Chris McCarthy, Health Policy, MPH '95
Chris McCarthy, ’95 MPH, is the Director of the Innovation Learning Network and an Innovation Specialist at Kaiser Permanente. On October 20, 2011, he appeared at American International College in Springfield, MA to deliver a talk titled “Design and Healthcare: Unlikely (But Lovely) Bedfellows.”
Tell us a little bit about yourself.
I’m Chris McCarthy, and I earned my MPH in Health Policy from the School of Public Health and Health Sciences in 1995.
What was your most memorable moment in the graduate program at UMass Amherst?
There are two, and it would be very hard to choose between them. The first would be my internship at Baystate Medical Center. I interned in a small community outreach program and that internship was really pivotal for me to make sense of public health in the real world. Everything up until then had been purely theoretical. The other one was a summer class I took in “Holistic and Alternative Medicines.” Every class covered a different form of alternative medicine. We got to read about it, learn about it, and then the instructor would bring in a practitioner to try out some of the techniques with the class. That really opened my eyes to a much broader view of what health and wellness could be. It was phenomenal.
How did the SPHHS help you to prepare for your career?
My first job after grad school was at Kaiser Permanente. I looked at the diabetic population, and thought about how our organization could use clinical technology tools to provide population care. I had no idea that these kinds of jobs existed. I just kind of stumbled into this job and it was pretty amazing. Having that public health perspective really helped me to think about populations and not just about individual people.
Tell us more about your professional career after graduating from UMass.
As I mentioned, my first job was trying to figure out how clinical systems could help take care of populations of people. Kaiser Permanente has 9 million members, so we have a huge population to care for. It was very exciting, but after a couple of years I realized I wanted to do something a little more creative. I just didn’t know what that meant. Up to that point my whole life had been thinking about healthcare and public health, and I wanted to explore other things.
I ended up leaving Kaiser and going back to Rensselaer Polytechnic Institute to get my MBA. I did half of my degree there and the other half at the Copenhagen Business School in Denmark. And it was while I was in Denmark that I really got exposed to design. The Scandinavian way of thinking about business is very holistic. It’s socialist, number one. And they really think about how business and community can co-exist to help each other. That’s a very different perspective from most American businesses. It was a really pivotal moment for me – to see that there’s a whole other way of thinking about how business can augment what happens in the community, and not just take resources from it.
After I graduated, I was offered an opportunity to co-create an internal design group back at Kaiser Permanente. We paired up with an organization called IDEO, one of the top-design firms in the world. We partnered with them for two years to learn how we could bring design methods into our organization. It really turned into a kind of two-year apprenticeship. We learned their ways, and we replicated them internally in our organization. We kicked that off in 2003, and almost every year since we have put into place a major innovation at Kaiser. And a lot of our innovations are starting to hit the world outside of Kaiser Permanente, so it’s pretty exciting.
And how does that tie in with your position as Director of the Innovation Learning Network?
In 2006 we realized that there were not many people doing this kind of work. We wrote a grant to create a network for people who are doing innovation and design work in healthcare. It was meant to be a one-year thing. But at the end of that first year the organizations saw that there was so much value in what we were doing. We went from 10 organizations in 2006 to 21 organizations in 2011. The VA, the Indian Health Services, Partners HealthCare out of Boston, the National Health Service out of England – some really great, big groups are all involved.
It must be nice to see that flourish.
Yeah! So what’s really exciting now is half of my life is innovation and design in healthcare at Kaiser, and the other half I get to connect with people like me across other organizations. When we discover an innovation that makes a big difference, we share it across systems. Innovation and design in healthcare is this emerging area. I think most healthcare organizations in the past five or ten years have added the word “innovation” in their mission statements but it hasn’t manifested in any real way. They’ve just thrown that in. But some of the most advanced organizations like Kaiser and Mayo and Cleveland and Partners HealthCare have taken it one step further – they’ve created infrastructure for design, they’ve added real innovators to their organizations and funded them to do really great stuff.
And that’s the subject of your talk in Springfield, correct?
Yes. This very strange coupling of design and healthcare. You know, when people think of design, they probably conjure all these images of things like Project Runway.
I wanted to ask you about that because “design” can be such a broad term. So when you’re talking about design and healthcare, what specifically do you mean by that?
Everything around us is designed, whether intentionally or unintentionally. What we’re saying is let’s be intentional about it. Let’s really think about it from the ground up and plan for all of it. Even something that is totally functional, if it’s badly put together, then it won’t feel good to use and therefore people won’t want to use it.
Most organizations solve their challenges from a business perspective. They say it needs to be more efficient, it needs to be more effective, we need to have better outcomes. And that’s all well and good. But often by attacking problems from the business perspective we forget about what the human needs of the system are.
Another way that organizations attack challenges is through technology. They think, “Oh, we can solve this problem if we just buy this software program or if we just implement this database.” But both the business and the technological approaches often disregard the human side of the equation.
We enter into complex challenges from the human perspective. We try to understand what drives people. And we often get to the same outcomes that the other approaches reach – we are more effective, we are more efficient – but we make sure it honors being a human in a system. You don’t feel crappier about your job or your experience as a patient. You actually feel like the space that you’re sitting in was designed for you. It feels good to be in this room. It feels good the way the nurse interacted with me. Most organizations don’t think about that.
Can you give an example of something that you’ve done with this design philosophy in mind?
One of our big innovations, which was featured in the Harvard Business Review, is called KP MedRite. KP MedRite is the way that nurses at Kaiser Permanente now administer medicines in our hospitals. Traditionally, nurses administer medicine using the 5 rights of medication administration: right time, right dose, right patient, and so on. They have very specific things they are supposed to do, and they’re taught in nursing school how to do them. However, in the actual system, it doesn’t always work that way. So many other things are happening at the same time, and nurses don’t feel good about it. And it’s the same thing for the patient – patients often feel like they’re being neglected, or they don’t know what is being given to them.
We talked to nurses and asked them what the problems with medication administration were. Almost all of them said there wasn’t a problem. But what’s really beautiful about design is that you need to approach the problem from many angles. Intellectually, they were saying there wasn’t a problem. Because they’re professionals, and they’re not going to admit that there are deficiencies in the way they do their work.
We needed to think of another way to get at the issue, so we asked the nurses to draw pictures. We gave out markers, paper, crayons, and we said close your eyes for two minutes and think about medication administration and when you open your eyes draw whatever comes to your mind. And the results were pretty remarkable. In almost all of the drawings the nurse’s hair was on fire, or lightning bolts were coming out of their heads.
The pictures said something very different, because drawing taps into an emotional or creative side that’s not filtered by the intellectual side. Good design looks for the disharmony between what people say and what they feel. When we debriefed the nurses we came up with three themes about what their pictures meant: chaos, interruptions, and unclear. And those three themes became the driving force behind how we redesigned medication administration.
The other thing we did is called analogous observation, where you go to other industries to see what they’re doing. We took pharmacists, doctors, and nurses to a Lexus dealership to see how Lexus handles the customer experience of getting your car serviced. And what we learned was that everyone was always updating the customer. That makes Lexus customers feel really good – even if there’s a long delay – due to the constant feedback and interaction.
We also sent them to a flight school. They got on the planes and talked to student pilots about learning to fly. And one of the key concepts they learned is that at 14,000 feet and below there is no conversation unless it’s about landing the plane or taking off. Nothing else exists. It’s called the sterile cockpit.
The nurses were blown away. They thought: “You know – I have potentially lethal poisons in my hand, and I’m about to give them to a patient and I get interrupted numerous times between getting the drug and giving it to them. Wouldn’t it be interesting if we had a way to let people know that we couldn’t be interrupted?”
We combined all of these different ideas and created a new way of administering medicines made up of three components. First, we created a process that is extremely human-centered, designed by the nurses and the patients together, as to how they want to give and receive medications. The second component is called no-interruption wear. When a nurse administers medicine, they wear a sash so that everybody in the hospital knows they are passing medication and should only be interrupted in the case of an emergency. And the third component is called sacred space, which we got directly from the sterile cockpit. The area where a nurse pulls medications is marked off by tape on the ground. In hospital systems tape on the ground is a really big thing. It’s used in the O.R. to mark off sterile areas. So if a nurse is in that space, no one else is able to enter and interrupt them.
And in the end we created a system that feels good. Patients love it, nurses love it, and we had a remarkable increase in reliability in medication delivery and a remarkable decrease in medication errors. We had pretty incredible business outcomes, incredible clinical outcomes, but most importantly, we honored the humans in our systems.
That’s a fabulous example.
And now you’ve got a 5-minute version of my talk tonight.
Is tonight’s talk part of a series of speaking engagements?
I give about a dozen talks a year now. After this I head to Montreal and Toronto. I’ve been to Denmark, to Spain and England, and all over the United States. As more healthcare organizations realize that design is fundamental, I’ve been getting asked to come speak more and more about it.
Thank you very much for your time.
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