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Disruptive Innovation, Sparks of Light, or the Evolution of Care: Recap of Mayo Transform Conference

In what has been a roller-coaster year for healthcare legislation, it’s the annual touchstone of the Mayo Clinic Transform Conference provided a welcome opportunity to reflect on where we are. This conference, sponsored by the Mayo Clinic Center for Innovation attracts powerhouse speakers like Andy Slavitt and Clayton Christensen, and yet manages to fly under the radar. This year’s theme was about closing the gap between people and health, so the social determinants of health were a key topic, as was whether disruption alone would solve the problem.

Dr Robert Pearl

This was my third year attending, and second year speaking at the conference, and I’ve noticed a trend: the conference starts by articulating the problem, and building up solutions and creative ways to reshape the problems over the course of the two days. This year the conference was deftly moderated by Elizabeth Rosenthal, MD,Editor-In-Chief of Kaiser Health News and author of “An American Sickness.” Rosenthal, an MD herself, and former NYTimes journalist, peppered her moderation with real-world examples of both waste and inefficiencies and effective programs based on her investigative journalism.

I’ve been wanting to write a blog post for a while that riffs on the theme of “You Are Here” trying to outline where we are in the digital evolution in healthcare, but it’s clear that we don’t know where we are, digital or otherwise: too much is currently in flux. There are points of light with effective programs, and things that seem very broken. The panel I was on, was titled “Disruptive Innovation” and I’m afraid we let the audience down, as while we are doing some very interesting things with health systems, we are not turning every model on its head. We work with providers and patients to help patients outside the clinic. Truly disruptive innovation would work completely outside the system, which leads to the question, can health systems disrupt themselves or will it come from entirely new entrants like say Google, Apple, or Amazon?

Dr. David Feinberg of Geisinger reads from debate opponent Dr. Robert Pearl’s book

Clayton Christensen, the closing keynote speaker, likens hospitals to mainframe computers, and basically says they will be overtaken by smaller more nimble organizations, much like the PC and now smartphone revolution. Organizations like Iora Health who holistically and preventatively manage a Medicare Advantage population are the epitome of these new entrants, and we’ve seen some hospitals struggle this year, but will they go away entirely? The answer to this question may lie in the excellent debate session “Is The US Healthcare System Terminally Broken” hosted by Intelligence Squared and moderated by author and ABC News Correspondent John Donovan.

 

Shannon Brownlee, senior VP of the Lown Institute and visiting scientist at the Harvard T.H. Chan School of Public Health, and Robert Pearl, MD, and former CEO of the Permanente Medical group were arguing that the system is broken, vs Ezekiel Emmanuel, MD, Senior Fellow Center for American Progress, and David Feinberg, MD, CEO of Geisinger.

While prior to the debate the audience favored the idea that the system is irreparably broken, by the end, they had come around to the idea that it’s not, which would point to the ability for healthcare to disrupt itself. The debate

Is Healthcare Terminally Broken

The final audience vote

was ridiculously fun, partially from the enthusiasm of the debaters, and because the topic was so dear to all attendees. You can listen to the podcast yourself. However, the posing of the question set up an almost impossible challenge for Pearl and Brownlee: they had to argue the patient is terminal, but without any possible solution. No one in the room wanted to hear that, and so when Emmanuel and Feinberg were able to point to innovative programs like the Geisinger Money Back Warranty or Fresh Food Pharmacy that just needed to find scale, the audience latched onto the hope that we can fix things, and we all have to believe in these points of light, to face each new day of challenges.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Legislation, Healthcare Policy, Healthcare Technology, Healthcare transformation

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Finding Change and Honesty at Mayo Transform Conference 2016

mayo-clinic-logoAlthough the theme of this year’s Mayo Transform conference was “Change,” it might as well have been dubbed “Honesty.”

From keynotes to breakout sessions, there was a raw sense of honesty and acceptance of the fact that change is hard, and we’ve reached a point where the evolution in healthcare doesn’t seem to be happening fast enough.

When you’re as successful as Mayo, it might be easy to brush failure under the rug – which made this session, “We Made This Thing, But It Didn’t Go as Planned. Now What?” unique. Now that some of the initial hype for digital health has died down, we are in a phase of realistic optimism where sharing both wins and misses represents a realistic way forward.

This interactive session in three parts by Steve Ommen, MD, Kelli Walvatne, and Amy Wicks unfolded a bit like a mystery. Questions were posed to the audience at each phase for our input on what might have gone right and wrong. Not surprisingly, the attentive audience proved as capable as the presenters, and some of the most valuable insights came from the audience questions.

The case study in this session was a three-year process to develop a new interface and workflow for the cardiology clinic. Dr. Ommen and the other presenters did not tip their hands to whether the project was successful or not, and we had to tease out the wins and losses that occurred during each phase.

The presenters shared stories, but did not show any artifacts of the process such as flow diagrams, screenshots, or personas. This methodology was effective because, instead of getting bogged down in critique of particular elements, we were able to see the bigger picture of challenges that could apply to any innovation or clinical change.

At the end of the session, the presenters summarized their top takeaways as:

  • Not having enough credibility and evidence

Much of the Transformation team were experts in design, but not necessarily the clinical experience for this service line. There were some misunderstandings between what could work in theory and in practice, although the team did identify areas of workflow improvement that saved time regardless of whether the technology was implemented.

  • Change fatigue (or “Agile shouldn’t be rigid”)

The team tried to use a lean or agile methodology with two-week product sprints: iterating on the design and introducing new features as well as interface changes biweekly. This pace was more than what the clinical users – especially the physicians – could handle, but the design aimed to stay true to the agile process. In this situation, the process was not flexible to the needs of the end users and possibly exacerbated the first point of lack of credibility.

  • Cultural resistance

The team lost champions because of the process. It also seemed like they may have spent too much effort convincing skeptics rather than listening to their champions. One physician in the audience wondered aloud whether the way physicians were included in the process had an outsized impact on the feedback the team received about what was working and wasn’t working. From his own experience, he noticed that a physician’s authority is often a barrier to collaboration and brainstorming.

From audience observations, it seemed like there may have been some other challenges such as:

  • Scope/Success Definition

There wasn’t a clear definition of success for the project. While the problem was identified that the current process was clunky and the technology was not adaptive and usable, not all parties had a clear understanding of what constituted success for the project.

Looking back, Dr. Ommen suggested that rather than trying to build a solution that addressed all co-morbidities, they should have chosen one that worked for the most common or “happy path” scenario. The too-broad scope and lack of alignment on goals made it challenging to conclude success.

  • Getting EPIC’ed

When the project started, the team was largely solving for usability problems created by having two instances of Cerner and one of GE used in the clinical workflow. During the course of this three-year project, Mayo made the decision to ink a deal with Epic, rendering the current problem they were solving for obsolete.

Going for a smaller win early on might have delivered value to end users before this massive shift in the underlying medical records software.

So what happened?

You can probably tell from the recap that the project was shelved. However, the team did have some wins, certainly in their understanding of how to better run a project like this in the future as well as in helping the clinical team optimize their workflow.

What should you take away?

Know your users, iterate, and move quickly to deploy quick wins – but not so quickly as to alienate your stakeholders.

Finally, ask your peers: we’re facing similar problems and can learn together.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare transformation, Outcomes, Research, Uncategorized

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You Could Get Well Here: Touring Mayo Clinic

Mayo Clinic Center for InnovationDuring the recent Mayo Clinic Center for Innovation Transform Conference, attendees had the opportunity to take tours of various Mayo facilities.

I was able to tour the Center For Innovation, where we will be working periodically over the next year as part of our prize for winning the Mayo and Avia Think Big Innovation challenge, and the Center for Healthy Living. A third tour, of the new Well Living Lab was sold out before we could get tickets.

Spirituality is part of health at Mayo

Spirituality is part of health at Mayo

The Well Living Lab is a research center where the health impacts of daily living can be tested. For example, researchers expect to study the impacts of air quality or lighting in office buildings on employee health. Tour organizers told me that the paint was still drying on the center as they start the tours so I’m sure we’ll be hearing more about this innovative center in the future.

Mayo Clinic Center for Innovation Tour

The Center For Innovation houses two main areas, one a clinical space where real patients and care teams can test different types of exam room configurations and equipment, and the other more like a typical software or design office. Pictures were limited in this area, so you’ll have to imagine from my descriptions.

All the walls in the clinical space are magnetic, enabling different types of room configurations on the fly. Even the artwork is affixed with magnets, so I suppose it’s possible to also test the effect of different artists as well. When medical teams work out of the CFI space, they are testing not just the patient experience but whether these new configurations make teams more productive or collaborative. The CFI has found a number of improvements to care are possible with better room configuration, and noted that clinics and exam rooms have changed very little since the 1950s.Human Centered Design

A few innovative examples include:

  • A kidney-shaped table encourages more collaboration and communication between doctors and patients
  • Separate consultation and exam rooms offer many benefits in both communication and efficiency. Patients are less stressed, more able to absorb information, and ask questions in a consultation room rather than sitting on a table in an exam room. Two physicians can share one exam room when there are two consultation rooms and therefore they can see more patients in only 1.5 times the space of a normal exam room.
  • An open plan office where all of the care team, nurses, medical assistants, schedulers can work encourages team collaboration and also empathy as each member has much better insight into what the others are doing.
    How Patients Experience Services

    How Patients Experience Services

At the CFI, we learned about projects that have recently been completed (although they were mum on work in progress), like a project to overhaul post-discharge instructions for total joint replacement. This is a hot topic lately as CMS moves to value-based bundles for reimbursing these procedures it’s even more important to manage care outside the clinic, and do to that patients need to understand what they need to do. This is a topic near and dear to our hearts at Wellpepper.

Other projects included exer-gaming for seniors, and Project Mars named as a challenge to completely reimagining the Mayo Clinic experience as though they were building a new Mayo on Mars. This experience spans pre-visit to post visit and includes patient care and the patient’s experience in the physical space.

Mayo Clinic Center for Healthy Living

The Center for Healthy Living is an impressive new facility in the middle of Mayo campus. The Center is focused on proactive and preventative experiences for people who want to take action managing their health.

IMG_2373

Yoga studio with a view

This may include executives who believe health and fitness is a competitive business advantage to people diagnosed as pre-diabetes who are motivated not to become diabetic, to people wanting to regain health and strength after cancer treatment. The Center takes a wholistic approach, and guests (as visitors are called) frequently book a week-long package that includes physical assessment, diet, and stress and spirituality consultations.

The living wall

The living wall

Consultations on diet include cooking classes and nutritional information including how to read labels and understand what’s really in your food.

The Center also houses a spa, which is apparently a best kept secret in Rochester. Throughout the center the design is calming, including floor to ceiling windows and a living wall, and it really feels like a place you can get well.

Clients are sent home with specialized treatment programs and recommendations to support their lifestyle changes permanently. The Center has only been open for a year, and ideally will seen clients coming back year over year for a tune up. It’s definitely a place I’d visit again.

More pictures of the Center for Healthy Living.

IMG_2370

The Nutrition Pantry

Guests learn to prepare healthy meals in this kitchen

Guests learn to prepare healthy meals in this kitchen

Rest with a view

Rest with a view

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health

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Telling Stories & Busting Myths at Mayo Clinic’s Transform 2015 Conference

We’re just back from Mayo Clinic’s excellent Transform Conference 2015. What struck us about the conference was just how fun it was. Bring together a group of people who are passionate about changing health, and put them in an innovative setting, and some magic happens.Mayo Transform 2015

Here are some other highlights of the conference that made it a stand out:

  • The Host: NPR host John Hockenberry was the MC for the entire conference. His ability to ask hard questions and also provide consistency across the themes and panels was fantastic. He was also able to talk about his own experiences as a patient from an early accident.
  • Mayo Transform THINKBIG Innovation ChallengeStorytelling: The power of story was on showcase from Minnesotan playwright Kevin Kling, to the Pecha Kucha talks, and even the ThinkBig Innovation Challenge, which featured real patients telling their stories to find a match with a startup. The two winning startups (disclosure: we were one of them) also both featured real stories that inspired founders to start the companies. In connecting with other attendees, everyone had a personal health story to share, even though attendees were in the healthcare industries it was the personal stories that resonated the most.
  • Diversity: Very low incidence of panels that were all white men. And not token diversity, these people are leaders in their fields and incredibly inspiring, like Dr. Nadine Burke Harris, founder of the Center For Youth Wellness, and expert on early adverse childhood experiences (ACES) and how they impact future health.
  • Mayo Transform ConferenceMyth Busting: Myths were busted all over the place. Here are some examples:
    • While 10% of people cause most of the costs in healthcare, we’ll all be in the 10% at some point, in the same way that we are in the 10% of spend for other life events like weddings, buying houses, or paying for education.
    • Shame and ritual can both be powerful motivators. Positive reinforcement has it’s place but we always think we’re perfect in the future so today sometimes we need shame to get us to do things we don’t want to. This was from behavioral economist and head of The Center for Advanced Hindsight at Duke University, Dan Ariely.
    • Free telehealth is cost-effective. Or this could also be subtitled: proactive, preventative, and accessible care is cheaper. This is from Oscar CEO Mario Schlosser.
    • Price transparency is not just for patients: how can providers evaluate treatments or drugs if they are unaware of the costs.
  • The Mayo Clinic: It was our first time visiting, and we loved the tours of the Center for Innovation, and the Center for Healthy Living. More on those in a future post.His Holiness, The Dalai Llama
  • Interactivity: From maker labs and nurse maker projects, to the ability to spend time with every speaker immediately after they talked, it was a hands on type of conference. The entire conference was live-streamed as well, and the top tweeter was watching from home!
  • His Holiness, The Dalai Llama: Yes, he was visiting Mayo.

 

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, Outcomes, Patient Satisfaction

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