“If it’s about us, but not with us, it’s not for us.”

Using Design Thinking to build trust, develop meaningful relationships and respond to unmet needs

By Caroline Lu, Advisory Designer, IBM Design/Watson Customer Engagement

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Selected images from our slideshow we played during our final presentation to 80 members of the Durham community.

Our first steps in Durham began with a city tour followed by a home-cooked Durham style barbeque. (This means that barbeque here is made with pork and vinegar, as opposed to the tomato based sauce in Memphis, opposed to no sauce and beef in Texas.)

Throughout our 3-week project, we embraced the principles of IBM Design Thinking and immersed ourselves in the community with many Design Thinking activities in getting to know Durham.

Our project kick-off with 60 members of the community included breaking out into 6 roundtable discussions. We continued with: 32 interviews with various members of the community ranging from community based organizations like the North Carolina Diaper Bank, Healing With CAARE, Inc., to various sectors of government, city, education, and, health, like the Durham County Department of Public Health. We also conducted interviews with people working on existing tools like United Way’s 211 and Durham Neighborhood Compass.

We boarded a mini-bus for a city tour of Durham by our friends from Brown Hat Tours. We spoke with and observed committee meetings at the Partnership for a Healthy Durham. We conducted site visits at Lincoln Community Health Center, a federally qualified health center. We also met with the East Durham Children’s Initiative and volunteered with kids in packing laundry detergent for distribution. And, we also experienced a basketball game at North Carolina Central University, the nation’s first public liberal arts college founded for African-Americans.

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Marching band playing at North Carolina Central University where the men’s basketball team, The Eagles, beat South Carolina State University 85-62

Design Thinking is a methodology about bringing people together. Design Thinking is about intent. It’s about basing any sort of outcome on human-centered needs. It’s about working together, co-creating and making sure that everybody is at the table. –And literally, we were from the start!

During our first week, we conducted a 25-person Design Thinking workshop with members of the community. Here, we were understanding things that are working and not working when it comes to addressing community and population health. We also asked the community to brainstorm “Big Ideas” that would respond to their needs.

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Members of the community voting on “Big Ideas” that they had each generated

At the end of week 2, we continued using Design Thinking with a 7-person co-creation workshop. During this stage of our project, we had concepts that we wanted to test out with this smaller group of Durham’s finest woman in health & child care management, social work & education.

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Participants co-creating a future state scenario of how a user will experience this new platform and ultimately measure collective impact for a specific health priority.

Design Thinking increases trust

At the beginning of our trip, one community member told us, “If it’s about us, but not with us, it’s not for us.”

Design Thinking helped realize that quote. It helped us work with Durham to truly understand, empathize and respond to each individual and community needs. This process helped us build trust, develop meaningful and relevant outcomes, and foster close relationships.

Design Thinking transforms ways of working

One piece of feedback after our final presentation was about how we inspired a new way of working. We activated leaders to “cut through the red tape and move towards true collaboration” through Design Thinking. We also heard that the Steering Committee at the Partnership for a Healthy Durham already used Design Thinking activities during a meeting last week!

Design Thinking as another mechanism for continuing what they have been doing

As a Designer who has followed this methodology for the past 9 years, it was encouraging and reaffirming to see this process actually work. The thing is, Design Thinking isn’t anything new. People, if given the opportunity to be at the table, will come. In Durham, people have been working together in pockets. There are hundreds of non-profits. Pilots come and go. People move from job to job and gain more and more knowledge in the new initiatives they join. There have been success stories of cross-sector, cross-organization collaboration, as seen in the Project Access. There have been unsuccessful stories to be learned from, too.

The people and community are compassionate, motivated and dedicated to a healthier Durham. They are committed to making a collective impact and fostering a culture of health. They have been doing this for years. Design Thinking has given them another point of view and mechanism to continue doing what they have been doing for years. Design Thinking helped them realize the art of what is possible.

***It would be remiss not to mention the input and support we received from the IBM RTP Design Studio on this project. Our thanks to Steve Kim, Tricia Garrett, Clay Braxton, Brian Burnette, Kristine Berry, Sean Farres (read his blog post), Eric Morrow, and Kevin Carr. From their leadership and facilitation of the design thinking workshop, to their creativity and dedication as they assisted us prepare for our final presentation, we so appreciate their willingness to help our team and the Durham community.

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A French point of view: Improving population and community health in Durham

By Christine O’Sullivan, IBM Executive Architect at IBM Client Center Montpellier, Member of IBM Academy of Technology

In January 2017, I had the privilege of becoming a member of IBM Health Corps (an IBM philanthropic program) for a project in Durham, North Carolina, USA. After a very intense 3 weeks’ work, it is time now for personal reflection.

The project’s mission was to work with the Duke Center for Community and Population Health Improvement to develop a framework and plan for establishing a Population Health Improvement Mapping platform. We were to deal with organizational challenges in addition to the technical architecture design, and to encompass a myriad of organizations serving the same objective but sometimes working independently, from large organizations such as the Durham Department of Public Health and Duke University, to smaller community based organizations such as the Diaper Bank or Healing with CAARE.

The mission also focused on measuring the collective impact of different organizations and programs on population health improvement. This requires data sharing and a platform to access, aggregate, and analyze a very large number and types of data sources. We have now delivered our final recommendations to the stakeholders, providing a high-level architecture of the target platform and related required capabilities (catalog, search function, referral, analytics, and a care plan at the population level) and a roadmap to move to the next steps. Even if technology was an important element of the project, the IBM team had to deal very quickly with governance questions and paid special attention to fostering collaboration and trust between the different health and social organizations to make information sharing possible.

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Our IBM Health Corps team meeting with Gayle Harris, MPH, RN, Director for the Durham County Department of Public Health

As a Cloud architect from IBM Montpellier Client Center in France, I had to face 2 big challenges: 1) In a limited amount of time, integrate the principles and needs of the United States health systems 2) Being the only non-native English speaker in a team of 7 persons — 5 of us were from the United States, 1 from Ireland and 1 from France. (Language was especially difficult before the first morning coffee and at the end of a demanding day after holding a series of meetings, interviews, and intense work.) But I was highly motivated by this human centered project and to contribute to the objective of improving population and community health, which I believe is a universal goal.

When the IBM Health Corps Team arrived in Durham, the agenda of the first week was already booked and carefully thought out by the IBM Health Corps program manager in collaboration with the Duke Health team to offer us the opportunity to meet the key organizations. We began our engagement with an assessment of the current situation, a review of ongoing community efforts, programs and needs, meeting and listening to many different organizations’ feedback. Within the first 2 weeks, we met 60 persons during the kickoff meeting and round tables, conducted 35 interviews, held 1 design thinking workshop and 1 co-creation workshop, and participated in 3 committee meetings of the Partnership for a Healthy Durham. With this steady pace and well-chosen conversations, I felt I learned about the health systems in 3 weeks what may have taken several months!

Being immersed in this world showed us the complexity of health. Health is not just physical, it is mental and it is social. Reducing health inequities requires addressing the social determinants of health (housing, nutrition, transportation problems, etc) and identifying the root cause of the issues. Social determinants of health are defined as a priority by Durham leaders and also by the World Health Organization (WHO) regional office for Europe.

The Healthcare system is quite different in France compared to the United States. The provision of health care in France is a national responsibility. The Ministry of Social Affairs, Health is responsible for defining national strategy in addition to allocating budget expenditures among different sectors (hospitals, ambulatory care, mental health, and services for disabled residents).

My French citizen’s perspective and experience helped me to understand the challenges of a non-centralized health system in the U.S. when it comes to information sharing, governance and organization siloes. No system is perfect and in fact, both European and American systems could benefit from an understanding of the other’s strengths. Where the national health systems in Europe may help to conduct a global strategy at the population level, I must say that I truly admire the innovative approaches and the commitment by the different U.S. organizations in Durham to improve population health and tackle the root cause of possible health issue. I met extraordinary, passionate and talented people building a chain of solidarity to serve individual well-being not only for medical & clinical care but also the social determinants of health.

I’m grateful for this unique and challenging opportunity to participate to an IBM Health project and to contribute to this outstanding objective of improving population health. I’m looking forward to hearing about the project’s progress and success!

Why is Community Population Health Improvement So Challenging?

Jason Gilder, Ph.D.

I am now firmly in the third week of my three-week adventure with the IBM Health Corps team in Durham, NC. We are partnering with Duke Health to build out a strategy to improve the health of the community, with the community. That last piece is crucial to building the trust of the community members and the many organizations already working hard to deliver healthcare and health-related services across the community. We have met with several community organizations that are directly involved with delivering health services, referring individuals to health service providers, care management services (such as assisting patients with managing their mental health visits), providing ancillary services (such as medication assistance around getting access to affordable medications), providing goods related to wellness (such as cell phones to stay in touch with a care manager or provider diapers for new mothers), and educational services to keep the public informed (such as HIV awareness around free testing and a pill that can help avoid contracting the disease).

Challenges

With so much effort across the community, why is population health improvement such a challenge? Why does Durham County lag on certain health outcomes, even with Duke Health in their backyard, a top healthcare system? Clearly, many organizations are working to address the population’s needs. These same groups will also be the first to lay out the challenges of delivering care in the community. As with many issues in healthcare, it usually comes down to people, process, and politics.

Awareness

Sometimes the biggest challenge in addressing an individual’s need is simply finding the organization or program that can best help them. Groups like United Way 211 and the Durham Network of Care work to catalog the many organizations, programs, and services that exist in the community. However, the task is a never-ending investment. Organizations change addresses and phone numbers, organizations close their doors, and new organizations and programs are created on a regular basis.

 Transparency

Many community organizations are not fully aware of what other organizations are doing. Even when one organization is aware of another, they typically aren’t fully aware of the other organization’s capabilities or quality. This lack of visibility can lead to uncertainty and distrust and prevent individuals from being referred to those organizations and services.

Competition

Funding is typically the primary challenge of most community based organizations. Grants are limited and the needs are great. Community organizations often compete for the same set of funding. Organizations can further compete around offering the same services as another, presenting competitive messaging around their services, and their approach of recruiting patients for services – all which can help justify their next round of grant funding.

Visibility

Successful population improvement efforts require the right information at the right time. However, information sharing rarely takes place between organizations. An organization dealing with diabetes management may not be aware of an individual’s ability to obtain nutritious food. A patient seen in the hospital may not have information around his or her housing environment and ability to care for himself after discharge. The disconnect can result in siloed care efforts where no single organization possesses a complete view of the patient’s condition and their social determinants of health.

Opportunities

None of the listed challenges mentioned a broken system, only one that can be improved with better coordination and collaboration.

Coordination Across Services

Individuals in need typically require multiple services. Organizations that are tightly coordinated can track referrals to ensure that an individual is enrolled in the program he or she needs. A patient in the hospital who has an issue with adequate housing can be referred to the right affordable housing program. The patient’s care manager can be informed when the patient has been enrolled and placed in a better home.

Collaboration Around Programs

Most community organizations have established goals for their own programs. However, community population health improvement efforts would likely be more successful if care management programs were jointly created across multiple organizations. Tackling diabetes and nutrition could involve a diabetes management group and a food access organization building out a common care program together.

Collaboration Around Funding

Collaboration across organizations extend beyond joint programs. There are opportunities for organizations to work together on joint grant opportunities. There are situations where a program may appear to be losing money in one area while driving overall savings around an individual’s care. Funding for such programs is often cut. Collaboration across organizations will allow for better tracking of overall program effectiveness, return on investment (ROI), and opportunities for better funding.

Collaboration Around Staffing

Typically, the second biggest need of an organization is adequate staffing. There are opportunities for organizations to partner around sharing resources. Individuals working in one organization can work in a partner organization as a “borrowed resource” when demand is high or when a specialized resource is needed, like a mental health professional.

Collaboration Around Data Sharing

Understanding the full view of an individual and their outcomes is often improved by sharing information between organizations. While legal and compliance hurdles can be problematic, they are not impossible. Proper data use agreements (DUAs) and business associate agreements (BAAs) often allow for data sharing to enable more complete patient management.

Collaboration Around Measuring Outcomes

Understanding true outcomes for a population are greatly enhanced with the collaboration of multiple organizations. Joint quality metrics across organizations can help track the population’s journey through the system to understand which areas are working and which need additional focus. That feedback loop is essential to improving our system of care.

Collaboration With The Community

Population health improvement efforts require the community’s active participation to be successful. The best way of getting community investment is through transparency and feedback. It should be clear what services are being offered, how quality is being measured, and what impact is being observed in the community. Community members should have an opportunity to take a role in shaping the programs and goals to ensure that the overall needs are being met.

These combined health improvement efforts introduce the opportunity to address true community population health. Once you understand the state of health of a community, you can introduce additional programs on social determinants of health to help drive community-based health improvement at a larger scale. Leveraging additional data sources, such as bus routes, bike trails, pollution levels, socioeconomic status, food pantries, parks, and program benefit coverage areas allow for a macro view of the community. This view then allows for more effective planning around what programs, services, and opportunities should exist for individuals and where they will make the greatest impact on the community. The future blueprint of the community forms a community health care plan and can be tracked and managed in a similar manner as traditional population health programs. A community care management program can establish quality metrics to track process and outcome metrics across neighborhoods to understand which areas are improving and which require greater focus and attention.

None of the opportunities here require a drastic redesign of the care delivery system or millions of dollars in infrastructure or software. However, it does take a concerted effort to align priorities and involvement across care delivery stakeholders, community partners, and the citizens themselves. Many components of these improvement efforts are already underway in Durham County and elsewhere across the US. It is important to identify which pockets of activity are working well to serve as a guide for others moving forward. Population health improvement does not need to be a big bang. Improvement efforts can be rolled out in phases to increase trust and collaboration across a community over time. However, it is crucial to continually maintain, expand, and refine improvement efforts so that health delivery stakeholders and the community remain engaged in the process and to ensure that the momentum of driving improved health outcomes is not lost.

Jason Gilder, Ph.D. is currently the Senior Director of Analytics and Informatics at IBM Watson Health Cleveland.  Jason has supported the design and development of population health and healthcare research solutions within Watson Health.  He manages an Innovations team that develops the strategy around the management and use of healthcare data and analytics to drive improved patient care and management as well as helping enable researchers to discover new insights.  Jason decided to pursue engineering at the age of 9 when his grandfather told him about his career as an engineer at IBM. 

 

 

Starting the Conversation

By Sean Farres

Sean is a Design Director for IBM Watson Health based in North Carolina. He and 5 other designers from RTP (Research Triangle Park) volunteered their time to lead a design thinking workshop for 30 Durham and Duke stakeholders.

Volunteering for a Design Thinking workshop for the IBM Health Corps, I did not know what to expect. I just knew the mission was to increase the overall health & well-being of the population of Durham county. The challenge seemed quite daunting. How do we align these community partners to transform and build a thriving healthy community?

Trust seems to be a key factor in the relationships between non-profits and health organizations. Much of the hesitancy comes from conflicting viewpoints. One perspective is based on theory & academia and the other resides in funding & reality.

Compounding this barrier is access to patient data. Who should have access? What can be shared? What is ethical? I think we need a safe place for “open-source” health information. How can communities start to share population data in a controlled manner? How can they be used for positive impact? How will we fund this initiative?

Everyone I spoke to mentioned their willingness to help and serve. No one knew quite where to go. What is next? Can technology help us? I think just starting the conversation helps us move in the right direction.

 

 

The Real World: Durham, NC — IBM Health Corps Edition

By Jason Gilder

Seven strangers picked to live in a house – and address health disparities across Durham County, North Carolina. That is the premise behind my latest IBM adventure as part of the IBM Health Corps initiative. IBM Health Corps is a service-based group focused on addressing health issues around the world. Last week, I started my journey with a team of six other IBMers with wildly different background and geographies. I was suddenly living with people from France, Ireland, a guy from Britain who now lives in California, and three people from New York City (which can sometimes seem equally foreign to someone from Ohio). We have three weeks to build out the community health strategy roadmap for Durham County in partnership with Duke Health – a task that typically takes years to solidify. No pressure.

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The team at the kickoff

When someone sees that you come from IBM, they typically think that we are there to present a bunch of technology to solve a problem. IBM, through Watson Health, is actively engaged in supporting population health efforts, but this engagement is much different. Here, we are working with people across the community to understand the current stakeholders, their capabilities, and their core needs. We will then build a conceptual framework of how organizations across the community can better collaborate and coordinate to drive improved health outcomes across the county.

Our first week was a whirlwind, but we accomplished more than I expected. We had:

  • A 3-hour kick-off meeting with 60 participants.  We had individual roundtables with groups of 10 community and healthcare stakeholders to understand their current process and needs.
  • A 3-hour Design Thinking session with 30 participants, where we worked together to break down and solidify the challenges and opportunities facing the groups and then voted on possible strategies and solutions moving forward.
  • A 3-hour tour of Durham to see how the city is planned, its history, and how it is evolving.
  • 14 interviews with healthcare and community stakeholders across Durham.
  • Tours of the Durham County Department of Public Health, the Duke Clinical Research Institute, the Lincoln Community Health Center, the Healing With CAARE free clinic, and the Diaper Bank.
  • A playback presentation with our main stakeholder to present our findings and initial framework approach.
  • 1 State of Emergency called for a water main break that closed area restaurants and caused us to miss the UNC vs. Notre Dame game.

There are large disparities in wealth and health outcomes in Durham County. The lack of Medicaid expansion in North Carolina has created a hole that has been challenging to address for a relatively large segment of the population that don’t qualify for federal aid. However, it quickly became clear that there is a large concerted effort to improve healthcare across the community. There are groups established focusing on the spectrum of care delivery, including primary care, specialty care, mental health, social work, access to medications, and ancillary services. Other groups focus on core needs, including everything from providing patients with a cell phone, to staying connected with a care manager, to providing diapers to new mothers, to establishing a free venue where people can exercise and dance. Clearly, Durham’s challenges are not caused by a lack of effort.

In the end, I was struck by an overwhelming sense of community. Individuals of all backgrounds are coming together to try and make their home a better one. They each care deeply about every single person in their community and are giving their personal time, money, and organizational effort to impact the lives of those who need it most. The stakeholder roundtable discussions and Design Thinking workshop I attended felt like a family coming together to get things done. We were even welcomed into the home of one of the major stakeholders in the community for a delicious Southern dinner.

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Design thinking session in our first week

I look forward to what we will accomplish over the next two weeks. The relationships we have formed will live on beyond this engagement. More importantly, this has made me reflect on the community health improvement efforts going on in my own back yard – and every other major city across the US. I am planning on engaging my local community organizations in Cleveland to see what challenges they face and what lessons I can provide from my experiences here in Durham. With any luck, I might be able to return the favor and bring some Cleveland community teachings back to Durham and help initiate a new cycle of community health improvement.

Jason Gilder, Ph.D.

Jason Gilder, Ph.D. is currently the Senior Director of Analytics and Informatics at IBM Watson Health Cleveland.  Jason has supported the design and development of population health and healthcare research solutions within Watson Health.  He manages an Innovations team that develops the strategy around the management and use of healthcare data and analytics to drive improved patient care and management as well as helping enable researchers to discover new insights.  Jason decided to pursue engineering at the age of 9 when his grandfather told him about his career as an engineer at IBM.