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Innovating Hubs of Health

Nick Dawson is the Executive Director of the Johns Hopkins Sibley Innovation Hub and a proponent of human-centered design in health care as a way to create a health system that is more desirable, compassionate and advanced. In the Innovation Hub, he helps lead an innovation team charged with tackling both simple and complex challenges for patients, staff and providers. The Hub promotes a see one, do one, lead one model.  It begins with offering a two-day intensive introduction to design thinking for everyone from the front line to senior leadership.

Nick is also the Chair of the Executive Board for Stanfords Medicine X program, a catalyst for innovation, patient empowerment and advances in academic medicine. His past roles include president of the Society for Participatory Medicine and leadership positions at various hospitals in strategy, finance and operations.  

What projects is the Sibley Innovation Hub working on?

Were doing a lot of creative confidence building. Its really easy for my team to be disruptiveand pitch wild ideas, but somebody has to implement those ideas. For us, it’s about building a hospital culture that is open to trying things differently. Its not radical or disruptiveor creating something completely new. Its rapid, small changes to get an entire organization used to changing quickly, being empathetic, and using data to drive action.

This year our CEO mandated that every person in a leadership position has to do two human-centered design projects. Thats about 300 projects. So the Hubs job is to train them in design, give them the coaching and support they need.

We have two or three projects that the innovation team is running ourselves. For instance, we spent about a year studying the inpatient experience. One of the things we learned is that when youre experiencing the grief of loss of health, the things you can control are disproportionately satisfying. Conversely, the things you cant control are disproportionately disturbing. Weve been developing tools to anticipate and react to the needs of patients in real time, as well as  give patients more control. One such tool is a mounted tablet on a patients bed. If patients want to order anything from a pillow to a chaplain visit, now they can. It also lets patients tell providers what they need and give feedback in real time. It even gives patients the ability to order food from the hospitals service or from any neighborhood restaurant.

How do you think design thinking can improve health care?

Design thinking helps you get to a deeper understanding of a problem, so you make sure youre solving for the right problemnot the surface-level problem. For instance, in some traditional approaches to addressing problems of public health, well go in and look at the data and maybe do some ethnographic research and lets say we discover that mothers arent breast feeding. So we decide to implement a program to teach the value of breastfeeding. I think that kind of program can be good and have an effect. But design thinking helps us go a notch deeper and find why this group of people isnt breastfeeding. Maybe theres something about these peoples traditions or some emotional barrier or some unmet want. Once you understand the root of the problem, the innovation is not always an app or a piece of technologyits what solves the right problem. The difference is having conversations with people for whom you are designing the solution. Its one of those things that at least from where Im standing is so obvious: lets involve the person who experiences the problem and get their perspective.

Heres another example: I was working at the VA and doctors told me, We are really good at listening to patients about how hard it is to have their conditions or deal with their medical device. We just try to work with them to get past these painful feelings. Why are we only helping them to cope? My thought is lets design a solution to get rid of the feelings. I see patientsexperience as insight into how to solve an upstream problem. Its an oversimplification, but you get the idea.

How have you found providers respond to design thinking?

When we first present design thinking, practitioners sometimes push back because they think they are supposed to be engaging patients in these deep empathy interviews in the clinic. Its unfair to expect practitioners to use clinic visits as a design opportunity in todays era of medicine. But on the other hand, people like being heard and theres probably a lot we can do to improve that. Theres a lot of low-hanging fruit that the health care industry is just ignoringsimple changes that would make patients feel better about their interactions with the system.

You’ve spent a lot of time working in health care in a variety of roles. What’s a major complaint you hear from providers these days?

I cant tell you how often I hear, I came into medicine to help heal people and instead Im entering notes on electronic medical records all day.We are (I hope) at the nadir of the adoption of technology to make care better, because it is causing so much interference relative to its value. But I am a total optimist when it comes to technology. Scribes seem to be one solution to this problem, but I think a design approach could lead to some real improvements.

What’s currently going on in health care that you find inspiring?

There are several things. One is this growing group (thats probably always been there) of peoplepatients and disease-specific communities and providers who are working with patientswho are creating maker-hacker-solutions.Heres what I mean: I have a friend who has had Type 1 diabetes since she was fourteen. She built herself her own artificial pancreas. Now she has essentially perfectly controlled blood glucose. Its way ahead of what Medtronic put out as their prototype. Thats the far end of the bell curve, but any patient who is a maker and hacker is really inspiring, solving for their life rather than a particular clinical problem.

Another thing Im particularly excited by is innovation around community health and public health. People are going upstream of traditional health care to find the barriers to communities living better days. The innovative energy around classic public health problems like jobs, walkability, and food deserts gives me a lot of hope.

In general, I am excited that patient-centered design is not taboo. In fact, its becoming more and more the norm in medical education and the world of health care. Its in vogue to have a Chief Innovation Officer of some kind, or roles like mine, in hospitals. It tells me the industry is willing to embrace change.

Speaking of inspiring, I have to share this anecdote. Obama held a conference last year called Frontiers, which focused on precision medicine and advancements in health care among other subjects. At one point, he had a patient advocate on stage and in the course of their conversation he said, It occurs to me what health care really needs is what Silicon Valley calls human-centered design.I was in the audience and nearly levitated out of my chair. That was the best validation I have ever received.