Focus on human needs to drive innovation

I am grateful for the opportunity to participate in the philanthropic IBM Health Corps. This may be one of the most intense, most rewarding experiences of my career. The program takes seven IBMers all with different backgrounds hands them a “wicked problem” and gives them three weeks to tackle it. There is no pre-defined work flow or process, the teams self-organize. Our challenge, in collaboration with the Taiwan Center for Disease Control, was to radically reduce Dengue Fever in Taiwan.  While there was a sharp decrease this year, 2014 and 2015 saw more cases than the last 100 year combined.  In simple terms, how to keep a year like 2015 or 2014 from ever happening again.  If ever there was a need for innovation this was it.

The ask from the CDC was a predictive math model. While always good to start with the end in mind, our approach was to first define the desired human outcome (what we call a Hill at IBM). Design Thinking was our mindset to tackle this challenge. Our journey started with meetings and interviews with the various groups and individuals within the CDC, plus the other government agencies (both national, regional, and local) that are involved in controlling Dengue in Taiwan.  To experience the front lines of Dengue, we traveled south to Kaohsiung.  There we learned first hand about many of the interventions used to control the spread of Dengue. We also conducted a thorough literature review to understand more deeply the current state of Dengue research and interventions.

Doing field work in Kaohsiung

To help us better understand the people and stakeholders, we held a series of framing workshop activities to identify our user groups as well as re-define the problem and our desired human outcomes. Co-creation is a key component of design thinking and one of the best ways to ensure usage and adoption of our solutions and recommendations. A model no matter how technically superior that doesn’t get used isn’t any better than having no solution at all.

Our Hills workshop with the Taiwan CDC

In a short time frame, we knew that the best way to accelerate our understanding of the problem was to start to “making.” We co-located with the Taiwan CDC.  We embedded members of the Taiwan CDC’s Epidemic Intelligence Center with our team to be a part of the design and making process (Sponsor Users in IBM-speak). To more broadly capture the expertise of the CDC, we held more workshops. Several of these workshops included over 100 people. They were held at CDC Headquarters, but included participants and expertise of the regional offices, especially those in Tainan and Kaohsiung. Our activities were a great opportunity to co-design concepts that address the needs of each specific user group. I have to admit that I have never facilitated a workshop quite so large with both local and remote teams, in Chinese, with only one co-facilitator.  A credit to Jennifer Lee, one of the designers in Taiwan, there is no way I could have done it without her expertise and skill.  Most especially credit goes to the Taiwan CDC.  Design Thinking was new to them. But they embraced this new approach to framing and solving problems with people at the center. This approach brought fresh perspective to Dengue control in Taiwan.

Co-designing the model with one of our CDC Sponsor Users

Interestingly, at the end of the three weeks we did deliver a model, but it was part of a much larger ecosystem that included empowering the Taiwan CDC with a people focused mindset, a framework for creating new models for alternative interventions, a road map to increase their analytics maturity, and concepts to more effectively engage everyone from the individual, to the local, regional, and national agencies and departments who are all in this fight against Dengue Fever.

As I reflect on this experience, there are several lessons (re)learned that can benefit any team focused on innovation.

1. Focus on human outcomes. Every wicked problem has people at the root, what are their individual human needs? Define your end state from their point of view.  Immerse yourself in their world. Have empathy for their challenges.
2. The value of diverse, cross functional teams, who respect and encourage each other’s differences and realize that the greater good is more important than each individuals’ ego
3. The power of co-design with your partner organization.  Be it a grantee, or a client, include them in the journey, also see number 1.
4. Have fun, don’t discount your team culture. While our three weeks was intense, we didn’t lock ourselves in a room.  We took time to experience Taiwan and many of its cultural wonders, natural beauty, and amazing food. Trust in each other came through both the hard work and hard play. see number 2.

Language: orientation and disorientation

By John Piccone, Global Leader, Agile Insights, IBM Watson Health

Complete disorientation, followed by progressive awareness and proceeding to guided ability. That’s the summary of our language experience in Taiwan. It began by dropping into a country where everything about the language was unfamiliar – a character set that is visually and phonetically foreign to our experience so that you can’t even approximate or guess meaning from the latin roots of words. The unfamiliarity disorients one in all activities where one would normally read signs – navigating through the airport, driving and walking through the city, finding a specific store, building or office, picking what you want for dinner. One of our Taiwan CDC hosts, Dr. Cheng explained that an average Chinese child of 6 years old knows 6,000 characters and a stellar student knows 15,000 – I think I came away from our three week IBM Health Corps assignment with familiarity of less than 10 characters – all of which I learned in the calligraphy club at the CDC.

 

Every week, the Taiwan CDC holds meetings of the Calligraphy club on Tuesday and Friday afternoons at lunchtime. They meet in a conference room between the disease outbreak control room and the Situation Room. They lay out black felt mats on the conference tables, fill wells full of black, orange and gold ink, wet the tips of their paint brushes with a little water and practice drawing mandarin characters or natural objects such as goldfish or bamboo stalks on brilliant red pieces of paper. Many times, they’ll just practice the form of characters by drawing them on thin sheets of white paper – much like the thin paper used for sewing patterns – with grid patterns pre-drawn on the paper so that an instructor can draw a character and the student can copy the master quadrant by quadrant.

Christine Liu, the Director of the Epidemic Intelligence Center (EIC) noticed that two of us IBMers – myself and our applied mathematician, Roslyn Hickson, Ph.D. – had missed the first meeting of the club because we were leading workshops and invited us to join the next meeting of the club. The paradigm was simple for our calligraphy exercise – the instructor would draw a character or form and then we would present it back for feedback and then re-draw it again incorporating the feedback into the next try. After 5 or 6 tries on the “happiness” character, I proudly presented my work thinking I had mastered the character. The CDC calligraphers chuckled encouragingly – the way a parent would chuckle at a child who’s made progress, but has a long way to go – and posted the work on the wall to dry. This is an illustration of the difficulty of learning the Mandarin written language and explains the visual disorientation.

The second dimension of our language journey was the verbal one. Over the first days, our guides Waya and Red, our hosts at the Taiwan CDC and our IBM Taiwan colleagues taught us the basic words in Mandarin we needed to know – ni hao means hello, xie xie means thank you and so on. As time went on and our neural networks processed more of the Mandarin that we were absolutely immersed in, words became recognizable in the flowing and foreign cadence of sounds that we were immersed in.

But the most effective language assistance we encountered were the two indispensable interpreters that we worked with – Tina and Valeria. On our first working day in Taiwan, Tina and Valeria presented us with a session on language interpretation and translation. They explained the differences between simultaneous interpretation (interpreting at the same time that the primary speaker is communicating) and consecutive interpretation (interpreting in alternating patterns where the primary speaker speaks a batch of ideas, then waits while the interpreter translates and then the whole process repeats). They coached us to enunciate our English clearly, to speak slowly and to plan enough content for only ½ of the meeting time since the translation effectively requires that each statement be said twice. They coached us in how to use the portable radios around our necks in most meetings with our Taiwanese hosts to listen to their interpretations while our hosts spoke in their native language. They always had with them thick notepads of blank, lineless paper and furiously scribbled notes as they interpreted conversations. Tina and Valeria formed in our team the good interpretation habit of debriefing after every interpreted conversation so that they could explain the subtleties of mood and culture and the sentiment of the Mandarin speakers. Our interpreters accompanied us to several of our extracurricular activities, we learned that they love Pocky sticks and that Pocky fuels better interpretation and our time together made us friends. Our communication confidence in Taiwan was significantly boosted by their presence and assistance and in the final press conference, there they were in a plexiglass cube, with their headsets on, ever present smiles on their faces and their pens writing at a furious pace on their ever present note pads.

As I made my way through Taoyuan airport at the end of the project, commencing my trip home, I realized I was reflexively saying ni hao and xie xie to the airline ticket clerk, the immigration agent, the restaurant waiter at breakfast and the airline gate checker. It’s probably going to take me several funny looks from Americans at home to cure me of the habit.

(from left to right) Our interpreters Tina and Valeria; Dr. Christine Liu (CDC); Lisa Chen (IBM Taiwan, Corporate Citizenship)

Sticky notes – the most powerful tool of the IBM team

By Patrick Kao

Patrick served as an IBM Taiwan intern for the IBM Health Corps team. He brought his background in immunology and experience as a medical technician in several Taiwan hospitals to help the team advance their understanding of healthcare in Taiwan.

When I first joined the IBM Health Corps, I imagined a group of people carrying state-of-the-art gadgets, glowing in blue light. After all, IBM is an IT master, right?

So imagine my surprise when I realized the favorite gadget of this team is sticky, the most requested items are the poster papers, and the time they spend on the whiteboard is even more than the time on computers. Instead of showing off the sci-fi level technologies, they sit down and talk. Talk to the people sitting in the CDC office and making policies, talk to the people walking under the scorching sun and looking for breeding sites, talk to the people who strive for budget to provide better interventions, talk to people who interact with the general public face to face. I didn’t understand, shouldn’t we come up with a plan of action as soon as possible? Time is very limited, so why not make progress on the deliverables right away?

Not until the first design thinking workshop did I realize that the mission of Health Corps is not to build a delicate product and then jump back on the plane and fly away. The mindset here is to help the user, to customize a system that not only stuns people because it’s fancy looking, but actually serves its purpose – help the CDC to transform health. What’s even more surprising is this kind of mindset actually became the most influential service this team has left behind. The whole CDC, including the central headquarters and the regional offices, participated in the design workshop two times, and their way of communication has changed.

Of course IBM does have the powerful equipment, and the computer model looks so amazing that someone can never tell it has been done in less than two weeks. The high-capacity modeling system and the user-friendly interface are unbelievable. However it is the attitude that affects me the most. Everyone, whether he is the expert of data science or the designer, is focused on the people they serve. When we held a Halloween party and played with children with cancer, everyone was devoted, even though there was a language barrier. This people-centered mindset is what makes Health Corps impactful, and as a Taiwan citizen, I am truly grateful for the opportunity to have this team come here and work with our government. With the wonderful technology and the beautiful mindset, the IBM Health Corps will certainly make the world a better, and safer, place to live.

Design thinking session with CDC – with lots of sticky notes!

An end to end string of adventures

By John Piccone, Global Leader, Agile Insights, IBM Watson Health

As I reflect on our work here in Taiwan on the night before our last working day, my feelings are bitter-sweet. On the one hand, our team will shortly be flying home to loved ones who’ve been patiently and dutifully interacting with our skype, facetime, zoom or whatsapp personas – it’s exhilarating to think that we’ll soon be able to hug them and share their presence in less than 48 hours. On the other hand, all of us have remarked how odd it will be not to meet in the lobby, walk to the MRT together, take the red line to Taipei Main Station, walk to the Taiwan CDC and share every waking moment together until we fall exhausted into our pillows at the end of the non-stop day. Even the weekends are jam packed with either overflow work, cultural activities at a temple or museum, outdoor activities in the mountains or downtown Taipei or Gastronomical adventures in one of the world’s most diverse culinary cultures. How weird is it going to be not to see each other every waking minute of every day?

Our IBM Health Corps team is engaged in very important work in Taiwan together with our sponsor, the Taiwan Centers for Disease Control. Recent outbreaks of Dengue Fever prompted large spikes in human Dengue Fever cases and fatalities in 2014 and 2015. CDC case reporting and mosquito eradication (probably as well as population immunity and other factors) have prevented similar case volumes in 2016.   The Taiwan CDC asked us to help them develop mathematical models to evaluate the impact of new interventions on the mosquito population and the number of human cases of Dengue Fever. The models will help them decide which portfolio of interventions will help them prevent Dengue Fever outbreaks in the future. The Dengue viruses cause morbidity in the form of sudden high fever, severe headache and pain behind the eyes, severe joint and muscle pains, fatigue, nausea, vomiting and skin rash. Some patients develop Dengue Hemorrhagic Fever, which can progress to Dengue Shock Syndrome and death.

Our IBM team had never met each other before this project, but our Health Corps Program Manager picked a group of professionals that quickly became friends and marshalled the capabilities and strengths of each individual. Amazingly, in just three weeks, we used Design Thinking to identify the needs of key users, a mathematical model to predict the ability of a specific intervention to reduce the mosquito population and reduce human cases of Dengue Fever, statistical analysis of Taiwan public health data to identify key inputs to the predictive model, a working prototype to visualize intervention impact and cost and a final presentation to the CDC this afternoon. This was a mash up of capabilities and approaches that came together because of a group of professionals were committed to an outcome and focused on the positive.

Equally amazing, our team self-organized, had no designated project manager or formal project plan and zero overhead. Each team member volunteered for specific activities and deliverables, everyone delivered on their commitments and it all came together very naturally. Conversation at our many family style meals frequently turned to home and family, but meandered through careers, hobbies, holiday traditions, lots of laughter, and yes, even the contentious US presidential election that occurred while we were away from home. The friendships we’ve formed are akin to the closeness achieved with college classmates, but formed at an incredibly accelerated pace.

Our sponsors and collaborators, the Taiwan CDC were a key reason for the success, adventure and enjoyability of this project. They supplied most of the subject matter expertise in Dengue Fever, public health and mosquito control and brought us up to speed on the required topics through a progression of experiences, reading materials and data. Their warm and welcoming hospitality was ever present – afternoon tea (either hot or bubble) every day, fabulous welcome dinner and concluding lunch, swag to keep us safe on our field trip, souvenirs of our work together and certificates of recognition. Our colleagues and friends at the CDC even invited us to join their afternoon calligraphy club and patiently and playfully chuckled at our childlike (for me anyway) Mandarin characters clumsily formed with brush and ink – they, on the other hand are skillful and modest masters at the art. We were hosted to a field trip in Kaohsiung city where we experienced first-hand breeding site inspections, cleaning and spraying of city storm drains, citation of a shopkeeper for harboring a mosquito breeding site and meetings and workshops with first line environmental and public health workers. The dedication and commitment of the field workers was as remarkable as their request for analytics to monitor their personal contributions to outbreak prevention and control. In the same way that we find it strange to think of leaving our Taiwan team rituals, we will miss the smiling faces and warm collaborations with our Taiwanese colleagues.

IBM Taiwan played a huge role in our project and provided competent support in the form of amazing translators/interpreters; mentees who coded, analyzed and researched; leadership who supported, coached and fed us. With what has become characteristic of our experiences in Taiwan, they also provided warm and welcoming friendship.

Finally, one can’t describe our experience without mentioning Waya and Red – who kept us fed, provisioned, oriented, entertained, and generally happy and well.

Our Health Corps program manager asked what story will stay with us. There isn’t one single story – these three weeks have been an end to end string of adventures and experiences that just keep looping like a tape. Some of the high points were – the visit to Lungshan Temple, Martyr’s Memorial, National Museum, Kaohsiung field trip, mountain hike in a tropical storm in Yangmingshan National Park, Taipei Eye circus and opera, teaching fist bumps at the Halloween party with the Children’s Cancer Foundation, Tonghua night market, mass and church social at Holy Family Parish, Mandarin calligraphy club at CDC, walking endless stairs (and steep too) up Elephant Mountain with colleagues that are in ten times better shape than me, breakfast at the local neighborhood joint (yeah that one), the senior citizen’s seats on the MRT red line, great chats on many walks, stirring coffee with Pocky in the team room, Taipei 101, shopping, video shoots, a new app or tool every day, birthday cake for Elle, Post-Its, white wine with Jacky, Saleem and Roslyn’s smiles, Natalie’s dances, Leanne’s structure, Sathya’s presence, Chris’ cool confidence and lots and lots of food.

IBM Health Corps team with CDC colleagues

Diverse and empowered teams – An IBM Taiwan mentee’s perspective

By Jennifer Lee, Advisory Designer, Creative & Design | iXM Taiwan

*Jennifer was selected to serve as mentee with the IBM Health Corps team in Taiwan

Researchers from the Kaohsiung-Pingtung Regional CDC with Chris Hammond (third from right) and Jennifer Lee (second from right)

I’ve conducted more than 50 IBM Design Thinking workshops with clients in banking and insurance industries, facing people from executive level to the front-line staff. Yet I’d never expected to have workshops with more than 100 of Masters and PhDs of Medical and Public Health, discussing effective interventions for Dengue Fever by IBM Design Thinking. This unforgettable experience has been ranked in top 3 of my workshops all time record.

Taking the site trip to Kaohsiung with the Health Corps team, we shadowed inspectors for environmental surveillance and household visits. By the end of the first workshop with Kaohsiung CDC (Centers for Disease Control), we understood the issues of Dengue Fever are so broad that they can be categorized into forecasting, resource allocation, people awareness, environment surveillance, and treatment and control.

When we were on HSR back to Taipei from Kaohsiung, I couldn’t believe what Chris told me—we would have 121 CDC staff across north, middle and south regional offices join the design thinking workshop for the following day. This was going to be a very exciting challenge, even to a very experienced instructor and facilitator.

I was surprised that many of the participants the next day were not necessarily involved with Dengue Fever, but they were so eager to learn new ways of problem solving that they were willing to spend their own time to join the discussion. While I was very impressed by how fast and engaged CDC staff pick up the new idea of Design Thinking, they told me “well, absorbing new information and learning new skills are everyday things to us. We need to be fast so that we can stay ahead of disease outbreaks for our citizens.” Looking at the audience of dedicated and intelligent researchers, physicians and doctors, it totally changed my impression of public sector.

Led by Chris Hammond, the IBM Design Research Lead, and together with IBM Health Corps team and Taiwan IBM, we as a strong team delivered very successful workshops and extracted many creative ideas. Can’t wait to see the human-centered outcome designed in the project. It is truly a synthesis of diverse and empowered teams!

Centers for Disease Control colleagues (Taipei) at the design thinking workshop

We don’t have a magic wand, but can change world…

By Sathya Venkatraman

Every object of nature on this planet has a purpose behind its creation. They benefit us in many ways. But, isn’t it true that we humans consume more than that we give back to nature or society and also sometimes not sure about our purpose in this creation. The least that we can do is to give some cycles in our lifetime for the benefit of the community and world.

Last week, our Health Corps team visited the Children’s Cancer Foundation in Taiwan where we hosted a Halloween party for small kids fighting a battle of their lives with cancer. As I saw the parents with sad faces written with many questions about the future walking in holding their children, a heart-wrenching feeling engulfed me. It was very disturbing to see these kids suffering and was even more painful to see their parents managing their loved ones with all the resources they could afford.  I wish we had a magic wand which we can use to cure all the children, but unfortunately, do not have one. While with our limited powers, we cannot change their future entirely, the least we can do is to make a difference for them for the duration they spend with us. The rest couple of hours we spent our efforts in making the kids happy, talking in Chinese, participating in fun games, quizzing, gifting, and interacting with them. As the party ended, we could see a huge difference in their faces with all the parents smiling and kids holding their small gifts proudly with a beaming face and waving us with a “shi shi” ( Thank You).  We all got a sense of accomplishment that we have given back something to them – Smiles & happiness for a couple of hours, and the memories of that for future.

The above was just one event. But for the last two weeks in Taiwan where all of us have been working now on a mission, there has been a sense of fulfillment of a larger purpose of our lives. We are helping Taiwan Govt. to fight Dengue disease. The country had many deaths last year because of this dreaded disease. It has been a great experience to see how our partner CDC Taiwan & IBM Health Corps team are actively working together, analyzing data, participating in workshops, and contributing to analytics model development. I am very proud to be a part of this team, and this has been a life-changing experience for me. There are many things I that learned and more importantly un-learned a few as well.

I know we do not have a magic wand, but we have a collective knowledge and experience that we are putting together now to save a few lives in Taiwan. Isn’t that enough to say that I am now in the process of rediscovering my purpose in life?

(from left to right) Leanne, Sathya, John, & Roslyn all dressed up for the Halloween party with the Children’s Cancer Foundation

The children and parents attending our Halloween party

“Dengue 101” with Dr. Roslyn Hickson (IBM Research)

How we deliver value to our partner every day

By Leanne Haselden

Midway through our Health Corps Program with the Taiwan Centers for Disease Control (CDC) I was running laps on a track in Taipei, reflecting on our work so far. As a team, we have joined together to be more self-aware of public health issues and infectious diseases specifically, but we have also come together as individuals with our fit bits, step counts, and hikes. We have been introduced to many new collaboration tools, as some may say “one a day”, which has helped us manage our random thoughts, share insights, and even keep things light and have some fun! Also as a team, we are starting to feel the pressure of delivering to a deadline.  We have learned so much about Dengue Fever and the hardships that it creates.  We have worked with our partners at the Taiwan CDC to better understand the impact on individuals and their communities.  Then late last night, we realized that we had a decision to make.   With our limited time, we had to focus on one path forward.  We were torn. With several challenges in front of us, and limited time and resources, we had a decision to make. Then the question was raised, “Don’t we just want to make a difference?”

As I continued to run, and my laps passed by, I realized that we already are making a difference.  Each in our own way, but as one team, we have come to Taiwan CDC to help them help their people.  I propose that we starting making a difference before we got here.  As soon as Taiwan CDC started the grant process for the program, change was happening.   They were preparing for our arrival, organizationally and mentally.   Their leadership was creating a level of excitement that we never could have anticipated.   A few of our team members even did some pre-work that built on the momentum created by the CDC members and helped us to prepare.   The environment was being shaped for positive change before we stepped foot on the plane.

So, how do you recognize if you have added value?   Is it only with a high-quality deliverable or is there more?   After just over a week of being on the ground, we have built relationships that will last for years, with our Health Corp team, our IBM Taiwan team, and our CDC partner. We have educated them about open source solutions and the value of data lakes.   Through our Design Thinking sessions with over 100 participants, we brought together partner teams in a way that they have never seen before, working through scenarios, empathy maps, and identifying hills.   We have inspired joint agency collaboration simply by asking questions, looking for information, requesting data and providing insights.   And maybe most significant of all, we have reinforced and even raised awareness of the need for a more citizen-centric focus.

At this midpoint in my run and on the program, I know that there is so much more that we can do to make a difference, whether on the Health Corp team and after we return to our home organizations.  But for now, I am thankful and appreciative for all the value we have contributed so far, and excited about what is to come.

I hope you’ll follow our team’s journey. You’ll see the inspiring work the CDC is doing to keep the Taiwanese people safe and healthy, and you’ll see how our IBM tools and thought leadership are adding value every day and making a difference.