The Most Important Innovation Skill

The new whiteboards in our ICU patient rooms didn't just appear one day.

The new whiteboards in our ICU patient rooms didn't just appear one day.

By Frankie Abralind

We’re building a culture of innovation at Sibley Memorial Hospital. It’s not always easy.

Back in the summer of 2016, a passionate nurse manager from the ICU (Intensive Care Unit) walked downstairs to the Innovation Hub with what seemed to be a simple problem: the whiteboards in the patient rooms were terrible. They weren’t the useful patient communication tools they could be. They didn’t have the right spaces for information, they looked ragged, and she felt Sibley could do better.  After a brief conversation to understand the scope of the project, I scheduled a prototyping session with her and her team for the next week.

A few days later, I gathered a couple handfuls of colored markers and a stack of 11x17 printer paper and walked up to the second floor. The nurse manager saw me coming. “Everyone in the break room!” she said with excitement to anyone in earshot. “We’re doing a design project!” A group of nurses and clinical assistants (CAs) assembled, curious and eager to see how they could participate. I made everyone go around and introduce themselves, then settled us in to the task at hand: reinventing this communication tool they use every day.

My role as a design coach in the Innovation Hub is to make innovators look good. It’s risky to put yourself out there with a new way to do things, and most people are (understandably) afraid failure will be hard to recover from.

The staff here are natural problem solvers. Sometimes, however, the pressures of a big institution can undermine the most well-intended nurse, CA, doctor or housekeeping staff. That’s why design coaches are so important to a fledgling innovation program that champions frontline staff. We provide training, support and facilitation, but our ultimate goal is empowerment.

I studied design at Cornell University and got my MBA at the University of Maryland’s Robert H. Smith School of Business. Expediter duty, though, may be the most important work that I do here. That simple, thankless, low-creativity work of shepherding a design project past barriers and through roadblocks is what makes or breaks it.

Armed with prototypes and notes from the conversation in the ICU break room, I went back to my desk in the Innovation Hub and drew up an aggregate prototype, still marker-on-paper, that summarized the different ideas. I walked back up to the floor to show this to the team and harvest some early feedback. “Oh, this box should move over here,” said one nurse. “Yeah, the sizing of this ought to be more like this,” said another. “Can you add a visual for this part?” asked a CA.  

Several rounds of testing produced more items for modification. Even though getting this far had taken many weeks, energy still pulsed through the team from being able to create actual mockups of something they had dreamt up themselves.  A new draft version went up. Another round of feedback came back. We were close, and the ICU team was excited. After a final round of revisions, we stood back, crossed our arms, and smiled at the result. Everyone was ready to see these whiteboards in action.

Alas, a number of barriers stood in the way. I discovered a big one many weeks after the nurse manager reported that she had placed the order with the custom whiteboard company. They hadn’t ever shown up. Feeling protective of the ICU staff and wanting them to have a smooth innovation experience, I took on the followup myself and called the vendor’s customer service person.

“You need to pay for them,” she said.

“I think we have paid for them,” I said, happy to be sharing my good news.

“Our system says no,” she said.

“Huh,” I replied. “I’m looking at the SAP (the purchasing system Sibley uses) notes and it shows everything is in order.”

“We don’t use SAP.”

“Oh! Well, you’re registered in the system as a vendor. Perhaps you have some money waiting for you somewhere that you don’t know about?” I’m nothing if not optimistic. This went back and forth for a few minutes before it became clear that we hadn’t actually paid anyone anything.

Ultimately, with other minor snafus and competing priorities, it was more than nine months from the time of the first design session in the break room to the time the boards were installed in patient rooms. Would the ICU have new whiteboards now without my involvement? Sure. They’d be the same old off-the-shelf versions with a one-size-fits-all layout. Inadequacies would slowly grate on the staff, decreasing job satisfaction and reinforcing that demoralizing “Why didn’t anyone ask us how we use it?” internal monologue.

Sibley, however, is committed to being “the role model for innovation in healthcare,” and that means not settling for the way things always have been. There’s a portrait of Clara Barton, who founded the American Red Cross in 1881, over my desk. She once said, “It irritates me to be told how things have always been done. I defy the tyranny of precedent.”

Heck yeah. We design coaches are here to support staff who take risks and defy the tyranny of precedent at Sibley. That's how we're helping create a brighter healthcare future. To provide that support, I’ve found an ounce of persistence is worth a pound of design training.

But a pound of persistence is best.

A Simple Pain Management Innovation

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Dr. Mete Akin, medical director of pain management at Sibley Memorial Hospital, passed away on September 21, 2017. He was an important part of this project.

By Frankie Abralind

A doctor sits next to the bed and types in a prescription. “I’m going to put you on medication for the pain you’ll have after we put that new knee in,” she says. “You should be fine with some Percocet every four hours.” She looks over at the patient with a smile, knowing she’s giving solid, proven care advice.  

“Actually, could I try TENS therapy first?” asks the patient, a seventy-three-year-old man named Dougie. He’s holding a little blue booklet, and he’s curious. “Or hot-cold therapy and meditation?”

Our hospital has many underutilized options for pain management. “Painkillers” are the ones that come to mind quickest. Patients ask for them, nurses offer them, doctors prescribe them. Unfortunately, many Americans’ lives have been completely upended by opioid addictions that started with honest, well-intended prescriptions to these powerful narcotics.

Dhiraj (DJ) Jagasia, an Anesthesiologist who’s been working at Sibley for years, had an idea about how to break this cycle.

Conscribing one of the Hub’s fabulous interns to the project, DJ and I applied Sibley’s Listen, Imagine, Do human-centered design process to the problem. A week after we met to create a project plan, we’d interviewed 18 nurses, nurse managers and patients about the options they knew and the options they offered. We focused our work with the question “How might we improve awareness of pain management options at Sibley?” and generated 52 ideas in a half hour of brainstorming. Eventually we settled on a couple and spent 20 minutes building prototypes to show each other. The idea that floated to the top: a “passport” with a page for each option. Patients could earn some sort of stamp or token for each kind of pain management they tried.

After several iterations and a few rounds of testing, DJ sought the help of Dr. Mete Akin, a passionate new pain medicine doctor who saw the potential for the project and was willing to help it succeed. He pushed us to the next level, finalizing the content so we could professionally print a batch of 100 to pilot on a floor and get patient feedback. It's now in testing on one unit.

Mete was a friendly, supportive voice and a wise source of guidance for this innovative new project. We’re grateful for his contribution and look forward to getting the Pain Management Passports adopted throughout Sibley.

Hub Fellow Spotlight: Dr. Jason Emejuru

Dr. Jason Emejuru (right) meets with Director Nick Dawson in the Sibley Innovation Hub.

Dr. Jason Emejuru (right) meets with Director Nick Dawson in the Sibley Innovation Hub.

by Frankie Abralind

If you get married in Nigeria, you’re going to have a big wedding. There’s no debate. All your family’s going to be there: uncles, aunts, cousins; everybody who’s related to you stays connected and is involved in your business. Nobody does a little ceremony with just a few friends.

Johns Hopkins Pediatric Psychiatry fellow Jason Emejuru, MD, was born in Washington, D.C. shortly after his parents immigrated to the U.S., and he grew up in the warm embrace of the Nigerian expat community. Dozens of people came together to celebrate every birthday party, graduation, and milestone. And they showed up for mourning, as well. “When my grandma passed away, I got a lot of support there, too.” he said. “It’s been instilled in me that you can’t do anything without family.”

The same should be true for medicine, says Jason. Especially mental health care. “Within mental health care, having social support is actually like a luxury in this country. It’s not actually part of the basic 'package' of treatment you will get as a patient/consumer. The patient and clinician are working together in a silo.” But that’s a missed opportunity. “Strong social support should be part of the remedy that the doctor prescribes.”

Jason typically works out of Hopkins’ East Baltimore campus figuring out ways to improve family engagement and family-informed health delivery in their Pediatric Community Mental Health Center. He has a strong interest in neurodevelopmental disorders, such as Autism and Schizophrenia.

Doing a fellowship with the Sibley Innovation Hub is invigorating for Jason. “It’s a different kind of energy. I get to free myself, to allow myself to think and brainstorm, which is nice. I know that people around me are also interested in innovation so it’s easier for me to make a connection, to just come up and talk to somebody, because that’s what they’re here for. They’re interested in that.”

It’s an exciting time to be at the Hub, but Jason’s research will pause in a few weeks so he can get married. He and his fiancee have ordered an extra large dance floor. It’s going to be a big crowd.

Please reach out to Jason if you have insights or interest in how family engagement can be a bigger part of patient treatment: jemejur1 (at) jhmi.edu. He’ll be at the Hub again on August 31st, and every other Thursday for the next several months, and would love to grab lunch or coffee with you.

The Elephant in the Room

Do you ever find yourself thinking about the elephant in the room? You know?  When you are sitting in that big meeting at work, with your family, or with yourself?  The cliche goes with someone saying, “I don’t think we are addressing the elephant in the room.”  Usually this arises when someone means that a conversation isn't capturing the big picture.  The conversation may be relevant, but there is some uncomfortable topic—that awkward thing that everyone probably knows but doesn’t know how to bring up.  Somehow this thing that is impossible to miss (an elephant in a room…really?) is somehow ignored.    

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In the Hub, we recently had Book Clhub on a book called Switch, which is about motivating change when change is hard (sounds like healthcare, right?).  How can we genuinely motivate ourselves, our community, our teams?  In the book, the authors use a three part model—an elephant, a rider riding that elephant, and a path.  The elephant is our emotion that we feel naturally.  The rider is our “rational” mind that uses logic and reason to decide what it wants to do.  The path is what lies ahead and describes the journey that the elephant and rider will theoretically follow.  One might be able to similarly think about these as our emotions (elephant), our thoughts (the rider), and our goals (path).  The strength of this analogy comes when thinking about the interaction between the three.  The rider sits on top and tries to guide the elephant.  But, in all reality, the elephant can go whichever way it wants—do you think you could redirect an elephant?  The rider and elephant can both follow the path, but if the path leads somewhere horrible, they can choose to ignore it.  It is necessary to acknowledge that all three must be addressed to make change most effective, and it is extremely important in my mind to remember that our emotions (elephant) are the most effective drivers of action in the long run.  Although the analogies weren’t originally meant to blend together, that’s one reason to always address “the elephant in the room.”    

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One of the things I have been thankful for in the past few years between college, my year at the Hub, and now my first year in medical school has been exposure to many teams and projects—a real variety of styles and missions.  When I think about it, I realize how many new initiatives begin by speaking to the rider.  It starts with something like, “here is our new project, the [insert accreditation/regulatory agency here] requires all places to do XYZ.”  Sometimes the conversation starts by describing the policies addressed by the project or the tactics behind implementation.  Each of our riders listens, knowing the project is the right thing, but the elephants are elsewhere—thinking about other projects we wish to explore.  It’s just like trying to adhere to a new diet or a new year’s resolution—the rider clearly agrees, but the long term success gets defined by whether the elephant does too.  What often amazes me about these meetings is how they commonly finish with a comment like “and it will be good for the patients” or “and it is the right thing to do”.  Somehow, the parts that speak to the elephant get left to the end.    

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One of the things I enjoy about design is its way of speaking to the elephant first.  A couple weeks ago, members from the outpatient oncology team came in to work on a project.  It was a half day session that brought in patients, caregivers, articles, and inspiring artifacts.  One patient described to us the loneliness of having a rare disease.  She talked about the struggles she faced while trying to find adequate support groups and the frustration of trying to find health providers that had the right niche of expertise.  She described instances where she would be teaching people in healthcare about her disease and joked about how maybe they should be paying her (as a med student, I have to admit she has a point).  After sharing out to one another about the interviews, the group finished the day by creating a journey map of the experiences—tracking checkpoints and emotions.  

Talk about a day that spoke to the elephant.  Even as the session closed, one idea would spark comments from the entire group.  The conversation could have continued for hours.  The passion in the room sang out loud and clear.  The elephants led the day, pulling the riders forward on the design path.  Work is a lot easier when the goals of the elephant align with the goals of the rider.  So, next time you think about presenting, sharing a story, introducing a new project, or just trying to convince yourself of something, remember that you need the elephant.  Remember that it isn’t just about addressing the elephant in the room, it is really about making it the star of the show.

"If you're walking down the right path and you are willing to keep walking, eventually you will make a path"—Barack Obama

In my own subtext to that quote, I might add that it takes more than a rider to make a path—it takes an elephant.  

Andrew Yin

Innovation Awards 2017-The Hubbies

Last Thursday, Sibley and the Innovation Hub had the great pleasure of hosting the first ever Innovation Awards (aka "The Hubbies") to celebrate the Design and Lean projects of Sibley staff and teams this past fiscal year.  There were an unimaginable number of projects last year—258 Lean projects, and before you catch your breath, 132 Design projects.  Imagine that!  390 projects during the year, more than a project a day.  Needless to say, there was a lot to celebrate.  Everyone entered what they thought to be a regular department managers meeting to find this surprise ceremony waiting for them.  The ceremony started with the video below and followed with the announcement of the 6 Lean and 6 Design Awards, presented by the Hubsters.  To celebrate their project, each awardee received a glowing 3D printed trophy (made in The Hub) as well as a poster describing their work.  Please enjoy below the video, descriptions of each award, and photos from the event.  Congratulations to all of the amazing work, and we can't wait to celebrate again sometime soon!

 

Jessica BarronMura Award. Mura is a Japanese word meaning unevenness or irregularity and describes the previous therapy pool schedule.  The outpatient rehab team ‘evened’ out the pool schedule providing better community service while simultaneously improving pool and therapist utilization.

Christine InglisaFlow Award. The Flow award is given for teams identifying value stream bottlenecks and devising innovative solutions.  The Orthopedics team in concert with case coordination, the PACU, and Renaissance has championed improved coordination and discharges as the mechanisms for improving Operating Room efficiency. 

DJ Jagasia, Pain Management PassportBiggest PotentialSome innovation projects deal with massive challenges. DJ, an anesthesiologist, wanted to find ways to get more patients managing their pain with non-narcotic options. In the first week, he talked with 12 nurses and nurse managers about awareness of alternatives. The “Pain Management Passport” he developed highlights offerings here at Sibley like acupuncture, peripheral nerve blockers, and mindfulness meditation that can reduce reliance on narcotics and opioids.

Nneka OkoyeHeijunka AwardHeijunka is a Japanese word that means balance-leveling and elegantly helps organizations meet and sustain demand without compromising resource productivity to support daily operations.  To support a healthy workforce, the Occupational Health & Safety team developed a Comprehensive Wellness Program that provide health education, health screenings and events that give employees insights and facilitate personal health changes.

 

Aly Stalzer, O.R. Board GameBest Pivot.  A pivot in basketball lets you change direction quickly; in innovation, it’s the same thing. Aly wanted to improve changeover times in the operating room and give PTAs more chances to practice table setups. Her project to create an iPad app for O.R. table training flopped when the estimates came in at $100k. Now she’s working on a board game that does the same thing, and it’s actually kind of fun!

Jennifer AbeleKanban AwardKanban method is a Japanese word for visualizing the flow of work which aids decision-making about what, when and how much service is needed in order to balance demand with available capacity.  To create patient acquisition and retention, patient experience and satisfaction, care coordination and management, efficiency and load balancing, the Emergency Department team identified an Online, self-scheduling and discharge scheduling software application solution that support Sibley’s performance and patient-centered care strategy.

Harpreet Gujral, Weight Loss Journey TimelinePatient Uplifter.  How might we support and uplift patients while they’re here? Harpreet and her team scrutinized the weight loss journey. They built a map of all the touchpoints, and started testing new ways to help patients visualize expectations. They ended up with a beautiful illustrated timeline that helps bariatric patients see what’s ahead and stay motivated to complete their goals.

Kristen Pruski, Physician EngagementInclusivityThe “Inclusivity Award” is for the project leader who put in exemplary effort to include diverse voices in her pursuit of innovation. Kristen reached out to a dozen physicians at varying levels of engagement with the Foundation, which earned us eight in-depth interviews. When she saw everything we’d gathered, she got her whole team together to share the insights and generate ideas of what they could do differently.

Brian CrickenbergerJust-Do-It AwardJust-Do-It method means when a solution is obvious to all parties and simply needs to be resolved immediately.  To reduce unnecessary administrative cost associated with billing and collection increase, the Revenue Cycle Management & Admissions team took it upon themselves to eliminate late charge write-off by department while prioritizing collection of visit payments prior to or at the time of service is received by every patient, every time.       

Lisa Hawkins, Foley Bag SatchelsStellar Prototyper.  This award spotlights someone who experimented early and often. Lisa got her team prototyping CAUTI-fighting solutions in their very first work session, and was hands on all through the process. Today she’s testing well-developed versions of two different prototypes on the fifth floor that are brand new to the world of CAUTI prevention.

Natasha Schultz—Innovation Mindset.  Despite best intentions, the constant interviews and observations of an innovation team can be disruptive to any department. Natasha welcomes and enables hubsters again and again, going out of her way to connect them with patients and smooth the way for Listening, Imagining and Doing.  

Dennis ReedLMS AwardLean Management System provides minimal structures to support daily operations by surfacing abnormalities closer to their occurrence and responding sooner with solutions.  The Imaging team has upgraded their management system through application of Lean tools and continuous process improvement.

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Design on a Dime - Recycling Project

Have you ever thought, “there must be a better way to do this?” When the challenge involves humans and behaviour, there may well be an easier way. You might even know the solution yourself. At the Sibley Innovation Hub, we use a three-stage process for innovation projects. We call it Listen, Imagine, Do! In this “Design on a Dime” series, we will be discussing some projects that didn’t take long at all to implement.

The first project in this series was led by Rob Jewel, a leader in the Environmental Services Department here at Sibley Hospital.

 

Listen:

Rob noticed there were four various receptacles for four different types of waste. He watched employees in the cafeteria throw out waste in the wrong bins. He suspected employees might not fully appreciate the recyclable material and proper sorting of it.

 

Imagine:

After Rob had gained enough information, he went into the Imagine phase of the Sibley Innovation Method. He drew from his past knowledge of places that have successfully made trash sorting easier and more obvious. Rob thought of college campuses where they often have physical representations of the waste which should go into specific cans.

 

Do:

Rob entered the Do phase. This is prototyping, testing and implementation. He started by prototyping signs to would hang next to the corresponding containers. He glued on real-life utensils and bowls (the ones used in the hospital cafeteria) to make it easier for employees to recognize by examples.

After his testing was complete, Rob put tape next to the containers and wrote the corresponding word on it. This made it obvious to employees where the different types waste should go. Lastly, Rob tested his prototypes by watching as employees spent more time considering where to place their waste.

This project is just one of many examples proving that design and implementation does not have to be a long process. All it takes is a little listening, imagining, and doing.

--

Tucker Hemphill

Experience Design Intern

Johns Hopkins Sibley Innovation Hub

 
 

Bringing the Person out of the Patient (pt. I)

I’ve been meaning to write this for a bit but moving into that big beautiful building has been the focal point of my professional life.  On that move: *standing ovation to all*!  We crushed that.

I know there have been many emails to that effect thus making this blog post all late and wrong but wow that was a heck of a thing to be a part of.  Many moons ago, as I sat in Hayes hall listening to Mr. Sloan during orientation, could I have imagined the Sibley we have now. I can tell you the amount of lives impacted in the New Sibley will make all of those who had a hand in its creation proud.  Many thanks to all involved.  

But. As great as it is, it's only a space, and with all respect it's the people who fill the space and provide the care that make it (the New) Sibley.

Sibley was at its finest during the move to the New Tower and that move was a special thing to be a part of.  The fact that so many employees basically bailed on their families for 4-5 days to help make sure patients, the people taking care of patients and the equipment needed to do so were moved safely and successfully showed that.

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Through all the moving of things there was a constant focus on people.  People, both employees and patients are what this blog post is about because 'employee' and 'patient' are just titles we just carry for a little while, and we should be able to connect with each other on levels beyond our temporary titles.

As incredible as the move and all the things leading up to the move was, I’m actually writing this blog post to walk you through the process of my favorite *bias disclosed* part of the New Tower.  They’re called About Me Boards and they’re in EVERY FLIPPING ROOM!  That is sort of the end of the journey so we’re going to pump the brakes and back up to the beginning of this tale.  I’m going to tell the tale (and it's a 2 parter so if you hate cliff hangers, then best to bail now).

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Being as this tale was born in the Innovation Hub, and this Internet space belongs to them and is reserved for Design, I'm going to tell the story in the Hub’s format: listen, imagine, do. Frankie would be quick to remind that the ‘tell’-explaining the work- is also crucial but I'm saying that 2 blog posts count as my ‘tell’.

Listen

‘About Me Boards’’ started with Dr. Ramunno (pictured showing his skillz on the hoverboard) and a great group of docs, nurses and some execs listening to patients talk about the experiences they had at Sibley.

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To be brutally honest, it was a tough day with so much to process and so much to hear from people for whom we missed opportunities to provide excellent care. But these being empathy interviews, we smiled and listened, and while we listened we took away themes.  One of those themes was one thing that everybody already knows but that we rarely know how to address—that patients want to be seen as people. They don't want to have to retell their story to every new person they meet. So we sought a way to help get patients seen as people.

Imagine

We thought of other places where they do this and came up with hotels which, don't roll your eyes, because I'm with you—I think the hospital is very different than a hotel and we shouldn't try to do all aspects of what they do. However, somebody noted how when you check into some of these fancy-pants hotels they know who you are before you even speak up, so we wondered how might we get some of the patients information shared without them having to say the same things over and over again.

Our pie-in-the-sky dream was some sort of screen above the patient's bed driven by a tablet they would have in their hands. The screen would show what the patient wanted to be called and one or two more tidbits of info that reminded everyone who came into the room that there was much more to the person in the bed than their diagnoses. The patient would be empowered to control the information on the screen, but we knew we had to start with something simple.  

DO

Our prototype for this model involved yours truly interviewing patients, then sprinting down to the Hub to type their responses up on a PowerPoint slide with some flashy clipart and printing it large and in color.  Then I’d hightail it back up to the room and show the patient what I’d made for them, and with their blessing, tape it above the head of their bed.

Patients loved to be given something that was about them.  One lady in particular brought her About Me from 4E to the Ren, back to 4E and back to the Ren again.  Having them placed above the head of the bed meant that it was very hard for anybody in the room to address the patient and NOT see the About Me Board. The problem here was scale.  Getting this substantial workflow hardwired into somebody’s already busy day was challenging.  I was the main person doing them, and while I loved the conversation, connection, and stories I heard, my favorite part was whenever I would hear a conversation other staff members had with a patient because of their About Me Board connection and most of all when I would hear them sharing their own.  As much as those stories would inspire me, I could not do an About Me Board for every patient.

The stories I heard and the conversations patients had with some of our staff made it easy to see that there was value in this.  Maybe not immediately in HCAHPs or some other measurable outcome, but in connecting people to their health care team in times of need.  I have a few HIPPA friendly examples I've shared of the early prototypes.  I’ve rambled enough for now, but next time I’ll share how we got to where we are now, and how I failed a whole bunch before getting it right.

Same as usual with a blog please leave some feedback (email me at mbrow163@jhmi.edu), thanks for reading and for all you do for Sibley.

promising togetherness

Hello Sibley!  Happy October!  Congratulations on the opening of the new building, I can only imagine what an exciting and exhausting time it must be.  I am truly honored that the Hubsters have invited me to write remotely from NYC.  Medical school has been exciting so far—there are endless amounts to learn about science, culture, and people.  The weeks seem to be flying by, even though I am awake the vast majority of the time.  I look forward to continue hearing about the things going on at Sibley, and I hope that you are all well and enjoying what feels like the true beginning of fall!          

Since arriving in NYC, I have quickly resumed my pursuit to understand what it means to join the medical profession (along with a new pursuit to try all the different foods in the city).  In the first week of school, we began to have conversations around this very topic, and much to my delight, we explored the Hippocratic Oath—the pledge that all medical students will take when they graduate (see full text at the end of the post).  Taking this oath marks the joining of the profession and becoming a part of something that is bigger than any individual.  It tells us to honor tradition, to represent those who have come before us, and commit to “preserve [medicine’s] finest traditions.”  Before this conversation, I don't think I have ever considered what it means to take an oath.    

Have you ever taken an oath?  It is such an impactful word in itself, regardless of the actual definition of the word.  The phrase “take an oath” just feels heavy.  I think the most common oaths are probably those that come in the form of wedding vows or in the military.  Maybe one would consider the Pledge of Allegiance a form of oath?  Joining a fraternity or sorority?  I am surely missing other things.  

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So, what has the Hippocratic Oath meant to medicine?  For some fun facts, the Hippocratic oath wasn’t formally used in all medical schools until recently.  It was actually only first used in the last couple centuries, with most medical schools joining to use some form of it in the last few decades.  For something written in the B.C. era, it seems odd to me that the oath is one of the more notorious aspects of the medical profession even though its use has only peaked recently.  Another fun fact, the exact phrase “do no harm” is not actually in the original oath—even though most of us sum up the oath with those three words.  The Hippocratic oath has evolved over the years to reflect the changes in views on abortion, lethal injection, and euthanasia, but much of the original sentiment remains the same.    

It excited me to have a chance to explore what the oath means for us as medical students.  I enjoyed seeing how my peers and some current physicians view the “why” of medicine.  How they use the oath to protect, guide, and define medicine and their actions.  It is the foundation of the culture of a community—a contract in its own way.  With my design thinking hat, however, my mind quickly drifted elsewhere.  Who is the user of this oath?  Who does it affect?  Why is it important?

The oath gives a broad outline of how physicians should act, how they should serve, and what they should value.  Surely these are things that are for physicians to know and use, but embracing these traits changes the way one interacts with the world.  It makes me think that, although the users are the physicians and medical professionals, the people affected by this oath are the patients and the community. I just have to wonder if anyone outside of medicine has ever been a part of defining this oath?  What would they want it to say?  What would a patient or community want their doctors to pledge?

One aspect I think is missing is the sentiment of being with patients—of togetherness.  The oath seems to constantly put physicians on a higher or lower level than patients—never the same.  Using “patients” in 4 of the 11 statements, the verbs of those statements are about serving, advocating, and protecting.  The other 7 statements speak to the need to uphold the tradition and integrity of the profession.  Thus, the physician’s role is to always either be serving the patient or be working to sustain something that is larger than any single person, which doesn’t seem to leave much space in the middle.  It doesn’t highlight being with someone—connecting with a person where they are and committing to joining them on that level.   

I thought more strongly about the oath just last week when I found out a high school teacher of mine passed away this summer due to cancer.  She was young, and it really broke my heart to hear the news.  My normal evening quickly turned blue.  I hadn’t been particularly close to this teacher since high school, but we had known each other well during that time.  I looked up to her, and she was one of those beautiful humans who would sacrifice themselves for each and every student, never letting anyone settle for less than their best.  She would always be able to tell when something was wrong.  She would see it on my face and wouldn’t let it go.  She would ask me and hear me.  Those were some of the first moments where I started to appreciate the way that sharing burdens can help someone not feeling alone or embarrassed or trapped—how seemingly individual challenges can be approached together.  She changed my journey, and I am sad for the loss of such a positive influence in this world.    

For some reason, I found a connection between the oath and my sadness from this news.  I find sadness in thinking about those that we lose, because they have all affected and influenced somebody else.  Every single person has changed the journey of others in some way.  I find some internal struggle at the thought that the physician's role (according to the oath) focuses on serving, advocating for, and protecting a person—not to begin by appreciating, connecting with, and valuing them. 

Maybe I am toeing a line, but I am not trying to say that the first set of verbs are bad, instead that they feel a bit incomplete and impersonal.  In moments of duress, why do we have to pledge to be either subservient or protective?  Do we assume that those are the best methods to help people when they are in need?  People are people.  My teacher’s mission was not to serve or protect me—her mission was to be with me and help me grow.  She saw me as me, no matter what, and that is what made her so amazing.  She joined me in whatever place I happened to be.  Do relationships naturally have moments of sacrificing for one another?  Yes.  Do they sometimes have moments of protectiveness?  Of course.  But, they aren't based on those sentiments first.  What if we pledged to be a team?  What if we pledged to always meet someone where they are and build from there?          

Oaths are the baseline for a culture and its expectations.  They are meant to be forever.  They help to explain motivations and objectives.  But, they also affect other people—not just the pledge takers.  They have effects outside of the professions, the institutions, or the nations in which they are made.  They surely change your outlook on the world, but they also change the way the world looks back.  

So, back to where I started—have you ever taken an oath?  Has that oath affected you? How about those around you?  Who does the oath serve?  What do you want your oath to be? 

Andrew Yin

Please feel free to share any thoughts or ideas, thanks for reading!

ayin4@jhmi.edu

 

The Oath as taken at Weill Cornell Medical College:

I do solemnly vow, to that which I value and hold most dear:

That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them in their service to humanity;

That just as I have learned from those who preceded me, so will I instruct those who follow me in the science and the art of medicine;

That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick and to prevent illness;

That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those who are entrusted to my care;

That I will not withdraw from my patients in their time of need;

That I will lead my life and practice my art with integrity and honor, using my power wisely;

That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep in confidence;

That into whatever house I shall enter, it shall be for the good of the sick;

That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice;

That above all else I will serve the highest interests of my patients through the practice of my science and my art;

That I will be an advocate for patients in need and strive for justice in the care of the sick.

I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in the joy of healing.

I make this vow freely and upon my honor.

The Virtual Chaplain Connection

Sibley Chaplain Robin Walker demonstrates the new ChapChat videoconferencing software.

Sibley Chaplain Robin Walker demonstrates the new ChapChat videoconferencing software.

Being housed in the only hospital in the D.C. metropolitan area with an Innovation Hub, Sibley’s chaplaincy care team has the opportunity to reconfigure hope in new and exciting ways. We have recently developed a new way to journey with our patients: ChapChat, a virtual chaplain connection much like Skype or FaceTime.

As care providers, we know many patients come through our doors experiencing a variety of medical obstacles. As a team, we are concerned with the spiritual and emotional healing of patients. Working with the Innovation Hub, our team has set up a secure videoconferencing platform which will allow our patients to request an e-chaplain appointment by dialing in using a secure link. Inpatients are then connected by video with the staff chaplain using a hospital-issued iPad. Upon request, outpatients will be issued a secure web link to connect to the staff chaplain from home. ChapChat allows up to three participants to conference into the session, which can allow family in a different city or state to be part of the spiritual care conversation. 

Our team has also embraced the "Lean" culture. Sibley’s ChapChat enables us to reach our patients with the ministry of presence when our patients need us most, within minutes, not hours. As a Lean initiative, ChapChat will operate as a cost saving initiative, too, reducing the necessity for a chaplain to physically be on site after-hours and by allowing outpatients to have continued spiritual care without being in the facility.

ChapChat, the virtual chaplain connection, will be available in fall 2016 for our oncology and palliative care inpatient and outpatient population. 

This article was written by care team writers Teressa Eggleston, Wesley Arning, Paulette A. McPherson and Robin P. Walker. For more information, please contact Chaplain Robin Walker at 202 537 4258 or smh-chapchat@jhmi.edu.

Extreme Sprint!

Rehab Clinical Program Manager Jessica Michie facilitated a design session to improve the community sessions held at Sibley’s warm-water therapeutic pool. The group of 16 brought together staff from all different areas of OP Rehab, including Registration, Front Desk, Therapists, Rehab Techs, and the Director of Rehabilitation Services.

This sprint differed from most, however.  It was one of the fastest sprints we’ve ever seen – the team went through the process of challenge/pain point identification, creating “How Might We’s,” several rounds of brainstorming and selecting ideas to test – all in one hour!

 

Jessica set the stage by echoing Chip’s words about the formidable assets at Sibley’s disposal – 20 acres at the top of Embassy Row in the nation’s capital at a time of unprecedented change in healthcare. She added that we also have the area’s only warm-water therapeutic pool that can provide relief for a variety of conditions – and our challenge and opportunity is to figure out how to best utilize that resource.

As the participants thought through ways to improve different aspects of the community pool experience, such as user safety and the scheduling process, Jessica encouraged her team to try a different kind of brainstorming: one which includes multiple, fast-paced group sessions using Hub Advisor Doug Solomon’s trademark of coming up with at least one idea that is either impractical, immoral, or illegal. With this technique, while none of the more wild ideas may ultimately end up being selected, they can open a pathway to new ways of thinking about the situation.

With the encouragement to go broad, the team came up with a wider variety of possible solutions, from new types of classes that could be offered, to tightening up attendance policies, to creating swipable IDs like most fitness clubs use.

 

Jessica and Dianne McCarthy, the team’s Director, were surprised and excited by the new ideas and suggestions they heard from the team. Jessica said “It was great to see everybody working together and having fun figuring out some things we’ve been thinking about for a while. We came up with some common themes and ideas that were new and unexpected.”

One of the best things about the Design Thinking methodology is its versatility: it can be used for many different purposes, from addressing an issue that is large-scale and complex to something very small and specific. While the process of designing a specific service or product can take weeks, months and even years, many of the DT tools can be used in quick sessions like this. Sometimes it’s enough just to bring a team together in a different environment, in a different way, and create space for them to be heard in the decision-making process.

Quite a few of the participants had never participated in a design thinking activity before, and many had never been in the Hub. We were blown away by the energy, creativity, and openness they brought to the process!

Janet Satter - jsatter5@jhmi.edu

Janet Satter - jsatter5@jhmi.edu

Leaving a Foot in the Door

This post is a bit overdue from the previous, but I did leave some thoughts on the table in that previous post.  As I write this post, I am amidst ending my full time presence at Sibley (for now) and am transitioning to my next adventure in medical school.  I am so thankful to Sibley and the Hub and each and every one of you for this past year-plus, because it has been more impactful than I could ever describe with words.  Each of you have forever changed the way I look at the world.  So, all I will say is thank you, and I hope you enjoy the post! 

Transitioning from one journey to another—taking one foot out and putting a new one in somewhere else—is one of the hardest things to do.  We are forced to move from one wide open door to another that is open just a crack.  We are given all this time to reflect on beginnings—how little, innocuous things can lead to big, impactful ones—suddenly recognizing some of the buds that have blossomed and bloomed beyond any of our original expectations. 

So, when did I first put my foot into Sibley’s journey?  I started as a volunteer—intimidated by the number of people in the hospital and still anxiously wondering if healthcare was where I wanted to be.  Thankfully, as always, the people here calmed me.  Marianne and Jonna were kind enough to find me an assignment even though I was late in signing up.  Mimi showed me the hospital in what proved to be the first of many wonderful, caring moments.  I still have my 3887 volunteer ID number pasted on the back of my badge, so I don’t forget where it all began! 

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That start proved to be the beginning of an irreplaceable period of time for me.  It was that little thing that led to something larger than I could have imagined.  But, behind the "when", there is also a "why".  Why did I decide to put my foot in the door of healthcare and then the Hub?

A core, foundational piece was losing my mom—to me she exemplifies the beauty and burden of unending selflessness.  Even as she paved her way through lung and brain surgery, radiation, chemo, and endless appointments, she never showed a crack in her armor or passion to take care of others.  Through thick and thin, she fought both cancer and the attention that being sick inevitably brings.  She never wavered in who she was and who she wanted to be.    

Through it all, she and I never really talked about it together—she cared for me, I cared for her, and she cared for me some more.  I watched her carry the burden of it all, fighting to protect others from the situation.  As she continued to decline, I stayed quiet.  I wasn’t really sure what to do.  I refused to believe the inevitable, even when she started hospice.  We just continued to care for one another.  She and I never figured out how to face the spotlight shining upon us—to face the situation.      

Over the years, I still wonder about the conversation that never happened.  I wonder about how or who or what would have opened that dialogue.  I fear what we would have said.  I don't even know what we would have talked about.  Maybe she didn’t want to share that with me or maybe I wouldn’t have been able to accept it, but I wish someone or something had at least built the bridge that we could then decide to walk across.  No matter how tough, I do think it was a conversation that should have happened.          

But, I can see why it didn’t happen.  I can see why this is all so tough.  No matter the treatment or the diagnosis, there are so many other factors that come along with that medical spotlight—so many burdens and unknowns for the person who is ill and the people there to support.  Going through it all with my mom was my first glimpse of that.  Whether it was getting her to appointments, or going through signing a power of attorney, or worrying about the financial stuff, there are moments that are nearly impossible to prepare for and even harder to feel like you can do them well.  Because of that, I think we fear that spotlight.  It means change.  It forces us to do things we are not used to or comfortable with.  It brings attention that we do not ask for.  Nowadays, the medicines and the treatments available give us more time to avoid the spotlight, but we must be careful not to believe that we can avoid it altogether. 

One of the most powerful things I have learned in my time at Sibley has been that there is an alternative approach to that spotlight.  You can face it head on.  Every moment I have spent in the Hub has been in some way about hearing people and making them feel heard—turning their stories into voices for action, turning solitary moments into moments of community, turning pain points into empowering ones.  It encourages the dialogue.  It needs the dialogue.  It builds the bridge that we can then walk across.  It channels the messages of Being Mortal or When Breath Becomes Air.  It provides that vital yet far less available care.        

The courage to have the conversations and to truly listen are values that I will carry forward.  I will continue to hear the Sibley voices comforting and motivating me.  I can feel the unending spirit of helping every person every time.  

As I said at the beginning, transitioning is hard.  Facing new challenges is hard.  But, I find comfort in knowing that—although things change—the people we meet, their stories, their passions, and their lessons are forever with us.  The door is always open, even if just a crack.  

Andrew Yin — ayin4@jhmi.edu

be you, be strong, be brave

part I of II: the warmth of the sunrise

As a forewarning, I am starting this post on a bittersweet note.  I couldn't figure out how to say it in the middle of a post, but, today marks two weeks before I shift away from my regular presence in the Hub.  I have many reflections to share, but they will be saved for the next post.  With that in mind, however, I decided that this and the next post should be connected by the theme of journey.  At the end of this first post, I will ask you all to share some reflections about your own journeys, and, in the second post, I will combine your reflections with some of my own.  So please, read on and definitely share your thoughts at the end!        

Over the past few weeks, the Hub has been in somewhat of a continuous sprint.  Projects have been moving to exciting places, many team members have been traveling to study innovation in other healthcare environments (shout out to our new friends in NYC, OH, DC, and more!), and the Hub continues transitioning into the summer. 

Visits to NYP-Cornell and NYP-Columbia

Visits to NYP-Cornell and NYP-Columbia

I think every team has these kinds of overly busy moments—maybe because of coinciding deadlines, need for more staff, or just a natural break in team rhythm.  Whatever the reason, these moments are frustrating and hard, and it is within them that we are most likely to be upset and impatient—not just with our work but with each other. 

I felt like we were in that kind of moment two weeks ago.  All of the sprinting caught up with us.  Time sped up, we felt overwhelmed, and we felt disjointed.  It was a bit tense.  Luckily, we recognized the importance of taking a collective breath.  We took a moment to put the journey in perspective.  We came together to slow things back down.

The team convened and began reflecting aloud: why the Hub?  Why healthcare?  Why now?  We each had a chance to share our thoughts.  I enjoyed listening to the answers of my colleagues.  Although we spend a lot of time together, it is not a common topic, and I had never thought of asking.  Now, I am very thankful that we shared this moment, because I was absolutely inspired. Here are some of the things I heard:

-the work in the Hub is about people, about hearing their voices, and about making them better by connecting with them.  I love people and anything that helps make them better is something worthwhile.

-the Hub allows me to be me.  It is a place that I don’t feel like I have to put on some façade and be someone else when I come into work.  The person I am at home is the person that gets to come here each day.  

-health and hospitals hit close to home right now because I have family who have been recently or are still ill.  To feel like I can be doing anything to help right now, it means a lot.

-I have used design thinking in many places, and it never occurred to me how well it fit for healthcare.  The process of having to come and stay at a hospital is packed with so many powerful experiences.  Working here feels more meaningful than any work I have done.      

-I love interviewing people and hearing their stories.  The Hub gives me the ability to not only do that everyday but also use those stories to fuel new ideas, and I love it. 

-the constant push for action and the willingness to try new things is something that I have never encountered before in healthcare, and it is inspiring to see in action here—it is all about making things better for people.

My teammates said things I did not expect, shared pains that I had not heard before, and revealed such a wide range of motivations and experiences.  I felt refreshed from the recent sprint of our work and a sudden renewed energy rooted in my connection with my teammates.  It reminded me that, although we each have our own reasons for being here, we are on the same journey.

Journey implies that there is a beginning, middle, and end.  It connotes adventure, hardship, and unknown.  What it doesn't relay is an amount of time—a journey can be one day, one year, one hour.  A journey can be all things that have a start and finish with something interesting in the middle.  That moment as a team was a journey we embarked on together.  The past month of sprinting together has been a journey.  The next day together will be a journey.  We all have unique motivations, but together we will share the journey.    

Before I ramble on for too long (I surely have a habit of rambling on this "cyber soapbox", as Matt Brown called it), I really want to hear about your journeys.  Whether you are at Sibley, in the DC area, or someone who has stumbled across this blog some other way, please click on the link below and share your reflections.  You can write a sentence or a paragraph, whatever you feel inspired to do.  Think about: why are you where you are now?  What inspires you each day?  Why this work?  Why Sibley?  

Please, click HERE to share, or, if you prefer, email me your reflections at ayin4@jhmi.edu

I look forward to reading your reflections, and be on the look out two weeks from now for part II!  

Andrew Yin

finding a happy medium

I’m nervous this time around.  Who knew so many people read this—people you may not expect. After the last time I yapped on here, some older fella I've never seen before yelled at me "I read your blog!" as the elevator door closed.  Never found out what he thought of it, but I'm telling myself he loved it.  I’m attempting to fill some pretty big shoes writing here today. Your regularly scheduled bloggers, and soon-to-be doctors, Andrew Yin and occasionally Jess Dawson, have been writing powerful, insightful, and inspiring posts for a while now.  Thanks so much for those you two.   They’re both headed off to med school; Jess has just gone and we have Andrew for a few more weeks. Sad to see them leave Sibley, but excited for the physicians they’ll **crosses fingers** come back to us as.  

My first blog post here almost a year ago was part Fat Head poster (that’s a Rob Jewell joke) and part introducing my new role as Geriatric Nurse Navigator in the NICHE (Nurses Improving the Care of Health System Elders) department. Something exciting in NICHE this past year is a Hub related update/shameless plug.  Suzanne Dutton, my boss and your NICHE Coordinator and I used to design thinking to come up with some ways to significantly impact patient experience scores for older patients on our target unit.   You can read our poster presentation of the results shown here. 

Another plug is that we are hosting a really cool community event next month, focused on making Sibley the most accepting hospital in the DMV, but enough about NICHE.  Over the past year, some things have changed and some have stayed the same.

Sibley is still awesome.

We all still do great work.

The Hub is still facilitating the development of the good ideas our staff are churning out.

That's not supposed to read like some ra-ra sports halftime speech, partially because that third bullet is long and nerdy-sounding, but more because it’s way bigger than sports.  Sometimes it's hard in a job that you enjoy (which I think most people here do), when you’re doing it so well, to look up and recognize the work that other people are doing. That’s one of the many reasons I quickly fell into working with the Hub. They see the tough work that everybody else is doing and genuinely just want to improve it. Make it easier. Make it better for the patient. Focusing on the end-user and not an end product means you don't go in with an idea of what will fix the problem. You go in with an idea of who has the problem and the question of how can you help them. So, whether it's a nursing issue, a communication issue, or a technology issue it is WHO is experiencing this issue that design thinking focuses on in solving the problem.  Design thinking focuses on the people, which are always the best part, and it’s their feedback that drives design. 

The last time I jumped on this cyber soapbox I went on about coming to the Hub and giving feedback. I recognize a lot of people reading this may not always have time to scoot down to the Hub, or find out what they're working on, but the Hub team recognizes this and makes a big effort to come to you and our patients. So my ‘ask’ this time is just to keep on contributing to great care in whatever your role is and to welcome those that may ask for your opinion to help others do the same. Give them honest feedback on the prototypes but also on the process of getting feedback from patients.  The Hub team will always respect that the flow of units can be complex, and because of that they sometimes they need a nudge in the right direction.  They are trying to make healthcare better for everyone involved, and they need yours and patients’ voices to do that. 

To end with a little story, I had a special moment two weeks ago with Miss Filler (if you don’t know her then SHAME) getting feedback about a new prototype.  That’s right, Miss Filler.  The best of the best—cap and all—took a few minutes to give feedback on a really cool prototype aiming to give patients control over their room while empowering them to use the call button (but that’s for another blog post).  I’m not saying she’s leading her own design sprint next week or anything, but Miss Filler took a few minutes to give feedback.  It made my month. This was big to me having worked 8 years for her because I know exactly where she stands on patients getting quality care. She would rather staff be in a patient room than anywhere else, yet she took the time to give feedback.  It was a little thing, but getting feedback and opening the minds that go with all the caring hearts at Sibley is one of the many things that make it an exciting time to be here. 

Same as usual with a blog please leave some feedback (email me at mbrow163@jhmi.edu), or yell it at me on an elevator, either way, thanks for reading and for all you do for Sibley.

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Matt Brown

How do you feel?

Happy National Nurses Week!  Thank you to all the amazing nurses who have helped the Hub on the floors and in the Hub.      

The Hub spends a lot of time exploring.  Depending on where you are in the hospital, you have probably seen members of the Hub roaming around doing interviews, observing what’s going on, or showing people some strange looking prototype.  It is likely that we have even asked you at some point for advice, information, or an interview.  We definitely ask a lot of questions and talk to a lot of people, and, as any Hubster might tell you, the reason for many of these explorations is to empathize with users to learn about their experience—a key to the design thinking process.  We need to hear, see, breath, feel, and live the life of the user to the best of our ability in order to make sure that our design matches their needs. 

As someone in the Hub and even before my time here, I feel that the word empathy is used quite a bit.  It has surely become a bit of a buzzword similar to how innovation and patient-centered are used in so many contexts.  Because of this, it can be difficult to decipher what these somewhat vague and abstract words actually mean.  One of the concepts most commonly mixed up with empathy is sympathy, and differentiating between the two can be hard.  It is important, however, because the projects that come out of design thinking and the Hub are fueled specifically by empathy instead of sympathy. 

Empathy and sympathy both involve listening and processing another person’s situation—the nuance comes in how they involve feeling.  Sympathy is when you feel for someone.  Empathy is when you feel with someone.  Sympathy is hearing someone’s situation and feeling good for them, bad for them, pitying them, relieved for them, etc.  Empathy is joining them in that moment.  It is having the same joy, sadness, fear, or anxiety of the other person.  Empathy is not judging or interpreting or trying to problem solve right away.  It is just being with that person in that moment.            

You can also watch this video by clicking here.

In our design work in the Hub, it is important that we take the time to feel with our end-users and not just feel for them.  Spending this time allows for us to more accurately think of ways to address their needs, because we focus on carrying those same pains and work to directly address them.  Conversely, feeling for the user leads to coming up mostly with ideas that we think are interesting, and we quickly fall into the trap of assuming that our users will think they are too.  Resisting interpreting or processing feelings is one of the hardest things to do.  We are so used to serving others by trying to immediately provide them with something—an answer, a plan, a service—that simply listening can feel uncomfortable. 

In a place like a hospital where we see people at their most vulnerable and can listen to full and rich life stories every day, the opportunity to practice using empathy is all too prevalent, but there is a reason that emotional and empathy fatigue exists.  Empathy demands energy and restraint.  It is an added emotional burden—one that we are not always prepared to carry.  

Know though, that we can share.  We have each other.  We can carry the burden together.  In the Hub, it is part of our work to share the moments and emotions—they are vital to our ability to design and create as one group.  Together, we share the joys and stresses and cultivate that resulting energy for action.  So, although things can sometimes be overwhelming wherever we are in the hospital, remember that there are always people that are ready to feel with you—we all share that responsibility.   

Andrew Yin

Happy Friday!  

Please email me at ayin4@jhmi.edu to share your feedback, experiences, feelings, comments, or ideas.  If you have an opportunity or challenge you would like to chat with the Hub about, submit it by clicking here!

 

Appreciating Why

As the Hub continues to build towards a culture of design, we have created a process by which anyone in the community can document and submit an opportunity or challenge that they see and would like to work on.  We know that taking the first steps on projects can be hard, so we want to be a resource that can help anyone take those first steps and be able to champion their own project!  So, if you have an opportunity or challenge you feel could use another pair of eyes, feel free to share it by clicking here!

 

Why did you get out of bed this morning?  Because you have to?  Because you always do at that time?  Because duty calls?  Because you have too much to do to just sit and “do nothing?”  How late were you up last night?  How early are you up this morning? 

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Many times we reflect on how it is that we do things—well, poorly, differently, efficiently, etc.  Sometimes we need to spend some time thinking about why we do things.  What drives us?  What gets us out of bed in the morning and what keeps us responding to work emails at some crazy late hour in the evening?  How can we recognize and appreciate those things about ourselves?

I have sometimes thought about what would happen if for one day, everyone in the world just took the day off.  It would probably be a struggle, even though it seems like a nice idea.  Alas, we do leave the comfy confines of our beds.  Additionally, we almost always have some list of tasks to do, we have our daily routines, and do our best to "have a good day".  Things don’t always go to plan—we procrastinate, we learn of extra steps involved, we have to face some adversity—yet we find a way to get them done.   We have some continual motivation to do.

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What is it?  When is the last time you tried to remind yourself or figure it out?  With the constant hustle of the every day going from meeting to meeting, speaking with patient after patient, or just going through the same routine over and over, it is easy to stop thinking about the why.  It is easy to get stuck thinking about what needs to be done instead of remembering why we do it.  So, what is the importance of asking why?

Because it forces us to name those motivations that make us do what we do—whether we are motivated by helping people, supporting our family, making an impact, learning, growing, find a purpose, or just being.  Physically naming them allows us to appreciate them.  We can recognize that it is these things that are worth sacrificing our time, sleep, comfort, relaxation, etc.  Take a moment to recognize that you are willing to make that sacrifice, even when nobody is watching.  Appreciate yourself for making that sacrifice.  Realize that those motivations are a part of you.  They say something about you.  Even though you are sometimes alone in recognizing these motivations, they still matter.  

   

Thinking about motivations is another reason that I really enjoy design thinking.  It is all too easy to settle for the superficial answer to a question—to just ask the superficial question without digging deeper.  It is easy to give a user an iPad as a prototype and ask “what do you think?”  The user might say “I like it, this is very cool.”  Without asking the next question, one might walk away and report that the user likes iPads, so we should get iPads.  You may find, however, that if you had asked the next question that the reason the user likedthe iPad is that it was small and light and presented information clearly.  They may not say anything about the technology itself.  Perhaps a simple little notebook would address the need?  

It can be hard to dive deeper.  Sometimes users have never thought about the why, so we have to ask the question in many different ways or just allow for time to process.  We can spend a lot of time trying to identify the motivations behind the “likes” or “dislikes” something.  Finding them, however, is critical.  The underlying motivations fuel our projects and our designs.  Thankfully, these motivations fuel us all everyday!

Andrew Yin

Please email me at ayin4@jhmi.edu to share your feedback, experiences, feelings, comments, or ideas.  Also, send an email if you want to join our feedback team and are willing to be interviewed for our future projects!  If you have an opportunity or challenge you would like to chat with the Hub about, submit it by clicking here!

 

 

 

 

 

 

Vulnerable Times Call for Vulnerable Measures

The big Hub announcement this week is that Joe, a Hub leader, our in-house coffee connoisseur, and generally talented extraordinaire will be leaving his full time role in the Hub at the end of this week.  Please come to the Hub to celebrate his work and his awesomeness today at 4pm, we really are going to miss him!  Today and tomorrow, we also have Doug Solomon in the Hub doing Design Team training!

Recently, I have been thinking a lot about what Joe's departure means for the Hub.  Joe has been here since the Hub first began, and his departure makes me curious to understand why the Hub team lives and breathes the way it does.  What makes the Hub tick?  What allows us to be quirky, random, empathetic, collaborative, and sometimes useful and productive (I hope!)?  I don't think I can talk coherently about intricate team dynamics in a short blog post, but I have started to think separately about one reason that seems to hit pretty close to home—vulnerability.

But what is that?  I don’t think that I have much of an answer, which is why I was happy to stumble across a TedTalk that could shine a little light on the matter.  Brené Brown roots her exploration of vulnerability in connection—explaining how connection is the first and foremost way that we find meaning in our lives.  We strive to find connections with people or concepts in order to find some greater meaning, in order to do something bigger than ourselves.  But, there is something that stands in the way—vulnerability.  What does that mean?  It is a fear of judgment, of tough decisions, of daunting issues.  It is also that nagging voice in our heads saying “I am not smart/attractive/experienced/etc. enough to be a part of this group”—that consistent fear that for some reason you are not worthy of some connection.  So, Brown set out to understand what it is that makes people feel worthy—what it is that allows them to face this fear.  What gives them the courage to embrace vulnerability?

In her research of people who were able to embrace vulnerability and build a strong sense of worthiness, she found two things—two simple things, but two powerful things.  Two things that I think are important to read slowly and deliberately (so please read slowly).  First, these people embraced authenticity—“they were willing to let go of who they thought they should be in order to be who they were”.  Second, “they believed that what made them vulnerable made them beautiful. They didn't talk about vulnerability being comfortable, nor did they really talk about it being excruciating…they just talked about it being necessary.”

While writing these quotes, I find myself unable to stop reading them (that’s my plug to have you read them again).  To me, the impact is not simply that she relays these findings so eloquently, it is that these are her findings after 6 years of research and listening to people—they are not a dream for the future but a reflection of part of the present.  That means we can find it.  That means we can connect with it.  That means we can really do it.  

To watch the whole ted talk, click here!

How does this tie back to the Hub?  Well, I would comfortably say that the Hub can be a strange group.  Many people may have heard of or done the stoke circles exercise at some point to inspire creativity—“stoke exercises” are pretty much synonymous with icebreakers, team builders, etc.—, but the circles exercise is just the tamest of the stokes that we do.  We do others that involve lots of movement, role-playing, and things where we undoubtedly have to be comfortable feeling a bit awkward and embarrassed in front of the team.  

For example, have you ever made random noises with your team?  Have you ever played the role of a caveman trying to understand the modern world as explained by your team?  Well, I have had a chance to, as a part of these stokes.  On the forefront, stokes force you to be creative, but more importantly they focus on making you all feel comfortable with one another.  The stokes give you a space to be ridiculous and open.  They help you eradicate the fear of judgement or embarrassment, which opens you to thinking in many different ways.  I admit that not all stokes are for everyone, but they all find a way to break down barriers.  They don’t just make you vulnerable.  They make you embrace it—dare I say enjoy it?

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To tie it back together a bit, I do want to bring this back to Joe.  He has been a huge reason why the culture within the Hub readily embraces vulnerability.  If you have ever heard him rant about coffee, movies, music, tasker, etc, he is full of both amazingly relevant and random information.  If you have ever been in a brainstorm session with him, you know that he always has some of the craziest and most inspiring ideas in the group.  He has continuously been willing to be open, listen to stories, weather tough storms, be encouraging, and be positive.  He showed me from day one that working in the Hub means being your full self and nothing less.  So, thank you Joe—for being you, for embracing vulnerability, and for setting this stage for us.  We wouldn't be where we are without you!    

 Andrew Yin

Please email SibleyHub@jhmi.edu to share your feedback, experiences, feelings, comments, or ideas.  Also, send an email if you want to join our feedback team and are willing to be interviewed for our future projects!

The Beginning of an ONC Adventure

Hello! My name is Jessica Dawson, and I am a project coordinator over at the Innovation Hub. You may have seen me around the hospital interviewing staff members, asking for patient feedback, and facilitating design classes. If we haven’t met, feel free to swing by the Hub and say hello!  

When I am not working in the Innovation Hub or trying to finish my bachelors at school, I intern downtown over at the Office of the National Coordinator for Health Information Technology (ONC). The ONC is a part of the federal government within the Department of Health and Human Services focused on supporting the adoption of health information technology and the promotion of nationwide health information interoperability to improve health and care.  

The beginning of a new blog post series

This blog post will be first in a new Innovation Hub blog post series about health information technology. This series will focus on the changing landscape of health information technology and what that means for Sibley medical providers in the near future. I am excited to share some of what I learn during my time at ONC and some insights into how ONC and Sibley can work together to improve the health and wellbeing of patients. 

How it all started

As a pre-med undergraduate student, I spent well over 200 hours shadowing physicians and RNs from a variety of disciplines at Sibley and at hospitals around the country. In order to get a well-rounded perspective, one of the questions I would ask each medical provider is “what is your least favorite aspect of your job?” The answer was always a variation of “I do not like how much administrative computer work I need to do.” My follow up was always: WHY? Tell me more. Over the years, I learned about difficulties of non-interoperable data, user un-friendly interfaces, constantly evolving programs, and the sheer volume of computer work. 

Last year, I interviewed a Sibley ER physician and asked “what percentage of your daily work shift is in front of a computer?” I was shocked to hear the physician frankly explain it ranged to about 50-60% of his day! 

There is no doubt that we live in a digital age. This technological and societal shift has caused healthcare to change in a variety of ways with new legislation, new technology, and new models of care. Consumer wants, needs, and expectations are evolving. 

Despite our rapid progression into the digital age, it seems that medical information systems still have much to be desired. One of the problems that electronic health systems across America face is the lack of interoperable data. 

Suppose a patient typically goes to hospital A for medical care and then needs to go to hospital B for care. It is very time-consuming and challenging to share medical information between providers due to differences in electronic health systems and a lack of standardized data delivery. The ability to easily share patient data between providers has potential benefits such as a reduction in repeated tests and diagnostic errors from incomplete histories. 

 The task to create health data interoperability is no easy feat. Stakeholders such as hospital systems like SIbley, electronic health record software publishers, health IT non-profits, and federal agencies such as the ONC are coming together to create solutions. In the coming months, I will go in-depth into the challenges in the health information technology industry, how the ONC is working to encourage solutions such as an industry standard of data sharing, and most importantly why this is so relevant for Sibley employees! 

I welcome you to join me on my adventure at the federal government! Look out for next week’s blog post! 

Thank you for reading! 
Jessica Dawson

Proto-what?

Have you ever wondered what "prototype" means?  I have.  Increasingly so.  It is one of those words that the Hub uses a lot, and, the more I hear it, the more interested I become to find out what it means to others and how our understandings differ.  I feel that some similar words—beta, pilot, mock-up, template, framework, sample, example—get used somewhat interchangeably.  These words swirl in and out of our Hub conversations, and I increasingly realize that I mix them all into one big cloud related to the idea of “prototyping”.

Having worked with people with very little design experience as well as those who are design veterans, I feel that people’s understandings of prototyping varies quite a bit.  It really depends on which similar word one quickly associates with "prototype".  On one end of the spectrum (let’s say the “mock-up” end), a prototype is not functional and is only a shell of the idea—as simple as an “app” drawn out on a piece of paper.  On the other end (the “beta” end), it is an “app” that we are already using with only minor adjustments occurring—like Google and Apple pretty much always have their software in the “beta” version.  Neither of these interpretations is wrong, but they are significantly different.  One is a lot of work away from being implementable, while the other is already functional with only small adjustments remaining—yet both could be easily classified as “prototypes”.          

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Varying interpretations are good, but I wonder how this affects our teams entering the prototyping step of the design thinking process.  Based on one’s interpretation, expectations for the prototype could vary widely.  In one case, one has to be “creative” enough to make a quick and easy version—knowing that it will get a lot of criticism and may not meaningfully deliver right away.  In another, one thinks the prototype needs to basically be a completed product.  Both scenarios can be quite intimidating.  So how does one approach it?

To give a long winded answer… As I have spent time in the Hub, I think that we use the word “prototype” to mean anything that represents our interpretation of a solution.  I think the key feature is that we are showing something to the end-user, as opposed to asking the end-user to share their general experiences with us.  We are bringing our idea to them.  Thus, in my mind, the first prototype should just be enough that I can get my idea across—it should take almost no time at all to create.  From there, continued iterations of the prototype will start to reflect the increasing depth of conversations with end-users.  The more things sound right, the further the prototype will naturally build from the rough mock-up, to the pilot, to the beta, etc.  So to answer the question above, the prototype should begin at that earliest of levels, just a representation of the idea.  In some cases, building it to beta will be quick and easy, but in others it will take longer.  Either way, start with that quick and easy version—it will save you a lot of effort.        

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Prototyping may be the hardest step of the design process.  Part of that may be attributed to a fear of the perceived scope of this step—again the blurred lines between a mock-up vs. a framework, an example vs. a pilot, a beta vs. a template, etc.  Another part could be attributed to the fear of putting ones own ideas out there instead of just being a listener.  I try (still working on it) to see it a third way. 

I try to view prototyping as the point where I can finally join the end-user in a conversation addressing their challenge, as opposed to simply listening.  Their role in the conversation is to continue to guide my ideas down the right path, while mine is to continue translating their guidance into potential solutions.  Whether they know it or not, the end-user lives with the challenge everyday, and prototyping is where we can finally sit down and say “let’s start to solve this together”.

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Andrew Yin

Please email SibleyHub@jhmi.edu to share your feedback, experiences, feelings, comments, or ideas.  Also, send an email if you want to join our feedback team and are willing to be interviewed for our future projects!

Release the Stories!

There have been some awesome things coming from the Hub recently.  First, read the latest edition of Coefficiently to learn about home automation and how it could be used at Sibley one day.  Second, you can watch this video of a presentation by sound designer Yoko to see how the hospital may be the orchestra of the future.  Thirdly, you can read the blog below.  Fourthly, you can do all of the above!  

I think one of the best things about working in a hospital and in a healthcare is the continuous relationship with people's stories.  We are interacting with many people during some of the most stressful or joyful moments in their lives, which is a powerful ingredient for storytelling.

Stories are everywhere—to me, just the simple idea of a beginning, middle, and an end describing a series of events.  We listen to them on the news, follow them in movies, read them in books, hear them from others, and tell our own everyday.  Stories have a magical element to them, too.  We can be entranced by their sound, absorbed into their words, lost amidst their emotion and suspense, transported to their worlds, and taught by their lessons.

There is one added nuance, however.  Stories only become magical when they are shared.  Until we share them with others, our stories are simply our own reality and memories.  One of the stories we sometimes share in the Hub, that I think can illustrate this, is that of a secretary who, instead of using the “conference” feature on the main phone console, used to make conference calls by taking two phones and holding them upside-down and together so the two people could talk to one another.  This realization only occurred after the designers had asked the secretary to show them how he did it, because the secretary had confidently said that he knew how to facilitate conference calls—technically he did, I guess.  Hearing stories like this, however, were the motivators for creating phone interfaces that were more readily understandable. 

Think about that secretary’s story.  To you or me, it is enlightening, slightly shocking, a bit humorous, and clearly displaying a gap in understanding.  To that secretary, however, it was simply reality—nothing more than that.  It was just how he made a conference call.  Now, this as an example is nothing special, but expand this to the many experiences that exist out there.  How many inspiring and terrifying stories have you heard from patients, family members, friends, or the larger world that seemed matter-of-fact to them but impacted you?  Inspired you?  Possibly a story of a seemingly unfazed patient who happened to be stuck on the ground at the time of your follow-up call?  Or, someone's life long battle against chronic illness?  Maybe someone's act of heroism trying to save another person?  All of these are just reality to whomever they occurred to, but they are very different once they are shared.      

In the Hub, we are in the practice of collecting, sharing, and learning from stories.  They are our fuel, fire, and inspiration.   That’s why projects like the ‘About Me’, aspects of our Room of the Future project, etc. can be so powerful, yet so simple.   Building avenues for stories opens the door for the exchange of more than just words, because even a simple, short story can be moving.  However, there is a danger to listening to just one story (click here for a TedTalk with a much more eloquent description of why), which is why we need to collect a variety of stories.  For some topics, we already have enough experience to put a story in perspective, but—when we explore new areas with which we are unfamiliar—we need a diversity of stories before we can understand the impact of that single story. 

As a final thought, don’t let the ending of a story be the end.  The most powerful stories are those that leave us feeling motivated or wanting more—they leave us itching for a sequel or wanting action.  We begin to imagine what we want to see next, what is the happy or sad ending?  What can you do to influence what happens next?  The ending becomes the beginning, which means there is a whole new story that needs to be written.  Each and every day, we have the opportunity to help write that story and make the next story even better than the last.  

 

Andrew Yin

Hope that everyone has a chance to enjoy this great weather, what a treat in March!

Please email SibleyHub@jhmi.edu to share your feedback, experiences, feelings, comments, or ideas.  Also, send an email if you want to join our feedback team and are willing to be interviewed for our future projects!

Just be.

Emotions aren’t good or bad, they just are.  A simple statement, but one that deserves a second, third, fourth, and hundredth thought and not just because it is an interesting concept to think or talk about but also because it serves as an important reminder that what is, simply is before we interpret it.  I first heard this phrase a few years ago from someone close to me, and I cherish it as one of the more powerful pieces of advice that I have ever received.  It has opened my mind to trying to, at some point during each day, just be.  To just acknowledge a moment—why it makes me feel a certain way, what that feels like, and how I can just let myself feel that briefly.  To just feel and understand that moment in an unbiased way.    

A story that reminds me about this concept and might help clarify what I am thinking occurred while I played baseball in college.  My college baseball field was smack in the center of campus—between the library and the dining hall—and was one of the busiest areas with students walking, biking, or just socializing.  One day, towards the end of a closely fought game, a Wesleyan batter, poised to win the game for us, stood waiting for his moment. 

The story goes that during that moment of total focus and concentration on the task at hand my coach approached him, put his arm around him, and just said “look at all the students walking around right now.  They don't even notice that there is a game going on.  You are about to engage in one of the most important moments of your playing career, and they don’t even know.  How about that?”    

Sometimes, the team would joke about this being some crazy and strange action from our coach, because—as players might think—he was just missing the point of the moment, like someone telling you that you should stare at the clouds while driving.  Maybe that is true, but maybe it was insight to embracing and realizing a moment.  Realizing that yes this moment is important for the baseball game and yes that it is all you want to focus on, but also that if you look 50 feet over the other way, there is someone with a completely non overlapping reality—they are just running because they are late to class.      

In the same way that we get caught up in our minds with stress, hurry, or worry, there is a beauty to taking a pause to be present in the entirety of a moment.  One would not be able to fully appreciate or embrace what made that baseball moment special unless they thought beyond their own immediate reality and focused and tried to just digest the moment as is.  There is no harm in going right back into the grind and the tunnel vision, but I think it is huge to just gain that momentary perspective every once in a while and simply acknowledge the moment without any judgement.    

One of my favorite things about design thinking is that it continuously emphasizes and works to understand the essence of people's experience—their feelings, emotions, and motivations.  “Designers” may have weird gadgets and gismos and have brainstorming sessions where we speculate out into the unknown future and challenge the realm of possibility, but, in interviewing end-users, we are just looking to find what makes people tick.  We want to let our users be themselves in the sense that we don't want them to feel like there has to be a right or wrong answer, a right or wrong feeling, or a right or wrong idea.  We are going to ask questions—what were you feeling during that experience, why did you feel that way, where do you think that feeling came from—that force someone to simply be themselves and to reflect on the raw things they experienced in a moment.  An experience isn’t right or wrong, it just is.  Emotions aren’t good or bad, they just are.  I love how design thinking emphasizes acknowledging an experience, instead of immediately interpreting it. 

Someone recently told me that we all have 30-50 thousand ideas any given day, which simply amazed me.  I would guess that has to mean that we process most if not all of them to some degree during the day.  We ignore, reject, execute, reflect, worry, stress, hope, act, procrastinate, or some variation of this on all of these ideas.  But, my new challenge is to just feel some of them.  Just let the thoughts or moments be, before executing some judgment or action.  It doesn’t have to be every one—just a few will do.  Let the experience, emotion, or thought be free before it gets put through the processor.  Just like that baseball player, try soaking in the moment.  How might we just be?

Andrew Yin

Hope everyone has a great rest of the week!  Happy almost March!

Please email SibleyHub@jhmi.edu to share your feedback, experiences, feelings, comments, or ideas.  Also, send an email if you want to join our feedback team and are willing to be interviewed for our future projects!