It’s not unusual to have a handful of visitors drop by the Health Leads desks in Chicago for a day, looking to find out exactly what it is we do. To us as student leadership, it’s always nice to be reminded that there are individuals outside of Health Leads who are interested in social determinants of health, and we welcome the outside perspective. It is pretty unusual, however, for our own interest in the group who is observing us to eclipse their interest in us. This is what happened when Allison and Perry from the Center for Innovation came to visit. Quickly we realized that the kinds of questions they were asking, about what did/didn’t work with Health Leads, reflected the kind of thinking we’d been “trained” to do at the University of Chicago – to walk 360˚ around a problem, welcome any nuances we find, expand our conception of the context the problem exists in, and then pull all of this back together at the end to see what the problem really is after all. Before meeting these CFI representatives, we had absolutely no idea that there was an institutionally endorsed, large-scale model for utilizing this kind of thinking in a practical way. We had no idea there was a group so invested in asking the right questions, encouraging innovation to flourish, or engaging in design thinking. Honestly, we had no idea what design thinking even was. So we decided to come to Mayo to find out.
Design thinking (as we understand it)
If we were looking for a crash course in design thinking, we definitely got it. Certainly, on the one hand, design thinking is about not being afraid to ask the right questions – moving beyond the “how do we improve patient compliance” question to explore the bigger, scarier questions behind it: what are the obstacles to compliance that lie outside of the health care realm, is our current EMR capable of recording that kind of ‘soft’ information, and can we achieve improvement with the current staff members and staff relationships we have in place. It’s about innovating instead of implementing small, band-aid solutions that you can only pray will end up working. It’s the difference between asking “how can we improve this system?” and “is this even the right system in the first place?”
Yet, on the other hand, even beyond asking the right questions and looking at systems with a mind to innovate them, design thinking is about listening carefully and communicating effectively. When you’re dealing with health care, this ends up meaning valuing the patient perspective and the personal challenges providers have in connecting with their patients, as well as with each other. In terms of listening carefully, the CFI has a commitment to observing how a system operates. Talking to the people who circulate in the system, soliciting their opinions and values – these are key elements of the designer’s process. Experimentation – trying out new models, even if you have absolutely no expectation that they will work – is another useful method for gathering information about the context you’re working within. At their core, these experiments are yet another form of active listening. One thing that the CFI really understands is that if you want to find a solution that will work with a specific set of people, you need to make sure you pick up on the quirks of how they interact with each other and the nuances of what is truly important them.
Then, once these insights are gathered, the next step for the designers is to synthesize what they have learned and to communicate it back – to each other and to the people asking for their help. Ideas are “blown up” into beautiful visual, auditory, or even sometimes kinesthetic representations. It’s hard to find a surface you can’t write or draw on in the CFI or, perhaps more importantly, that hasn’t been written or drawn on already. Making insights communicable is an essential step in realizing, and then sequentially conveying, why certain solutions will or will not work. Systems are modeled in visuals that clearly represent the relations between the different cogs in the machine, and bring life to these cogs – reminding us that they are either people themselves, or things that people interact with closely. This allows form, function, and human factors to shape the thoughts and conversations around the problem and its solution. Furthermore, it allows everyone involved to occupy a common mental space. It facilitates clear, effective communication between parties, as well as the trust necessary for someone to say “yes, please help us implement this solution.”
If anything, it was this type of trust, collaboration, and willingness to listen that really seemed to follow us around, popping up in every department we visited and every interaction we had during our visit at Mayo. The commitment of the people who work here to coming together to provide the best care possible is remarkable. Though we were warned about the cold weather before we came to Minnesota, it ended up feeling like one of the warmest places we’d ever been.
Incredibly enough, the longer we were here, the more this united spirit really seemed to start resonating throughout the clinic physically. From the moment we walked in, it was impossible not be struck by how surprisingly beautiful the Mayo Clinic was. Over time, as our appreciation for the atmosphere of Mayo grew, the wide open atriums, softly waving glass walls, and marble hallways became spaces that atmosphere filled and thrived in. One of Kajsa’s favorite memories of our time here was inevitably the five minutes she got to sit in the Center for the Spirit, a soothing resource patients and their family members can use to absorb some calm and caring while they’re going through difficult times in the clinic. Walking through any part of the clinic, surrounded by art and serenaded by a live piano, we couldn’t help but feel that we might not mind having to be patients here, if the occasion ever arose.
As we explored the rural surroundings of Rochester, the warmth and connectedness we’d felt inside the clinic proved to be endemic of the people in this area as a whole. We got a good dose of this Minnesota Nice while we tagged along with the team to the towns in Dodge County, getting on-the-ground experience with design research. Our first day, we dropped in on a small restaurant called Country Pleasures and, while chowing down on sandwiches and watermelon, got the inevitable, “Y’all aren’t from around here, are you…I don’t recognize your faces.” The small town feel touched us in other ways as we stopped in Kasson, Dodge Center, West Concord, and Hayfield. We sipped coffee amongst the locals at Omar’s Cafe, treating ourselves to fresh-baked, home-made cinnamon rolls before popping in on the senior center’s holiday party next door. We chatted with the brunch and coffee crowd at Daniel’s, and listened as they reminisced about the old days (when Kasson had 7 grocery stores and 3 new-car dealerships) and shared their hopes and dreams for the community to grow and strengthen.
Not only did we find out that Dodge County led the nation in Relay for Life donations per capita, we learned that the community got a troupe of volunteers together and built their own golf course. Sure, sometimes we got that half-joking accusation, “So what are you tryin’ to sell me?” Sometimes even, “Gonna try to make me pay more taxes, huh?” But through it all – driving from town to town, just sitting down and really listening to people –we immersed ourselves in the community. We saw and heard and felt the warm undertones of pride in all of our conversations. We collected dozens of stories that spoke to peoples’ generosity and the spirit of volunteerism that gave the whole community its profound strength.
It’s amazing how the simplest insights can change your entire perspective on a project. It’s even more amazing that this kind of research isn’t always done before delving into such an endeavor. Wanting to provide social services as part of a larger health care perspective is one thing, but knowing how to best deliver these services – actually knowing what a community wants and needs – is another thing entirely. That kind of intuition and familiarity could not have been captured by surveys or questionnaires or literature searches online. The real complexity of community is flavored by coffee chats, senior holiday parties, and an appreciation of what the community has been, who they are, and where they’re going.
A future of innovation
In between trips to small-town Minnesota, multi-million-dollar grant meetings, and conversations with brilliant people, there’s no doubt that unbeatable opportunities lie within Mayo’s 15 million square feet (and, of course, we plan to do everything but beat down the doors to try to take advantage of all of them). But we’re taking a lot back with us to Chicago as well.
As students on the long and winding road to a career in serving patients, we’ve been extremely lucky to have had the experiences we’ve had. Working with Health Leads pushed us out of the bubble of healthcare as medical care and forced us to think about the social determinants of health. Two plus years of experience taught us to question the systems by which care is delivered, and to think more critically about the parts of the patient perspective you’ll never see unless you solicit more information about the patient’s context. Trying to build our own Health Leads version 2.0 keyed us in to how important institutional infrastructure and culture are to designing and implementing change. We blew up ideas, connected with a community, and dreamed up experiments to inform social service interventions at the CFI – all in service to patients.
Experts in design thinking we may not yet be, but we leave with the warm and fuzzy feeling that our experiences will be put to good use in the future. These past 10 days have been invaluable to our education not only as (hopefully) future physicians, but also as people. Whether we’re developing a new program, learning to become doctors, or just being receptive to design thinking, the ideations of innovation will always inform the way we approach the world.
Thanks, CFI. It’s been real.
Erica Ting and Kajsa Nichols-Smith are seniors at the University of Chicago and part of the Chicago Health Leads team. Perry Erdahl, Sr. Project Manager and Allison Verdoorn, Service Designer, both from the Center for Innovation, met them during a site visit to Chicago and had wonderful engaging conversations with them about their work and the CFI approach to design thinking. The CFI methodology peaked their interest and they contacted the Center wondering if they could spend their winter break at CFI learning more. For the past two weeks their time here has included shadowing designers, spending time at the medical school, site visits, interviews, many meetings and great collaboration.
Once they graduate from the University of Chicago they are both hoping to attend medical school after a year off. We wish you well, stay in touch!