Could Biomimetic Engineering for Healthcare Surfaces Reduce the Potential for Dangerous Pathogen Transfer?

UMNSystems and Sappi North America's Conference Paper for the 2017 8th International Conference on Applied Human Factors and Ergonomics (AHFE) is now available from Springer (https://link.springer.com/chapter/10.1007/978-3-319-60483-1_1). The focus of this work is to present preliminary data on how Human-Centered Design and strategic Resilient Surface Technologies could potentially play a role in mitigating dangerous disease-causing pathogen transfer from healthcare surfaces to caregivers, families, and patients.

The authors of this paper will be presenting this information at the 2017 AHFE Conference in Los Angeles this July 17-21.  This article represents work that is part of a recently mobilized and longterm team-based research effort with select Health Systems and Healthcare Evidence-based Architecture & Design research partners. The purpose of which is to assess the ongoing performance impact of patented biomimetic surface-patterning in healthcare environments. 

New Study Published in Journal of Interior Design on the Human Value of Evidence-Based Mental Health Design

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A new peer-reviewed study by Dr. Sheila Bosch and Dr. Daejin Kim of the University of Florida, and Lisa Sundahl Platt of UMNSystems LLC has been published in the latest issue of the Journal of Interior Design. This research is a compilation of several VA-based Mental Health design quality improvement case studies that have been cross-referenced with principles of Human Factors and Ergonomics, and a comprehensive research and literature review that highlights the value identifying environmental factors that may influence Veteran and staff behavior and response within Mental Health Environments.

There is a great need for more study on how the environments that surround us impact our mental health and well-being. The authors of this study hope that this effort may elicit greater focus on this needed area of research

The study may be resourced from the following online link: http://onlinelibrary.wiley.com/wol1/doi/10.1111/joid.12095/full

How TEDMED 2016 and a "Metaphoric Murmuration" Helped Reset My Vision of the Future of Healthcare

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In a year of what has truly been abundant with personal life changing events, one of my most memorable is being accepted as a Frontline Scholar to TEDMED (www.tedmed.com). I have been an ardent fan of TED and TEDMED for their ability to be vehicles for spreading innovative thought information ever since I became aware of them. I was incredibly honored to be accepted to their 2016 Frontline Scholars group and was secretly hoping that my experience this past November 30-December 2, would be the “shot in the arm” I needed to bolster my hope in the future of healthcare. I must say that my experience was not what I expected. It was better! In a professional career that has spanned now over a quarter of a century, I have attended a lot of conferences as both a speaker and an attendee. TEDMED was distinctly different. Let me tell you why.

The Power of Passionate Curiosity:      

First, I was struck by the immediate realization that, regardless of their role in the conference, everyone seemed willing to share their knowledge and stories and there were multiple platforms for doing so designed into the experience. This, of course, occurred in formal TEDMED talks, but perhaps, more importantly, a great deal occurred in ad-hoc incidental but meaningful conversations that, in my experience, are not at all common at typical industry conferences.  For example, I had a conversation the first night I was there about communicating the relevance and myriad health and community benefits of housing security with one of the keynote speakers I happened to sit next to during the first presentations. Lloyd Pendleton, a former Ford Motor Company executive, is successfully working to eradicate homelessness in Utah (www.endhomelessness.org) and generously shared some of his personal insights with me regarding demonstrating a return on investment for the "right thing to do." I also met Paul Lindberg, at a TEDMED “Hive Discussion,” who is a health specialist for the Columbia Gorge region whose program (www.gorgeimpact.com) was the Culture of Health Prize 2016 Winner from the 2016 Robert Wood Johnson Foundation. He has since shared some anecdote related to meaningful improvements their work has elicited in their part of the country which is relevant to my own doctoral research related to the intersection of sustainable community infrastructure and population health. In fact, there seemed to be a genuine, mutual, and universal curiosity on the part of attendees, speakers, volunteers, and scholars to discover and learn about the spaces that one another were working in and what drives our interest and passion in changing health and wellness in our communities. Some of us discussed ways we can join forces in future efforts to create greater impact, but often conversations occurred because of genuine interest and a desire to learn about innovation and ideas that were outside the realm of our own personal experience.

The Driving Force of Divergent Perspectives:

The first thing I noticed about my fellow frontline scholars, was how truly diverse our backgrounds and experiences were. In our cadre, each one of our individual missions, which were all related to driving health delivery and wellness reliability towards a more human-centered focus, was fueled by distinctly different operators. Our group included members like Lydia Green (@RxBalance), a pharmacist that is actively working as a medical writer to democratize health and wellness data and streamline healthcare communications; Liz Salmi (@TheLizArmy), a patient and punk rock drummer, who is using her own experiences battling Brain Cancer to demystify and improve the healthcare experience; and finally, the amazing Jessica Willet (@jkwillettmd ) an ER doctor and volunteer physician for Flying Doctors of America. That’s right folks, you know those heroic men and women you see on the news working to provide essential emergency medical care to people hit by natural disasters or are refugees of military conflicts, Jessica is one of them. This is just a small sample of some of the remarkable people I had the privilege to meet in this incredible group of diverse and committed change-makers. It is fair to say I am pretty much in awe of the work all of my fellow frontline scholars are engaged in and have stayed in touch with many of them. Once you gain access to this level of innovator and agent of positive disruption of the status quo, you want to stay up to date on what they are working on if only for expanding your own personal inspiration repository

A Murmuration of Motivated Minds:      

Being a lifelong student of the Behavior of Systems, I am constantly seeking out patterns in system component actions that can cause noticeable reaction and results. I have always thought it was a little bit “magic” how even small changes in the behaviors of the parts of a system could significantly change its trajectory and consequently its outcomes. “Human Systems” such as those we see that drive the health and well-being of local and global communities essentially share this same characteristic.  As a testament to how this behavior looks in biological systems, I will offer the following video that was shared in one of the breaks during TEDMED titled “A Bird Ballet."  https://vimeo.com/58291553

This amazing synchrony of independent organisms is referred to as a “Murmuration.”  You will notice how sometimes a smaller part of the flock, or system of starlings in flight, will at times break off into an open part of the sky, but then comes back to the others to alter the direction and change the shape of the whole. After a bit of investigative research into murmurations, I was struck by what we know about the science behind this bird behavior and how it impacts the design of their flight patterns. In my opinion, this responsive fluidity in system change could be especially relevant to driving change in human powered systems.  This was my last and major takeaway from TEDMED and this phenomenon serves as an appropriate symbol to sum up my experience. That is even when individuals are working in different areas of interest if these separate efforts are linked by a unified shared vision, and we can connect and share information from multiple perspectives, amazing things can occur. You only need to watch the video to see how the science behind signals of shared information can meaningfully change a system’s trajectory.

A key point, those willing to “break away from the flock” to gather or share information are the ones to watch. If you want to see the brighter and bolder future of human-centered healthcare pay attention to these people. They are the ones, because of their divergent and unconventional ideas, passionate and compassionate curiosity, and willingness to be the first to venture away from the flock, whom I believe can finally move health and wellness systems toward true resilience. Meeting some of them at TEDMED has reaffirmed my hope in the future of human health and well-being and transformed my spirit to strive harder and more boldly into re-engineering our current system. To reference an overused, but in this context apt, quote of Margaret Mead “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

 

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Lisa Sundahl Platt is the CEO and Founder of UMNSystems LLC.  She writes about the systems and science of organizational and cultural resilience and how it impacts the human experience.

 

Establishing Trust through Traceability

I think that nowadays, any time any of us are feeling especially masochistic, we know we can successfully meet our daily exasperation quotas just by turning on the news.  Full disclosure, this is in no way meant to be a diatribe on the media and their communication of information related to world events and the US-based political circus that continues to unfold before our weary eyes.  Rather it’s an observation of what seems to be an emerging theme that continues to grow within our collective consciousness. A pervasive and persistent lack of trust in the validity and transparency of our information sources.

As a scientist, I have been inured to have a healthy degree of skepticism. The education we receive in the sciences in applying research and analytic methods to assess cause and effect drills the concept of “no theory can ever be proven in absolute terms” into us at early and iterative stages of our training.  Similarly, as a designer we are conditioned to perpetually seek a “goodness of fit” for any temporary solution that may provide a moderating fix to a constantly evolving problem. At first glance, these two disciplines may not seem eminently relatable. As someone who practices both though I can attest that indeed they are. In fact, one of the key elements that unite these two fields is the confidence one has in the veracity and completeness of the data that is guiding their decision making and read of circumstances surrounding a certain problem or opportunity. In scientific analysis, this reliance on normative data to produce predictable results is expressed in quantitative terms referred to as a “confidence interval.”  It essentially measures the degree of specifically how much the researcher trusts that the information they are using is producing reliable outcomes in which valid inferences can be made. However, in applying a scientific approach to designing solutions to problems in their actual settings I would recommend a slightly different approach to augment trust of information.  One that doesn’t require pontificating about “p values” and is far more straightforward. Traceability. 

Traceability tools in Systems Engineering provide a complete macro and micro operational assessment that lends itself to the development of subsystem, component, and system support infrastructure matrices allowing for traceability from high-level to low-level design requirements and vice versa. (Blanchard & Fabrycky, 2011).  More simply put, these tools allow all stakeholders of an improvement or design team a simple graphic interface to better interpret the connections and relationships between goals and objectives and the variables that are influencing them.  Additionally, it provides the system engineer or change management specialist a viable set of quantifiable terms to incorporate into system design parameters and lifecycle performance analysis.  Most importantly, it provides a framework for providing comprehensive and easy to digest information related to problem resolution or opportunity improvement. The presentation of an inclusive picture of system factors and their behaviors that everyone can understand and discuss builds trust in stakeholders. This is largely due to the fact that everyone involved in the effort has access to the same complete and easy to comprehend data.  Everyone trusts the information informing the design of a system to achieve a specific vision because, in essence, everyone is reading off the same sheet of music metaphorically speaking.   

One of my favorite traceability tools is what I refer to as a “What/Why” matrix.  This is a simple to use and extremely portable tool that can be used essentially by any group of individuals, regardless of background or training, that wish to collectively realize a specific objective.  In using this tool, a team leads with the “WHYs” they think a specific goal needs to be accomplished and then ranks these in terms importance on a scale of 1-10 (1 being least important, 10 being most important).  

We start with the “WHY’s” in this approach because it automatically introduces “purpose” as opposed to merely “process” into achieving a goal. Evidence supports that most individuals are more likely to commit to accomplishing goals they feel are personally meaningful to them and have the potential to directly improve their own circumstances (Latham & Locke, 2007). Leading with your “WHYs” can also be a critical asset in building team tenacity to get through “the ugly middle” of many projects.

Next, the team lists the “WHATs” in the system development process they think will help them accomplish their objective and then ranks these factors in terms of importance.

Finally, the group links which “WHAT” factors they feel will be most instrumental to achieving specific “WHY” factors.

            
Then the process is simply to multiply the WHAT and WHY weights along with their correlation links to get a system’s design criteria or process step prioritized.

This traceability tool demonstrates how what can at project inception, first be perceived as an inconsequential “WHAT” in a project process step can quickly rise to the top in importance because of its potential to support the purpose and meaning behind goal achievement. This method which ties objective achievement to the values that group members find personally valuable is a great way of imbuing team trust. Stakeholders trust that in pursuing a defined goal they are also fulfilling their own hopes and dreams because they can actually see how the process based “WHATs” and the purpose-based “WHYs” are linked and consequentially prioritized. The framework also provides the system engineer or change management specialist some critical metrics to use to inform system design development and performance benchmarking. This approach can be a great first step in integrating co-design into performance-driven system development and demystifying data collection and interpretation in design and improvement teams.

In future posts, we will discuss how traceability tools and co-design can improve the efficacy of emergent system processes and resilience in system infrastructure. Both critical factors in achieving solutions to “Wicked Problems.”

References:        

  1. Blanchard, B., & Fabrycky, W. J. (2011). Systems engineering and analysis (5th ed., Prentice Hall   international series in industrial and systems engineering). Boston: Prentice Hall.
  2. Latham, G. P., & Locke, E. A. (2007). New developments in and directions for goal-setting research. European Psychologist, 12(4), pp.290-300.

Lisa Sundahl Platt is the CEO and Founder of UMNSystems LLC.  She writes about the systems and science of organizational and cultural resilience and how it impacts the human experience.

 

Strategies for Synchronizing Social Systems and Safe Behaviors

Alliteration aside, the concept of “Safety” has been an overriding theme of the Summer of 2016.  It seems as though most newsworthy topics over the past several months have sparked conversations about how we can find ways of better preserving and promoting personal and public safety.  The industry in which I have spent the better part of two decades working has been no exception to this trend.  In May of this year, the Medical and Scientific Journal BMJ published a John Hopkins study that indicated 250,000 deaths per year in America were due to medical error. This makes Human Error the third leading cause of mortality in the US (Makary & Daniel, 2016).  Although a sobering figure, evaluating this type of data and its variables are critical to better understanding potential safety gaps and designing systems that better mitigate poor outcomes caused by them.  

Over the years I have worked with many organizations throughout the US and abroad, helping them to develop and implement performance improvement infrastructures to improve their safety-related process outcomes.  In doing so, I have often encountered two corrective action response approaches from organizational leaders that want to impact their safety related quality data; I call the first approach “Dystopian” and the other “Denial.” The Dystopian Safety Improvement method is frequently exemplified by a draconian lockdown on absolutely anything which could introduce risk regardless of how remote the possibility.  The results of this can create service experiences for both staff and clientele that feel more Orwellian and punitive than secure and inviting.  Ironically this approach can also lead to employee burnout which contributes to a rate of diminishing returns in safety measure effectiveness (Leiter, 1997).  The Denial approach, in the context I am defining it, although not necessarily ignoring safety data, attempts to address it by layering other positive components into service delivery mechanisms.  Although these amendments can be tangential to improving a product and/or service they are typically unrelated to actual gap or problem resolution. They instead serve as convenient distractions and a sort of, “Apart from that Mrs. Lincoln how did you enjoy the play?” approach to performance improvement.  Luckily this is not the only leadership response I have witnessed when safety improvement outcomes become salient in an organization.  
Proactive leaders, just like any good student of risk probability, understand that opportunities for performance improvement related to safety are an inevitable and continuous part of managing complex and dynamic systems.  Organizations such as healthcare are particularly susceptible to this due to the type of services they are providing and the multivariate and mutable nature of the environments in which they are operating.  One methodology that is proving to be especially useful in parsing both safety-related causes and outcomes and offering viable solutions for error mitigation is Cognitive Systems Engineering. 

Cognitive Systems Engineering, which came into being in the late 1960s, was born out of the idea that increasing automaticity alone was insufficient to ensuring reliable safety in any complex process (Flach, 2015).  It puts forth the notion that physical (environment/equipment) and logical (software/IT) systems must incorporate human-centered control design that facilitates performance goal-oriented behavior and reduces performance risk-oriented behavior in the human beings that are interacting with them.  Furthermore, its analytic tools introduce easy to understand and visual bi-directional traceability between the “Why”, “What,” and “How” of safety outcome cause and effects. (Lee et.al. 2010).  To summarize, it implements an approach to creating robust and evidence-based architectures that can reliably support safe outcomes within systems that are both flexible to changeable circumstances and not soul-crushing to the people using them to deliver or receive services. 

I will be providing some examples of these tools and their usage in future posts along with evidence of how they can be absolute game changers in increasing safety and performance reliability in sustainable ways.   
 

References:

  1. Flach, J. (2015). Supporting productive thinking: The semiotic context for Cognitive Systems Engineering (CSE). Applied Ergonomics, Applied Ergonomics.
  2. Lee, Katta, Jee, & Raspotnig. (2010). Means-ends and whole-part traceability analysis of safety requirements. The Journal of Systems & Software, 83(9), 1612-1621.
  3. Leiter, M., Robichaud, L., & Quick, James Campbell. (1997). Relationships of Occupational Hazards with Burnout: An Assessment of Measures and Models. Journal of Occupational Health Psychology, 2(1), 35-44.
  4. Makary MA; Daniel M. (May 2016) Medical error-the third leading cause of death in the US.  BMJ.  2016; 353: i2139

 

Lisa Sundahl Platt is the CEO and Founder of UMNSystems LLC.  She writes about the systems and science of organizational and cultural resilience and how it impacts the human experience.