Population Health Improvement: Why women engagement and leadership matters

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

Writing this article on March 8th (International Women’s Day) and as the IBM Women in Technology leader for France, working in an industry where women are underrepresented in the fields of science, technology (17% of women at my workplace), I’d like to highlight women’s engagement and the role models I met in the Durham-IBM Health Corps project. Michelle, Gina and Pam are three very talented women, and each of them is bringing incredible value to the mission of improving community and population health in Durham.

My first interaction with the Durham stakeholders took place at the kick off event, where I had the chance to talk during roundtable discussions with a group of 6 motivated and mission-driven women from the Durham Department of Health, Duke School of Nursing, NPCC Medicaid, Duke Center for Community and Population Health Improvement and Diaper Bank of North Carolina. They provided me with key insights on the current situation and existing challenges in population health improvement. Michelle Old, Executive Director and Founder of the Diaper Bank of North Carolina, was one of them. The Diaper Bank aims to ensure that families receive hygiene products they need by working with established family-support organizations to distribute diapers to low-income families and those in greatest need.

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Michelle decided to start the bank following a personal experience when her child was hospitalized and when going through 15-20 diapers a day, she realized how terrible the situation of parents could be when they can’t afford to pay for diapers. Making the decision to create the diaper bank had a big impact on their job and on her family life as she decided to quit her job to dedicate her time to this new mission.

Michelle offered us the opportunity to visit the Diaper Bank site and I want to testify how key, impressive and successful the work of Michelle and the Diaper Bank team are to ensure that families can cover essential needs that impact their health.

Among the impressive list of interviews and visits we had in the first two weeks of our project, I had the true privilege to meet with Gina Upchurch, RPh, MPH, founder and executive director of Senior PharmAssist (founded in 1994) at the Durham Center for Senior Life. Senior PharmAssist helps seniors with limited incomes improve the quality of their lives via medication payment and connecting them to the services needed to remain independent. Health insurance literacy is critical and the organization helps Medicare beneficiaries understand and maximize their medical and prescription coverage. Listening to Gina, it’s apparent that organizations such as Senior PharmAssist have a very critical and outstanding role in population health improvement. Gina and the Senior PharmAssist team help seniors in taking their medication, maintaining their ability to perform tasks and to stay independent with concrete outcomes like a decline in the rate of any hospitalizations.

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If you are making a stop at the Center for Senior Life you will be met by all the senior smiley faces in this very lively place! (And you can watch Gina’s remarks at the closing event for IBM Health Corps here.)

Third, I’ll talk about Pam Maxson, PhD, Director of Operations for the Duke Center for Community and Population Health Improvement. We were very fortunate to have Pam as our sponsor and focal point in the Duke team. Pam is an impressive and very knowledgeable person on population health. In addition to bringing value and insights to our work, her authentic community engagement and experience were a true asset to this project and a door opener to working with the key organizations in Durham. Her kindness, generosity and openness made the difference in integrating the IBM Health Corps team in the Durham ecosystem, in embarking and fostering collaboration between all the organizations.

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Technology and tools are an important foundation, as the Durham community needs a platform to share data, to improve connectivity among stakeholders, to provide key functions (such as a global catalog of resources, referral and analytics capabilities and new population-level care management), and deepen impact for the community.

But the success of the on-going work and the possible evolution also clearly rely on the quality and capacity of everyone in these organizations to deliver services to community members, and to connect and coordinate to achieve better outcomes.

Above all, this Health Corps project is about people, with people and for people:

  • About people who are not only patients but also individuals whose health are affected by social and environmental conditions
  • With people who belong to many organizations representing the healthcare system, social services and the communities’ members, engaged to improve population health in Durham, pointing their efforts in the direction of creating a collaborative system that creates health as opposed to dealing reactively to sickness
  • For people, requiring assistance to improve their living conditions, health and well-being

We interacted with many people committed to the mission of community and population health improvement: interviewing, listening to the different organizations, and visiting community sites (including the Diaper Bank, Lincoln Community Health Center, Senior PharmAssist, Department of Health, Alliance Behavioral Health) to understand the requirements, the on-going effort and the challenges. We also organized workshops, using design thinking methods to facilitate the interaction and collaboration between the different organizations, acting as a catalyst to leverage all the great on-going work and to continue building trust. It has been a great opportunity to work with awesome women (Dr. Ebony Boulware, Michelle Lyn, Joanne Pierce, Gayle Harris…) and awesome men (Dr. Eugene Washington, Dr. Angeloe Burch, Jeff Quinn, Fred Johnson…) mobilized to improve population health.

It is the passion and drive of those working in health that leads to disruption and innovation.

Meeting with amazing and brilliant people from the communities based organizations and Durham health stakeholders has been a gift for me. I believe it is also the cornerstone for the success of the population improvement project.

Thanks to the entire team who let us join their journey, to the exceptional women and men who are making a difference in community and population health improvement!

——

Christine O’Sullivan was a part of the IBM Health Corps team, a philanthropic program, which worked with the Duke Center for Community and Population Health Improvement, city and county of Durham, and many community based organizations for 3 weeks in February 2017 to help improve population health. The focus was to develop a framework to map community health and health equity improvement efforts across Durham County (and within Duke), and to measure the collective impact of efforts on health across the geographic region. Read more here.

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Only Child Time

Musings about living in a house with 6 teammates

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

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Our home away from home

Growing up as an only child, I’ve never lived in a house with so many people. During our project, our 7-person team lived in a 7-bedroom house. There were three floors, a professional kitchen complete with two sinks and a massive Sub-Zero refrigerator. We had a “waiting room” with a grand piano. The basement was equipped with an elliptical and treadmill. Outside, was a sitting area to take in the lake-side view.

This house was built for nonstop activity…And people say New York is the city that never sleeps.

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Our first dinner together making pizza for dinner

Constant movement

There seemed to be constant movement in our house. Something was always cooking, toasting, nuking, draining, boiling. Feet kept moving across the hard wood floors. Laundry was always running, followed by the sing-song beeping of the dryer completing loads that were damp to completely dry. The dishwasher did not stop. In the dining room— which doubled as our work room— both the chatter of collaboration and blaring silence of stress was always heard: the clicking of keyboards, ripping-off of flip chart paper, and scrunching of Post-It’s. Even when I, the night owl, while awake in the stillness of night, could hear my teammates in my head.

But this home was a treat. It was adult camp. It was about immersing ourselves into each other’s lives and quickly getting to know each other. It was about being immersed in a 3-week assignment outside of our regular day jobs to dedicate ourselves to reducing health disparities— a common mission we all decided to leave home for.

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The dining room that dubbed as our team work room

Gifts and Hooks

Once we all arrived in our new home that Saturday afternoon, Natalie Dawe, our program manager (and my bathroom-mate), took us a through a series of team building exercises. With Post-It’s in hand, Gifts and Hooks was about writing down the gifts we each think we bring to the team, and the hooks we needed to remain fully engaged and active as our project progressed. Huddled around the living room coffee table, we shared our thoughts, got to know each other as real people and completed our first team activity.

This reminded me of another activity I did during another project kick-off called Hopes and Fears. (See page 26 of the IBM Design Thinking field guide.) There, we expressed our aspirations and concerns for the project—like Gifts and Hooks where we shared a small bit of what makes us human.

Code of Conduct

To be honest, being accountable to each other at every moment was sometimes amiss, especially when it’s 8pm and we still had 5 interviews to debrief, plan for tomorrow’s interviews, and a 7-person co-creation workshop to prep. This was a high pressure, think quickly, act quickly, pivot, adjust, re-adjust situation. All the while, trying to make 7 different styles of working work.

We were a team of 7 with different expertise: engineer, architecture, data science, client relations, program management, design. We also had 7 distinct personalities. Some might call this a social experiment, or something like MTV’s Real World. See Jason Gilder’s blog called, “The Real World: Durham, NC. IBM Health Corps Edition.

As our 3-week project came close and tensions built, we each, unfortunately, had inadvertently violated our Code of Conduct. This Code was something Natalie had us co-draft and agree upon soon after doing Gifts and Hooks. At that point, we needed a way to discipline our very opinionated, exhausted and cranky selves. Imagine: 7 grown adults needing a green ladle to remind us of good behavior— whoever held the ladle could speak and nobody else. Not our strongest moment.

However, I believe having had a team Code of Conduct in the first place gave us a way to articulate and express desires we wanted for each other and for our project. Each of our intentions were pure. So, for me, when things got heated, I reminded myself of that and tried to calm down.

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Working in the enclosed porch

No man left behind                 

One night, we all agreed to regroup in the work (dining) room at 8:15pm. Ten minutes passed and one teammate hadn’t shown. This was unlike him to be late. We checked his bedroom and bathroom in case he passed out. We were about to take the car and scour the neighborhood since he said he was going for a run. At 8:29 he shows up sweaty and thinking we were meeting at 8:30. He is the brother I never had.

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Only child time doing work on a loveseat at the top of the stairs overlooking the foyer

Only child time

There were moments when I needed “only child time”, my way of saying I wanted to be alone. Whether it was alone time to work, or, alone time to detach from my team, I needed that time to recharge. Admittedly, there were times when I really wanted only child time, but knew in my head that I should socialize. Those times ended up being fond memories.

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On a rare night-off a few of us went to see illuminated outdoor art installations

Back home in New York City

It’s quiet in my 1-bedroom, 1 floor, and 1 sink kitchen in New York City. Outside, a truck just ran over a manhole. Some cars are driving through the gusty night. I hear the hum of my humble GE refrigerator.

I use these words to describe the past 3-weeks of my life:

Intense.

Incredible.

Meaningful.

Life-evaluating.

At the beginning, I thought it was a bit nuts to be living in a house. Now, looking back, it couldn’t have been any other way. Private hotel rooms would not have cultivated and nurtured a team. Even the very nature of our project being about improving community health seemed to be asking the same of us. We, too, as a team, had to understand and empathize with each other: To commune, to collaborate and co-create, to build our little community in our home away from home. To make sure that no man is left behind, or hurt and lost in the woods.

IBM Health Corps – Duke Health: A New Yorker’s Personal Perspective

By Michelle Medina, Client Executive, Health and Human Services

Being a Native New Yorker and braving a rigorous weekly commute into the melting pot metropolis that never sleeps, I figured, for sure I am up to the task of joining the IBM Health Corps philanthropic project for Duke Health.  This entailed leaving my family (including two teens) and work life behind for 21 consecutive days and living, eating and working around the clock with six people I would meet for the first time in Durham, North Carolina. At that point, our only common thread was that we worked for IBM and each of us had a keen desire to contribute our talents toward having an impact on the health outcomes for Durham County. The mission, to immerse ourselves completely with our sponsor, Duke Health and key community stakeholders in order to emerge with a recommended framework that would enable Duke Health and the community at large to harness their most valued assets: People, Resources and Information to improve health outcomes for the community of Durham.  The expectations were high, as the goals to decrease healthcare disparities and promote health equity across the community were a vision shared by all.  This was not just about getting it right in Durham, it was about establishing a model that could be replicated across the country.  

That expression of “being in the boat together” was never more pronounced as it was on the day we all arrived to Durham, Saturday, January 28th, as we sat around in a circle and began to share why we were there and what we each hoped to accomplish.  It was through those daily team interactions; morning coffee, team brainstorming, endless analysis and synthesis, honesty, rawness, rubbing eyes tiredness, occasional fits, break through ideas and nightly check ins, that I came to realize, being selected for this project, was by no means an accident.  I came to see we formed a tapestry of skills, experiences and talents in areas such as healthcare IT, social services, clinical, design, architecture, software engineering, cloud, emerging technologies, marketing and client relations.  We were diverse in culture; Hispanic, Asian, American, Irish, British, 50% men, 50% woman ranging from millennials to those who braved the Y2K era!  Honestly, it was a beautiful thing and it set the stage for 3 intense weeks of hard work on our part and massive commitment from Duke Health and the community at large.

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Our first team lunch with the Duke Center for Community and Population Health Improvement

There is something about Mondays; kick offs, the start of a new diet, a new workweek, list of things to get accomplished and so on that set the stage.  The IBM Health Corps project kicked off on Monday, January 30th in the center of Durham; it was truly all the buzz.  We were greeted with warm hello’s, real southern hugs, a line up of carafes brimming with coffee and tea, pastries, happy people with name tags, Duke Coordinators tending to every last detail in a large, open airy forum with great lighting, high ceilings and brick walls.  You knew you were in a building that had rich history and pride.  It was great energy with over 80 people set up in tables of 10 with a giant white board surrounding nearly half the room.  There was chatter as to whether the Mayor would be in attendance or not.  First it was on, then it was off, staff were scurrying, the coordinators were unsure and then shortly after the first presenter began, Mayor Bell quietly slipped into the back signaling to all, this was a pivotal moment for Durham.

Our key sponsors, Chancellor Washington and Dr. Ebony Boulware addressed the audience.  Dr. Boulware did a great job through visual aid and discussion to set the stage for how academic health systems, such as Duke Health, are evolving to a more population health oriented model.  She characterized this transition as the 3rd curve which considers a much wider health improvement approach that places a better lens on the biomedical, contextual and behavioral factors across populations and enhanced collaboration across a wider set of partners within the community.

Each member of the IBM Health Corps team took the podium and introduced themselves and you could literally hear a pin drop as all eyes and ears were upon us.  Participants from all parts of Duke Health and the community talked enthusiastically about what was working and what could be improved as many were shaking hands and introducing themselves to each other for the very first time.  Many business cards were exchanged and people were excited to learn about each other’s work.  We learned of their mission to strengthen the well being of individuals and families through prevention and education.  They re-affirmed the value of partnering across their ecosystem to create greater access to health and wellness services.

On the first Wednesday, it was then time for design thinking and suddenly a sea of people stood up and were ushered to the white boards with multi-colored post notes and guided through a design thinking workshop.  It was like a massive jam, so well orchestrated as we moved in teams looking at what each team had to say and being guided through a process that helped us to harness these brilliant inputs.   Everyone loved being heard, seeing what others were saying, sharing their bold ideas and watching a collaborative human centered process unfold before their eyes.  Little did I know, that session would spark a desire from the community to adopt design thinking as their new mode of operating.  Early observations were oriented around the need for greater trust, communication, collaboration and engagement across the community and with Duke Health.  There was a desire for smarter use of tools and technologies, access to critical information and data on a more timely basis and ability to know of and access resources and programs to aide clients or collaborate more effectively on mutual areas of interest.   It became clear early on that in Durham, there was no lack of hard work, commitment or talent from those with missions around the health and well being of individuals and the community.  Yet, even so, there was something standing in the way of full or perhaps faster realization of progress in health outcomes in a more system-wide way.  Something would need to be different.  Something would need to change or be activated in order to have that broader, more visible and measurable impact on population health improvement that is beckoned by the 3rd curve.

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At our design thinking workshop

So, what is the problem when Durham County has so much going for it?  Duke University Hospital is ranked nationally in 13 adult specialties.  There is also a plethora of community based organizations, programs, health services, call centers, faith based organization, volunteers and mission driven staff all looking to fulfill every possible health need in the highest quality way.  The Partnership for a Healthy Durham is a shining example of collaboration at its best, which has leveraged the 2014 Durham County Health Assessment and resulting 6 priorities organized into 6 active committees on Access to Healthcare, Education, HIV/STIs, Mental Health / Substance Use, Obesity and Chronic Illness and Poverty.  Over time, it became clear and with our good understanding for what was working and where the challenges still existed, I grew excited about what was possible largely because of great work already underway in Durham, but also because we had an engaged community, committed sponsor and motivated IBM Health Corps team.  

I’ll admit, while 3 weeks goes by in a flash, you still miss your family and there were days I longed for the hug from my child and just when I thought homesickness would overtake me, someone in the community offered a warm smile, a big hug, a cup of coffee and recommendations on where to eat or what to do.  I marveled at how cars would randomly stop at a place that was not a typical cross walk, just to let us cross the street.  That’s certainly a stark comparison as to what you might experience in the Big Apple!  Everyone made us feel welcomed, not only the project sponsors and key community stakeholders, but everyone; from the building security guard, parking attendants, pedestrians, shop owners, neighbors, Uber car service and many more.  While the project goal felt large and the time frame compressed, with long days spilling into evenings and weekends, the IBM team comradery and community at large, made it doable.

I still look back and say I can’t believe how much we accomplished in such a short time; 32 interviews, 60 person round table, 25 person Design Thinking workshop, 3 Partnership For a Healthy Durham committee meetings and a 7 person co-creation workshop, not to mention our own team meetings and breakouts among ourselves!  It was a fascinating process to take part in, that resulted in a representation of what our sponsor and key community stakeholders told us they needed.  The mantra, “If It’s With Us, About Us then It’s For Us”, was our guiding principle in our design efforts.  The result was a recommended framework that would activate the strengths of a coordinated and connected community through the implementation and adoption of a new platform.  The platform takes advantage of the robust tools and systems that exist today which house clinical, claims, social determinants, public and other data sources in a manner that is secure, aggregated and governed.  Fundamentally the platform provides a shared resource catalogue, communications channel and set of tools that together, empowers Duke Health and Durham community stakeholders to take the right set of actions aimed at improving health outcomes.

The day of the final presentation was as energetic as day one.  I’ll admit, you can’t help but wonder, will they like our recommendation?  Will they believe in it?  Will they adopt it?  Now, looking back two weeks post project, and reflecting on that last day, the enthusiasm, the commitments, the feedback and subsequent press releases, I can honestly say, together, IBM, Duke Health and all members within the community, made this happen.  Certainly moving the needle on health outcomes or reducing health inequity will not happen by the flick of a switch, but it will happen because it’s already happening.  We reaffirmed they can do this, we provided the critical success factors to build on their momentum, we assembled a rational and doable analytics framework and more than that, we activated a community!  What a great day, a great moment and a mark in IBM and Durham history. I am proud to say, I was an integral part of with an esteemed IBM team.  I look forward to staying connected to the project and continuing to offer my support.

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From Dublin to Durham

By Eoin Carroll

I’ve just returned from an IBM Health Corps assignment working with several very dedicated community based organizations and health agencies in Durham, North Carolina on how to help improve community health in the region. The IBM Health Corps is a relatively new IBM Philanthropic Program – a close cousin to the IBM Corporate Services Corps and IBM Smarter Cities Challenge philanthropic programs. The program has a very specific focus on tackling health disparities around the world. It involves sending small teams of IBMers to health organizations around the world for three weeks in order to improve health access, health services, and health outcomes.

I first heard of the new program in mid 2016, and its focus on assisting communities to improve health outcomes very much appealed to me. In particular, I am interested in how health outcomes can be improved through tackling some of the broader health determinants such as social and environmental factors. These are widely acknowledged to be some of the most significant influences on population health. So, I applied to join the program, and was delighted to be offered the opportunity to be part of the team traveling to Durham, where we would work closely with community stakeholders on how to address some of the health challenges experienced by the city’s communities.

Our project sponsor, the Duke Center for Community and Population Health Improvement, asked us to work closely with the community in Durham in order to come up with a framework and roadmap for a Population and Community Health Improvement Information Sharing and Mapping platform. The aim of this platform is to facilitate communication and collaboration between the various organizations and agencies working to improve health outcomes in Durham. Quite a challenge for a three week assignment! But we hit the ground running.

Even before arriving in Durham, we had several calls with both our sponsor and with a few community based organizations – all organized by our energetic Program Manager, Natalie, from IBM Corporate Citizenship. So, we were well appraised on several of the challenges in advance. Members of the team gradually arrived over the course of a cold Friday evening and Saturday morning at the end of January, and, as this was the first time we had met, we started by going on a Saturday afternoon “getting to know you” team walk on a woodland trail near our house. During the walk, one of the team members spotted a large owl flying overhead. It settled high up in a nearby tree, and we all rushed over to see it. It sat quite calmly on a branch, looking down at us – and so it was that the owl, symbol of knowledge and wisdom in Ancient Greek and Roman cultures, became the unofficial mascot for our project. Every time we saw an owl over the next few weeks, we were sure to get a picture!

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The Owl

The next day, we had our first proper look at Durham, when we went on a whistle-stop tour led by Malcolm White of Brown Hat Tours. We saw firsthand the ongoing renewal and renovation of many of the former tobacco warehouses and manufacturing plants in Durham. These very solid buildings are being converted into workspaces, apartments, shopping, and recreational facilities. Malcolm also showed us several great community projects during the course of the tour – including some from organizations that we were to meet later in the assignment. That same evening, we had an early taste of the southern hospitality we were to experience so many times over the following weeks, when we were invited for a wonderful grill at the home of one of the community stakeholders.

The assignment kicked off in earnest on Monday morning, with an introductory workshop to capture initial thoughts, involving over sixty participants. This granted us our first opportunity to meet with some of the key community stakeholders in person – many of whom we were to meet again over the course of the assignment. The following fortnight involved a whirlwind of meetings with over thirty stakeholders from across the community, tours of several amazing community facilities, and two design thinking sessions. The very dedicated – and very busy – people involved in the community organizations and agencies all gave their time generously, and so we started to build a picture on what was working well, where there was room for improvement, and on how a platform could help.

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The IBM Health Corps team outside Lincoln Community Health Center, Durham

In between and after meetings and tours, we brainstormed, discussed, and came up with the scope and plans for the framework. We did this using the principles set out in a team code of conduct which we had put together in the first days of the assignment. Amongst other things, this involved using brainstorming techniques to figure out focus areas, and using a consent-based decision making process to decide on key points.

Concepts for the platform started to crystallize early, and, with help from organizations and agencies in the community, we refined them, and came up with the core strands for the platform. These involved a number of functions to help community based organizations, agencies, and health care providers to find out about each other, communicate with each other, perform cross-cutting analytics, and create holistic, community-based plans to improve health. We stuck with the avian theme in selecting internal names for the various parts of the platform – the wise Owl (analytics) was soon joined by a Finch (finder component) and a Stork (planning component)!

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The IBM Health Corps team meet with Dr. Eugene Washington, Chancellor of Duke Health .

During the latter half of the assignment, we ran the platform concepts past our community stakeholders, and made changes in response to feedback. Finally, we presented our findings and thoughts on next steps at an event in downtown Durham attended by many of the main stakeholders from the community. After our presentation, we ran a short workshop with the attendees to obtain valuable feedback and thoughts on the preferred next steps. There was a very positive response, and several good ideas on where to focus the next steps. There was even some coverage of the event by local media.

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Keynote at closing event by Gina Upchurch of Senior PharmAssist, an organization which promotes healthier living for Durham seniors. View her speech here.

The three week IBM Health Corps assignment in Durham was a wonderful opportunity and a privilege – particular highlights include meeting with so many people dedicated to improving community health, proving that the whole really is greater than the sum of the parts while working with a strong and diverse IBM Health Corps team, and, of course, getting such encouraging feedback on the platform framework and roadmap.

Eoin Carroll is a Lead Software Architect in IBM Watson Health based in Dublin, Ireland – where he works on the architecture of cloud-based products focused on addressing the needs of the Health and Human Services sectors.

 

 

IBM Studios RTP engages with Durham community on population health

By Tricia Garrett, Design Principal and Master Inventor, IBM Design – Research Triangle Park (North Carolina)

Six enthusiastic IBM Health Corps volunteers from around the world embarked on a whirlwind three-week project in Durham last month, working with Duke Health. They were here to lend their technical and health care expertise to envision an enduring population health improvement information sharing and mapping platform.

It is essential to engage a few dozen community health organizations around the shared goal of improving community health outcomes by measuring all types of health determinants over time. IBM Health Corps Program Manager Natalie Dawe and IBM Studios RTP Director Steve Kim saw an opportunity to collaborate.

Aligning community health stakeholders

Health Corps team member and designer Caroline Lu envisioned a Design Thinking workshop to understand things that were working and not working with regard to community health, inviting ideas from stakeholders. Many IBM Studios RTP designers jumped in to help plan and facilitate the workshop when this need became apparent to me.

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Brian Burnette facilitates a Design Thinking workshop for Durham community health stakeholders, along with Clay Braxton, Kristine Berry, Kevin Carr, Sean Farres, Caroline Lu, and Eric Morrow

“To get 25 stakeholders in a room and align around the challenges and opportunities… That alone was incredible,” remarked Jason Gilder, another IBM Health Corps team member. IBM Studios RTP designer Sean Farres blogged about the workshop in “Starting the Conversation.”

Natalie Dawe observed that the workshop activated leaders to “move towards true collaboration.” She was pleased to report that the Steering Committee of the Partnership for a Healthy Durham already had begun to use Design Thinking activities after the Health Corps team’s departure.

Doing our part to keep the momentum going

IBM Studios RTP designers also rallied to provide quick user interface mockups to impart stakeholders with a concrete glimpse of the possible, guided by Caroline and Natalie as the Health Corps team hurried to prepare the final presentation.

Mockups generated excitement, providing a sense of accomplishment, as well as encouraging continued momentum following the three-week engagement.

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An imagined user experience for Jade, a community health worker for patients with diabetes. Jade wants to find organizations that meet her patients’ needs, refer the patients, and understand the patient and organization follow-up.

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Designer and Health Corps team member Caroline Lu describes the role of Design Thinking to around 80 people from Duke Health and the Durham community in a final presentation at the Durham Criminal Justice Resource Center

Being a local and a Duke alum (Masters of Management in Clinical Informatics, 2012), I found it exciting to see the level of enthusiasm and engagement among community stakeholders when I attended the final presentation.

In her blog entry,“If it’s about us, but not with us, it’s not for us,” Caroline describes how her team gained a deep understanding of Durham through an iterative Design Thinking approach. Numerous co-creation activities helped the Health Corps team and participants to envision a future based on community needs.

Per Natalie Dawe, Design Thinking has been invaluable because “our mission as Health Corps is to partner with communities — not impose a solution, and we know we need to really understand the communities we serve so the recommendations we offer are feasible and sustainable.”

The IBM Studios RTP team thanks Natalie, Caroline, and the Health Corps team for the opportunity to make an impact on improving health outcomes in the community where many of us live, work, and play.

A big thanks to the aforementioned IBM Studios RTP Designers and these additional designers who supported our involvement in this project: Jacquie Goyena, Kimberly Holmes, Danielle Kingberg, Sarah Blackmon Lips, and Michael Stokes

“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.

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.