committee work for that campus were listed according to the four Strategic Initiatives identified by our organization. Information about new units or programs at the specific hospital was also listed. Although this format gave the reader a flavor for happenings at each location, the overall publication was more of a collection of accolades for each individual entity. For the 2011 Nursing Annual Report, something different was proposed. While making rounds on hospital units at different campuses and having conversations with nurses, the Chief Nursing Officer, Jane Carmody, DNP, RN, CENP,

Silos to Stories

heard many fabulous stories of innovations to improve care of patients or stories that involved nurses. Jane wondered “Why not highlight stories of what nurses at Alegent Health were doing?” And that sparked the birth of the new design. before Working with Marketing, we created a production plan and worked closely with the nursing department to reach the deadline. This was challenging because there was always one more story to add to the publication! Beth Gibbs, MS, RN collected the stories, pictures and quotes from the authors, and together with the help of the marketing department, edited the stories. The graphic artist completed a beautiful lay out for the publication. We categorized the stories into

the Strategic Initiatives identified by the organization that year – Relationships, Clinical Quality and Integration, Population Health and Well-being, Growth, Technology and Stewardship. Many changes

The nursing foundational documents were highlighted at the beginning of the publication to give readers a framework for the report. The nursing professional practice model and nursing philosophy which had been revised were among the documents included. In making the transition to the new format, we wanted to ensure equality between the campuses and to show a representation of nursing across the continuum of care. Stories about how nursing impacted the care of the patient were sought out as well as some fun stories on nursing recognition. One such story was how the Emergency Department at one campus held a “black tie” (scrubs were allowed) Golden Awards Night. Instead of awarding golden statues, they presented award winners such as ‘No Core Measures Fall Outs’ with gold decorated urinals. Healthcare humor at its after best! Distribution included sending printed copies to had occurred in the organization’s key stakeholders such as Board nursing structure during 2011 members, local schools of nursing, including a change in leadership. nurse leaders at each location,

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Silos to Stories

nursing units and all of those who contributed to the publication. To help increase readership, the marketing department purchased a software package which utilized a flip page technology (seen here) instead of scrolling through a PDF version of the piece. Stories were highlighted in an all employee email that is distributed each week. The stories in the email contained a link to the report on the nursing webpage. All of these efforts helped to increase readership of the report. The report received over 17,000 views

as compared to the previous year’s 1,200 views posted PDF version. The new design helped engage the audience and brought together nurses throughout the organization. People enjoyed reading about their co-workers and enjoyed seeing themselves in the piece. As one

reader said: “This year’s annual report was very pertinent to the accomplishments of the bedside nurse,” Dottie Brown, BSN, RN, MA, Senior Services Executive. We are already making plans for next year’s report ­— thus demonstrating the power of stories.

Beth Gibbs, MS, RN Advanced Nurse Specialist Alegent Creighton Health Omaha, Nebraska, USA

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Article Title

ILN ART

“ILN Goes Op”

Art b y Ro y ce Eve ro ne

This piece, “ILN Goes Op,” is an addition to my exploration of symbols and objects rendered in checkerboards which can result in some interesting effects and vibrations. I painted on high-grade white paper with Ivory Black Liquitex Acrylic Paint. Fall 2012

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Insights An annual publication of the Innovation Learning Network

Editors / Chris McCarthy Director, ILN

Tim Rawson Lead Designer

Contributors / Eric Santos, photography Bradley Bozarth, photography Barry Kudrowitz, author, illustrations Rhonda Montalvo, ILN art contributor John Collins, author Diana Spiliotis, author Penny Ford-Carleton, author Christine Folck, author Margaret Laws, author Rebecca Nguyen, photography Manny Darden, photography/layout Carleen Hawn, author J. Kiely Jr., photography Deanna Konrath, author

Lyle Berkowitz, author George Simons, ILN art contributor Mary Katica, author/layout design Laura Janisse, author/layout design Kayt Havens, author Cornelia Bailey, author Amanda Geppert, author Judith Gregory, author Jodeena M. Kepnich, author Ted Eytan, author/photography Beth Gibbs, author Royce Everone, ILN art contributor Yasmin Staton, proofer/editor

Innovation Learning Offices / 1800 Harrison Street 17th Floor Oakland, CA, 94612 www.innovationlearningnetwork.org

Publication / Insights Vol. 7 January - December, 2012 © Innovation Learning Network, 2013 ISSN: 2325-520X

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