August 14, 2020

Episode 18: Why these two design experts think nurses are uniquely well-suited to be agents of innovation

Available on:
spotify icon of a circle and sound wavesitunes icon of a music notestitcher icon of 5 barsHPN icon of headphones and a plus sign
← Back to Handoff Podcast Page

Podcast

Description

It’s easy to look at other organizations’ innovation initiatives and feel envious and overwhelmed by the idea of trying to initiate similar change within your own workplace. But Chris McCarthy and Christi Zuber argue that nurses are actually well-suited to this challenge because of their skills as “conveners of people” who are accustomed to working with stakeholders across multiple disciplines. They also believe that the purpose-oriented nature of nursing is one of its superpowers and gives nurses the unique ability to be change agents. 

In this episode, Chris and Christi, who spent more than a decade working together as co-founders and leaders of Kaiser Permanente’s Innovation Consultancy, discuss the role of human-centered design in healthcare, the role that culture plays in innovation and why value trumps both passion and methodology. 

Links to recommended reading: 

https://www.nursefamilypartnership.org/ 

https://hopelab.org/ 

https://www.aspenlabsnetwork.com/ 

https://www.nurseleader.com/article/S1541-4612(20)30070-7/pdf

https://hbr.org/2010/09/kaiser-permanentes-innovation-on-the-front-lines

Podcast

Transcript

Dan:
First let's do a round of introductions. Christi, would love to have the audience hear a little bit about you and your background and what you're up to.

Christi:
Yeah, you bet. Thank you, Dr. Dan. I'm a registered nurse and spent the first part of my life doing mostly home health and outpatient surgery, and then went into hospital administration and opened up a children's hospital. And then sort of fast forward in my career where I went into larger health systems at Kaiser Permanente.

Christi:
And Chris and I have lots of great stories of being partners in crime at Kaiser Permanente, of founding and leading their Innovation and Human Centered Design practice.

Christi:
And then left Kaiser a couple of years ago, got my PhD in Innovation and Human Centered Design and how to bring human centered design into large complex organizations. And then started my own innovation design consulting firm called Aspen Labs. And that's what I'm doing now. And also leading a group that actually Chris founded called the Innovation Learning Network. And so that's a little about me, and then I teach Service Design at Northwestern University.

Dan:
Awesome. I want to dig into all of that with both of you. And Chris, tell us a little bit about you.

Chris:
Yeah. Hi, happy to be here as well. I'm Chris McCarthy. And a little bit of my background. I started off really in public health, was just super fascinated, in the 80s and 90s. The whole HIV epidemic really got me interested in how we could think about solving really complex challenges that affects entire populations. Interestingly, in the 90s, Kaiser Permanente started doing some really interesting fusion of population care and technology. And that was really one of my first jobs.

Chris:
And I ended up staying at Kaiser Permanente for 20 years, which is so odd to still say, even to this day. I was there from 96 to 2016.

Christi:
I think you started working when you were 14 there, Chris.

Chris:
Oh boy. If only. So while I was there just started realizing... And in fact, actually back in the 90s, innovation wasn't even really uttered in healthcare. And yet I realized what I was doing and the people I was working with were doing in hindsight, really was innovation. I left for 18 months to get an MBA where I really got exposed to design. There's a classic Harvard Business Review design case on IDEO. I think that most good MBA programs do. Instantly fell in love with that methodology. Came back to KP and the stars aligned and I was able to join Christi. And as she said, really co-lead and bring to life human centered design in that organization.

Chris:
In 2006, both Christi and I were wondering, who else around us is doing this kind of work. And that led to the formation of the Innovation Learning Network, which connected 40 care delivery systems, foundations and design firms for the past 15 years. To really build not only relationships, but to share best practices and help establish and maintain design as a way of innovating in our healthcare systems.

Chris:
And then a few years ago, I got an incredible opportunity to join one of our Innovation Learning Network organizations called Hopelab. It's an organization that tackles complex challenges for teens and young adults, using design and science as a foundation to do that. And I've been the Vice President of Strategy and Design ever since. So and that's a little bit about who I am and happy to be here.

Dan:
And you've both been mentors in innovation to me, and we had a chance to work at Kaiser Permanente together. So one of the challenges that we hear from innovators and nurses specifically is like, how do I start innovation in my organization? And many of the nurses are working for large health systems and they seem to hit their head on the wall, trying to figure out how they get people to do something different.

Dan:
And you both were able to build an entire team out by Kaiser before innovation. Can you talk a little bit about how you got that idea planted and how you started that group in such a complex, crazy organization?

Christi:
It's interesting, I think, speaking as a nurse, I completely understand that question. And I don't necessarily feel like when I went to nursing school that, that was something that I was taught. It was very focused around clinical care and public health and how you do the right thing and how you take care of chronic conditions and how you manage care plans. And it was a lot of complex, but very clinically focused curriculum and content and teaching.

Christi:
And I think when I started changing the work that I was doing, I realized I wasn't really very equipped to understand parts around, how do you really begin to start movements inside of organizations, if you will? We work inside of organizations that might not be doing the kinds of things that we would love to be doing. We might read about these fantastic case studies, like Chris was talking about, or hear people that work at other organizations saying, "Why isn't my organization doing this?"

Christi:
And I really want to try to tackle A, B, C and D. And it's really easy to get frustrated and blame the bigger system, if you will, that you're a part of. And I think what I started to learn myself, one as a nurse is that there were things that I didn't really couch as the ability to start something brand new in an organization. That I had learned which is, how do you work with multidisciplinary teams? How do you get people on the same page towards a common purpose?

Christi:
And I think those things translate very well when you're trying to bring something into an organization. How do you work with people that have different skillsets and be better because they have different skill sets? These diverse teams and diversity comes in all sorts of shapes and forms and it leads at the end of the day to more innovative outcomes. And so I think as a nurse, it did give me some of that foundation that I didn't even really realize, but it was very, you could transfer it into this context of innovation. You know, how do you work with the teams that way?

Christi:
And then, like I said, how do you find people that have this drive for purpose of making an impact in this way? Because purpose will overcome a lot of the hassles that are put in front of you. It doesn't fix everything obviously, but it does set that North star so that you have that excitement, you have that commonality, you have that thing that you're striving for together. And if you could put those things together and help people within your organization that, say that small band of team begin to make some progress towards that bigger goal, you've got gold.

Christi:
You're not going to transform your entire organization in one fell swoop. But if you could have a good diverse multidisciplinary team, you could have a shared common purpose and you can begin to make some progress towards that purpose. That's, I think where a lot of that starts.

Dan:
And Chris, how did you convince the leadership to jump in with this?

Chris:
Part of it was a secret weapon called Christi Zuber. Yeah, Seriously. So I distinctly remember the very first meeting we ever had. And really, I think both of us, including our partner at the time Adrienne Philpart, we all knew that this was something that we believed in and were passionate about. At the same time, we didn't necessarily have a perfectly mapped out plan on how we were in convinced leadership and how we were going to make this an ongoing entity.

Chris:
I think what we inherently understood was that the passion and the desire for this could only go so far, but we needed to show value. And again, I think we've reflected on this several times in the many years since we've started this, and that is a hindsight analysis, but boy, was it powerful. That right from the beginning we demonstrated value and we put the value forward first. And so rather than trying to convince leaders that design was the way to do things. It was that we solved a real set of challenges that Kaiser Permanente was having. And then marrying that to the message of, well, how the heck did we do that so fast? Well, we did that so fast and furious, which is rare in healthcare delivery, is by the methods that we brought it to life. And that happens to be human centered design.

Chris:
And so I think it would have fallen flat and I've seen it fall flat in many organizations where they lead with a methodology, they lead with their aspirations. And you have to have those, but really in order to convince a leader who has very little time in their day to go deep is show them value, bring value to the organization. And it makes it much easier to deliver the message of change that goes with it.

Dan:
So you bring up a good point about leading with human centered design. So I think we've all seen that across organizations. They're like, "Hey, we have designers now, or we have this. We're going to go bring patients in and frontline staff in to solve this problem." And I think sometimes that falls flat because it becomes more about executing a process than solving the problem.

Dan:
And I know you've been all over the world doing this work. Do you have thoughts on that and how you can actually not focus maybe on the human centered design, but more on solving the problem and the human centered design is kind of in the background as the process to get that done?

Christi:
Yeah. I'll say that, that's were an excellent point, Chris, that you bring up. If you're not solving a problem that anyone cares about or really not solving a problem at all, it's just activity. But organizations are busy, then you're competing on what? We could do some great workshops. Look at all the wonderful pictures of our post-it notes. You know, that doesn't hold up for very long.

Dan:
Mm-hmm (affirmative).

Christi:
That might make people feel good in a moment, but that's not something that's very sustainable. And so when you're looking at trying to do this within your organization, and this is a part of the methodology, what is the problem that you're trying to solve? There's two main parts, there's problem framing and problem solving, if you were to break down human centered design. So this problem framing piece is really, what is it that you're attempting to do?

Christi:
Also, if you come more from the lean startup world, or what have you, jobs to be done might be a phrase that you talk about. If you're not very clear on what's the job to be done, what's the problem that you're trying to solve, then it ends up being a lot of busy work that might feel good in the moment and might yield you some great pictures and some fun stories, but that's not sustainable within an organization.

Christi:
If you're actually really looking to create change in your organization, look for some of those more valuable problems. Better understand them, utilizing these kinds of methods and then rapidly begin to create change around them, to be able to show that you can do something. And I would say, kind of refining on beginning to create some sort of value, don't start with the hardest thing in your organization because you don't have the skills yet. You're learning how to do this. So start with something that you have a chance on.

Christi:
If you were just to learn these methods, you wouldn't say, now I'm 101 in the program, so I'm going to solve world hunger. That's probably not the best coming out of the box approach. Start with something that you can begin to chip away with, even if it's a very complex problem, find a piece of it that you can begin to use and create some movement towards. Because your organization, the context of your organization, who the players are, how they're going to respond, how you try things within that organization, how you message, how you tell the stories, those are all really unique to your organization. And it's a incredibly interesting and fascinating journey to go down.

Christi:
But don't underestimate that, you need to understand how that looks and feels within your organization. And part of understanding that is taking on something and beginning to make some progress and movement towards it. So if you take on the most complex thing, you get stuck somewhere between step one and three, and then you just blame, well, these methods are stupid and this is ridiculous. Or we don't know how to do this, or we have bad leadership, or the host of things that we'll say.

Christi:
So start with something that you could actually make some approach on and then you'll begin to learn how to do this and take on more and more complex things. And I see this around the globe of organizations all over the place that say, "Well, we just aren't that kind of organization that can do these sorts of things." And I say, "You know, not true. You just might not know how it fits and works within your organization yet."

Dan:
Mm-hmm (affirmative).

Christi:
But beginning to make progress and not just leaving it to running a bunch of ideation sessions with post-it notes, that's not going to get you anything. Those are fun, but take on something and try to see it through and see what you learn along the way. And you'll do it better the next go round and better the next go around, et cetera.

Dan:
Yeah, I think you bring up two good points. Like the culture piece is huge. So you can't just plop these processes into anywhere. You have to adjust them and figure out the flow of the people and the interaction between people.

Christi:
Yeah.

Dan:
That's a great point. Chris, what are your thoughts?

Chris:
Yeah. A parallel build to starting with something small or actually the desire that most organizations have as Christi put it, they're trying to solve world hunger. Is that often they'll also want the culture to be installed on day one, this innovation culture, and that too needs to start small. And I think these ideas of lower hanging fruit and starting small on your culture effort, they go hand in hand. Organizations and people will look outside for inspiration and they see these very advanced organizations.

Chris:
And they think that through a training program that they can bypass all of the learning, pain, and joy in years of work. And they can bypass that and just get to that level. And so if they're able to bypass it, then they should also be able to take on the world hunger problems. And instead, I think we all know that real deep learning happens in a very measured and it's organic.

Chris:
It can be kind of planned, but you grow, you don't just balloon out into this elephant. And so in addition to choosing wisely and small is really to think about some of the micro changes in culture that need to happen alongside of that. And let that snowball just as you build experience in adding more value on more complex things, your culture also starts mirroring that as well. But you can't bypass that, that has to be measured and it takes time to do it. And that's what I think a lot of leaders don't actually want or appreciate.

Dan:
Yeah, that's a good point too. I mean, culture change in the literature, I think says between five and seven years, you can have a culture change. I know Christi you've written about microclimates, I'm a big fan of Edgar Schein and the artifacts changing culture. And Chris, I think you hit on that as well. Which is you have to do little tiny changes that change the way people interact and think about things and that doesn't happen overnight and you can't hire it in, you have to build up these changes over time. So that just the way you approach work and show up every day becomes a new normal, I think. And so, yeah.

Christi:
Yeah.

Dan:
It's that intentional work. And I think what I see is people jump right into rapid brainstorming and they throw a post-it notes on a wall. And like you said, they take pictures of it and bam, we have innovation.

Christi:
Right.

Dan:
And then everything else drops off. And there's nothing else after that, it goes into some black hole and people say, we'll revisit it when it's strategy time, five years from now or whatever it is. So in terms of that, what are some of the big missed opportunities as far as human centered design goes, that new innovators maybe forget about, or don't do? I think they're all doing the rapid brainstorming. I think that's what they associate with innovation.

Christi:
Yeah.

Dan:
But what are some of the other skills or other practices that they should be thinking more about that would get them further along innovation journey?

Christi:
I'd say prototyping, I think is one of the number one things in my mind. Which is, and I think Chris can tell some great stories about the work that his organization did with Nurse-Family Partnership. And I think those will be some really cool things to bring that to life. But I think, when we talk about prototyping... What actually Dan, one of your past guests talked about creativity.

Dan:
Yeah, Dan Pesut.

Christi:
Yeah. He brought up liberating structures.

Dan:
Mm-hmm (affirmative).

Christi:
And he was talking about the 15% solutions. And he used it in describing it in a context that I hadn't really thought about it before, but he was saying, "I really like 15% solutions, which is you don't have to have the entire thing put together." What is just that, you know, just enough. And he was saying, "That's really important in organizations because most people don't have the ability or the opportunity to create that entire thing. You don't have control over everything in that organization. So do something in the space that you do have some control over." And so I would relate that into prototyping.

Christi:
So 15% solutions is fundamentally around prototyping, is how do you get out something that's just good enough to be able to continue to learn and evolve your ideas. And it starts to pull in the same components of brainstorming, which is okay, that didn't work. Now, what are the new ideas? So you have to keep evolving those and creatively thinking about those.

Christi:
It also brings in empathy and understanding of your user because as you begin to try something and actually put it in front of people, how they react to it will often tell you much more about their idea and what their needs are, then simply asking them directly or sometimes even observing them. So I think prototyping is just one of those super powers that if an organization can become that learning organization and really get good at prototyping, the world unlocks for them.

Dan:
Chris, tell us about the Nurse-Family Partnership.

Chris:
Yeah, I will, in one second. This will build up to the Nurse-Family Partnership. One other angle that I think is extraordinarily important. And again, I think this is in hindsight of the work that Christi and I did for so many years at KP was, relationship building. We have seen so many innovation groups across the healthcare landscape, both inside and outside of KP. That when it becomes too innovation centric or team centric, you often will lose the very people who you absolutely need to have on your side to make these things go.

Chris:
And in hindsight, that turned out to be super power of the work that Christi and I did. And it was also necessary. We didn't even quite realize how much relationship building we were doing because it was inherent. We were this small national group, no one really heard of us. And the way we got things moving was really working on trust building and making sure we took everybody on the journey. And made sure everybody shared in the success of what came out of that work. And when I think about the current work that I now do at Hopelab, everything we do is in partnership. And it really made me appreciate the inherent stuff that I learned at Kaiser Permanente and its politics at its best.

Chris:
It's really about changing the hearts and minds and really ensuring that we all win. And so, one of our big projects at Hopelab has been partnering with the Nurse-Family Partnership. It's an amazing program of 40 years, 40 plus years of evidence of really helping first time, low income moms have better health outcomes for themselves and their babies. Something that they didn't have at the Nurse-Family Partnership was a real digital forward application of that work and especially important for digital natives.

Chris:
And so through partnership with them and with Ayogo who was the technology platform and working with these first time low-income moms, all of that came together. Very different organizations, Nurse-Family Partnership, this massive organization that cares for 55,000 families across the United States. Ayogo was a Canadian technology firm, and then Hopelab is a small social innovation lab in San Francisco.

Chris:
All three organizations have their own superpowers, have their own needs, have their own things they're trying to accomplish. But relationship building, partnership building is really, I think the superpower that allows innovation to thrive. And so that threesome created an innovation called Goal Mama. It's now scaling up to the 55,000 families that the Nurse-Family Partnership. And it's a really novel digital technology that enhances the relationship between nurses and moms.

Chris:
And it augments what the program does, which is sends a nurse into a mom's home. So that's a very analog, in person experience, but it creates a digital experience that fills in the gaps in between those visits. And that was something that these young moms were craving. It fits their lifestyle as digital natives, and really allows the Nurse-Family Partnership to be now in the forefront and be a very innovative organization and deeply relevant.

Christi:
Hey Dan, can I grab the host mic from you and ask a follow up question of Chris?

Dan:
Of course. Yes, of course.

Christi:
You've got an unruly group here today.

Dan:
I like it. I like it. Season two.

Christi:
Exactly. It's on baby, it's all.

Dan:
It's on.

Christi:
So Chris, I have a question. This comes up a lot and I'd love to know your viewpoint from the Hopelab standpoint of what do you look for either in process or this [foreign language 00:00:24:34]? I don't know what it is that you look for in trying to find a good partner. So you talked about the group in Canada.

Chris:
Mm-hmm (affirmative).

Christi:
So I hear very frequently organizations say, "These are various ideas. We're trying to figure out who these external partners would be to help us to begin to bring things forward." Particularly from, and we're talking about a technology platform here, the technology partner. Can you talk about, what do you all do? How do you separate out, who might be great partners and who might not to go on this journey with you?

Chris:
Yeah, it's a great question. And my answer changes monthly.

Christi:
Mm-hmm (affirmative). Yeah.

Chris:
As we continue to learn more from more and more partners.

Christi:
Mm-hmm (affirmative).

Chris:
I would say the meta, the meta unifier here is, and this is going to sound like a cop out, but it's not, truly, we're looking for mission orientation.

Christi:
Mm-hmm (affirmative).

Chris:
And that mission orientation has really allowed us to have difficult and complex conversations because the missions are deeply aligned. And so what we're looking for at the first pass is, is the mission not just aligned with ours, but does it seem to be manifested in what they do and how they interact? Because as I know you are deeply steeped in, mission does not often align to culture. And often the mission statements are just statements. You really don't see organizations living them.

Christi:
Yeah.

Chris:
So we're at the very first pass. We're looking for organizations that are aligned into how we think about the world, but we want to see it manifested in what they actually do, even in our first sets of conversations that we have with them. And those are such leading indicators that this can work or not. So that is absolutely the first pass that we're looking for at Hopelab.

Christi:
Yeah. There's an interesting space in there. I think when we're talking about nurses and what nurses know, and what they can bring into that. Either partnering up with startups, if they're the clinicians inside of an organization or what kind of role they could play within these startups of what is this actually about? What is it that we're trying to achieve beyond understanding?

Christi:
There are plenty of people who know the technicalities behind things, but like the desirability, the, what is the purpose behind this? What is that need that we're trying to fit? I think that's such an awesome space for nurses to be able to play in. And on whichever camp that you want to be in, whether it's the organization or the startup. I think there's some fascinating opportunities there for nurses to be able to be that translator, that aligner, that convener of people for that higher good.

Dan:
Yeah. Nurses are really a mission driven profession.

Christi:
Yeah.

Dan:
And so they make great partners in this work.

Christi:
Mm-hmm (affirmative).

Chris:
Yeah, yeah. And one build on that, very specifically onto the startup world is I think that is still a little bit of the Wild West.

Christi:
Yeah.

Chris:
Where you will often see... You can very easily detect a misalignment in mission. When these small startups show up, their missions are beautiful, but it's really about pushing product and being very slick and overly savvy. You can feel that disconnect. And just as a counterpoint, Ayogo, you see in their actions that not only do they have great technology, but they are mission aligned. They're doing a lot of work and donating a lot of their services to really push what's possible for organizations that serve the underserved. And those kinds of signals, I think, are really important.

Chris:
You can feel their CEO, the heart forward in business mind forward together. And I think so many organizations lose that. And that to us is really, really important.

Dan:
Yeah, that's a great point. I mean, I've noticed that in our small startup as well, the mission focused. I mean, we partnered with Ohio State to help provide mental health resources to nurses and some other things that have just been outside the norm of a venture backed company.

Christi:
Yeah.

Dan:
And it translates directly into relationship building. I mean, I can now confidently go and speak to colleagues of mine and say, "Hey, we're doing something great." And not have to sell.

Christi:
Yeah.

Dan:
It's about like, we are doing this whether you want to talk to us or not. We're moving forward, we have this bigger vision of what's possible. And we'd love to have you come along with us and it's not trying to pitch a product or a technology or a service or whatever. And I think years at Kaiser Permanente meeting with startups, I saw so much of that.

Christi:
Yeah.

Dan:
Just the polished decks and the, just the people coming in, is telling us how great they are and how many users they have and not really aligning with that mission. And I think it does make a huge difference partnership.

Christi:
I remember, Dan, the very first conversation that I had with you after you'd started the job at Trusted Health, and you were talking about, I really want to do things that really empower nurses. That's a clear purpose beyond what it is that your business plan might say. And if you bring that to life, other things start to come from that, right? And so I think that, that purpose, that mission has been, I mean, I think you guys at Trusted Health, you guys are leading an amazing new space for nurses and really investing in the profession. And whether you're a frontline care provider, whether you're a leader in it, whether you interacted with it at some other area around the fringe. And I think that, that shows up in what it is that can become possible and hopefully for the doors that open.

Dan:
Yeah. Yeah, no, I agree. Thank you for that.

Christi:
Yeah, yeah.

Dan:
So we're coming up on the end of our time here together. So what we like to do at the end of The Handoff podcast is actually hand off some information to nurse leaders to help them advance the ball in whatever topic we've discussed. And so what I would like you to think about is, what would you like to hand off to nurse leaders about how they can incorporate human centered design and innovation into their organizations more effectively? So I don't care who goes first. Whoever has an idea on that, Chris or Christi.

Christi:
I would say don't let perfection be the enemy of just getting started. So begin to get started. And whether that's in your playing around and learning the methods in your personal life, translating them into your work life, but just get started. I would also say, there's lots of fantastic resources out there in the world that you can tap into. Free things that you can begin to get exposed to and begin to understand.

Christi:
And then I would also say in terms of partnerships, Chris and Dan, and I've talked a lot about partnerships, if you do find partners that you want to bring into your journey, make sure that they're partners that want to help you to build your capabilities and help you to be successful. When we talked about missions, that's a fundamental mission at Aspen Labs that we have, and other organizations have that as well. Look for that in partners that you might partner with, as people that want to build your capabilities and make you better and empower you through the process. So solve a problem that's important. Start small and build your skills and capabilities and get ready for the exciting journey ahead.

Chris:
That was for great Christi.

Christi:
Thanks.

Chris:
I mean, I kind of feel like this whole podcast we were handing off all kinds of these tips.

Dan:
Maybe lets just is join the ILN and then get connected with other innovators. I don't know.

Chris:
Exactly, exactly. There's one more I will add, which is don't forget the superpowers you already have. Healthcare has been notoriously good about data and measurement. And that married to good innovation practice can go so, so far. I mean, circling back to what we said earlier in this podcast about showing value, that is an important part of getting a good innovation practice founded.

Chris:
And I think sometimes innovation and design the way it's presented to healthcare forgets about that piece of it. It kind of veers towards the creative, which is deeply needed. But that plus being able to measure and show how you are impacting the system. And by the way, it's a superpower that many nurses actually already have in their arsenal, bring that together with starting an innovation and design practice and you will go far.

Dan:
Awesome, great tips. And you can read more about some of this stuff. Chris, Christi, and I have an article that just released in Nurse Leader this month. And so you can read more about leading innovation at the front lines. You can also find Christi at Aspen Labs and Chris McCarthy at Hopelab.

Dan:
Thank you both so much for being on the show. We'll put links to your bios and your organizations for the listeners to connect with and just really appreciate the fun conversation. And thanks for kicking off season two of The Handoff.

Christi:
All right. Thanks Dan.

Chris:
It was awesome. Thank you so much.

Dan:
Thank you so much for tuning into The Handoff. If you like what you heard today, please consider writing us a review on iTunes or wherever you listen to podcasts. This is Dr. Nurse Dan. See you next time.

Thank you and welcome to the Trusted Community!
Oops! Something went wrong while submitting the form.