The Medical Revolution You Haven’t Heard About … Yet

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Thomas Jefferson University's Stephen Klasko and Bon Ku discuss the importance of health care design.

The science and art of medicine have been undergoing increasingly rapid change for decades. New treatments are developed. New diagnostic tools arrive. Cures become imaginable where none were before. But there’s one area where change has been slow: design. And if you’re wondering what design has to do with health care, you’ve uncovered part of the reason why: Most medical professionals don’t even think about poor design as a problem. But it is.

Enter Stephen Klasko, an MD with an MBA, who is CEO of Jefferson Health System and Thomas Jefferson University, and Bon Ku, MD, a  professor of emergency medicine at Thomas Jefferson University Hospital. Ku runs a new program to turn less traditional medical students into innovative, creative problem-solvers, route them into medical school, and create a new type of physician trained to solve health care problems through design methodology. “Everything in health care is design,” says Ku.

Klasko and Ku joined the Knowledge@Wharton show on Wharton Business Radio on SiriusXM channel 111 to talk about why design is so important to health care’s future, and the unabashedly cool ways they intend to harness to force the medical profession to evolve. You can listen to the interview using the player above. An edited transcript of the conversation appears below.

Knowledge@Wharton: Why design?

Stephen Klasko: I’m going to turn this over to Bon, but it’s sort of a great week to talk about this because I had a chance to interview for the Arts & Business Council [of Greater Philadelphia], an individual named Bruce Mau, who runs something called Massive Change, who’s actually done design for Mecca (the Muslim holy city). And his point is, the core of optimism is design, and when industries are going through a major change, your experience is the design.

So last time we were here, we were talking about things moving to a consumer experience in health care. It’s not just good enough to say “OK, we’re going to go and take care of you in the emergency room.” What’s the experience? Well, Bon is not only involved in transforming and disrupting that experience, but actually creating a college within a college so that our students really can understand design with places like Princeton involved. So Bon, you might want to talk a little bit about what you do during the day.

“When we design hospitals, we should want to design the best and most beautiful building which happens to be a hospital, but instead, we design mediocre buildings.” –Bon Ku

Bon Ku: I run a design program at Sidney Kimmel Medical College [at Thomas Jefferson University]. It’s the first design program for medical school in the country. We take students during their first year of medical school, and we teach them design methodology. This involves empathy, rapid prototyping and iteration, and we teach them before they enter their pre-clinical years how to solve health care problems through design methodology — to really think outside the box and become creative problem solvers.

Knowledge@Wharton: How important is this for the future doctors right now, and how key is it to get to them in that first year?

Ku: I think it’s vitally important because in medical school, we are good memorizers and we’re pretty good technicians, but I think we are not great problem solvers. In order to innovate in health care, we need to really redesign how we train and teach doctors of the future. Twitter  We need to equip them with tools in the rapidly changing landscape of health care.

Klasko: Last time we were here, we talked about the fact that we still accept students based on science GPA, MCATs and organic chemistry grades, and somehow, we’re amazed that doctors aren’t more empathetic, communicative and creative. Under Bon’s leadership, we’ve now done a partnership with Princeton University, and it’s really cool because it’s exactly what we talked about. It’s going to students and saying “Before we suck the creativity out of you by forcing you to memorize every organic chemistry formula, go and major in something really cool, take the minimum amount of science courses you need to take ….” Do you want to talk a little bit about that and what kind of students you hope to get out of that?

Ku: Yes. We accept students during their sophomore year, and we don’t make them take the MCAT because we feel like we can teach them medicine when they get to medical school, and we really want them to use their undergraduate experience to explore and be creative, to take design classes. We want to attract a different type of medical student to our school. For example, I was a humanities major, a classical studies major, and less than 5% of med school applicants are humanities majors. We traditionally just take biology majors.

Knowledge@Wharton: So undergrads who think that they want to be doctors are just focused so much on getting to that next step of getting into med school that they miss a lot of opportunities along the way.

Ku: Absolutely. And a lot of students are reluctant to go to medical school, because they look at it, this massive amount, years of memorizing and jumping through all these hoops. I think we lose a lot of students who are innovative and creative to other fields that do it better than us, like the tech industries.

Klasko: Let’s tie this to Wharton because I think this is one of the things that Wharton has done very well. When I did the Wharton Executive MBA program, they got to a point where they said “We want to round out our class.” Just like Jefferson, we have 12,000 applicants for 290 slots, and if all that we look at is science GPA and MCATs, we’re going to get a certain kind of class. Why did a gynecologist from Allentown get into Wharton? Because they wanted to round out their class instead of just getting all finance people.

So the ability for us to say, “Look, there’s some people that we need to get that are going to be physicians, scientists or going to be technicians,” but also getting that human component…. Those kids over 10 years will be 150 of the smartest, most creative folks on the planet that probably won’t go out and become physician NIH scientists. They might go and start their own companies, they might go and teach, they might go and practice, but they’ll be very, very different.

Knowledge@Wharton: What is it, though, that really got you going down this path of thinking about design and how it was an important educational component for future doctors? What was the key?

Ku: Just to share a personal story, I work in the emergency department, and I was getting frustrated seeing some of the same problems in health care show up at our doorstep, and I felt frustrated because I felt I could not change the system. A lot of us in medicine become jaded, a little bit cynical. Design affords an opportunity to really say, “How can we change the system?” And it creates that optimism that we can pivot the needle in health care.

“Thirty-five percent of Stanford’s medical students never go and take a residency in 2015. They basically decide to go to medical school so that they can start new companies or do new things.” –Steve Klasko

Knowledge@Wharton: So in some respects, you’re going to have not many doctors, but you’re going to potentially have some architects in terms of the process of medicine.

Ku: We would love that. We need more right-brained thinkers in medicine, and most of us don’t realize that everything in health care is design. Twitter  Someone designed the pills that we swallow, those gowns that we wear in examination rooms. But I think most of it’s designed poorly; we too often will design mediocrity in health care.

Klasko: I think the really operative word here is “optimism.” I mentioned to you before that when I started my job here at Jefferson, somebody said, “The two things you don’t want to be running in the next three years are academics and health care.” And I said, “Dang, I just took a job at academic health care.”

If you go around to most places, people are really depressed. Why? Because they’re thinking about things the way it used to be. And if you don’t think you have the skill sets to fundamentally do well in a disruptive environment, then you get depressed. The great thing about what’s happening at Jefferson — and Bon is a great part of it, we have this whole division of coolness which Bon is a part of — is that literally, he’s leading this movement towards “Hey, change can be good for us and let’s use this to change the way people experience the emergency room or our students experience this.”

Not everybody gets it. People say, “How did you go through a 180-degree change at Jefferson and not have a faculty revolt?” It’s partly because we’re giving people the skill sets that they need.

Knowledge@Wharton: I would think that being an emergency room doctor and seeing patient after patient who were repeats would have to be frustrating at some point, and cause you to want to spur this change on.

Ku: Yes. It’s really easy to blame patients, and especially those patients who are super-utilizers of the health care system. But when you do a human-centered approach, you really want to put yourself in the shoes of the patient, and think, “Why am I continually using emergency care services? What is it about my social situation or my lifestyle that keeps me coming back to the emergency department?” So instead of blaming the patient, we really try to look at what it looks like through the patient’s eyes.

Klasko: And the thinking that you probably will get from some of these students will be not just on the specific policies that should be put in place by hospitals going forward, but the design of the hospital itself. Hey, we need to change the emergency room to make it more convenient and affordable for the patients. For a variety of aspects of it. It’s kind of limitless, the potential for change.

Ku: Yes. Just this past week, we did a workshop with an architecture firm here in Philadelphia where I challenged my students to think like architects, and we actually designed a floor plan for a hospital wing. It was a great challenge and it really had the students use their right side of the brain and think about what these spaces would look like.

We settle for design mediocrity, like I said. When we design hospitals, we should want to design the best and most beautiful building which happens to be a hospital, but instead, we design mediocre buildings.

“Most of us don’t realize that everything in health care is design. Someone designed the pills that we swallow, those gowns that we wear in examination rooms.” –Bon Ku

Knowledge@Wharton: But it is interesting that … may be something that we don’t think about as much as we probably should.

Klasko: Look, I think that the big change that’s going to come is the generational change. What makes Uber special is not just the ride, it’s the experience. Not necessarily the experience of the car, but the experience of the app. And a good part of what Bon and folks like Neil Gomes [vice president for technology innovation and consumer experience at Thomas Jefferson University] are proposing is to really start to look at … how you experience Jefferson if you’re a student from your home to the classroom to the hospital. So it’s the buildings, it’s the apps, it’s the telehealth, it’s the communication, and it’s basically trying to think about what’s going to be obvious 10 years from now and start to try to do it today.

Knowledge@Wharton: Probably some of the students you’ll have running through this program are the ones that have ideas for a new cool app or something that will be transformational in the medical field at some point.

Ku: They’re inspiring. They have so many ideas and we’re just tapping them through design methodology. They’re thinking about how to create new solutions in space design and service design and device design, and they’re hungry for this. It’s really amazing to see them approach health care this way.

Klasko: Here’s the coolest thing that’s happening, I’ll give you a number of the day: 35%. 35% of Stanford’s medical students never go and take a residency in 2015. They basically decide to go to medical school so that they can start new companies or do new things, but they feel they need that medical training. Now, you can get into a philosophic argument: Is that a good thing or a bad thing? Did you waste a medical education on someone that’s not going to be doing surgery or whatever? I think it’s a great thing, because I think what’s happening is we’re getting these young people to think about health care in a different way.

Knowledge@Wharton: If we can develop different processes and ideas to the point where we are making people healthier so that, in general, people are using hospitals less, then we’ve really accomplished something, correct?

Klasko: So Bon, what might make sense to talk a little bit about is how we’ve organized this. I think one of the things that’s different about what we’ve done in an entrepreneurial, academic model is to take these things like innovation and college within a college and design, instead of putting them over there and creating the department, putting it right in the core. So Bon’s in the dean’s office. Neil Gomes is in IS&T [Information Services and Technology]. The telehealth people are right in my office. The innovation person we just hired from Duke to run our innovation pillar is one of four people that reports to me. At the end of the day, in most places, the people who handle our “coolness stuff,” they’re over on the side someplace. This is right at the core, so it’s almost like one of those “Invasion of the Body Snatchers” things. Every single one of our conservative pieces has a bond there that is basically changing the way they all think.

Ku: Historically, we’ve really outsourced innovation, and we are really trying to develop innovation within by changing how we train doctors, changing how we train students. We want the innovation to come within the health system as well.

Knowledge@Wharton: How big of a change is that, for the core of the medical community to be able to bring that in-house and keep it in-house, instead of outsourcing it?

Ku: It’s inspiring for many of the physicians and students that we have. For example, we had a health care hack-a-thon a few weeks ago. We invited engineers and students and designers and entrepreneurs to Jefferson and, over a weekend, we looked at how we could solve these wicked problems in health care. We had a “How do we reduce re-admissions?” track. We had a “How do we use drone technology to improve health care delivery?” track. How do we use wearables to improve health? We were really providing that vehicle for people to think outside a box and create solutions.

Klasko: It’s a great example of why having them in the organization matters. It started with the $1 million grant from Independence Group for an innovation. In most medical schools, that would have gone to the provost and the head of the hospitals and just got put into the overall budget. We brought it to these guys and said, “What would be the coolest thing we could do?”

I’m leading something new within a 192-year-old institution. Nobody’s within 30 years of me talking about drones, talking about wearables. But we’re using that $1 million dollars to become one of the most innovative things. We’re working with NextFab, we’re working with Drexel, Penn, places all over the country, really, around how drones can effect health care and how wearables can affect health care.

Knowledge@Wharton: How can drones affect health care?

Ku: The winning team had this concept: How do we find victims who are in a disaster, like in an earthquake? They built a device, basically, it’s an Arduino, which is a programmable computer chip, and put a hearing sensor on it. They would fly their drones where these earthquake victims are, and they would drop these sensors and they could actually listen to where the patients are. It was a rough prototype, but they were able to do that within 36 hours. It’s amazing what you can do when you give people the tools to do that.

“Our goal is totally, totally disrupt the curriculum for health care, because it hasn’t changed in 50 years. There’s nothing else that hasn’t changed in 50 years….” –Steve Klasko

Knowledge@Wharton: For you, being in the medical community for as many years as you have, to see this change in how medicine is viewed and where it’s going to go has to be staggering.

Klasko: Well, it is, but what’s fun is leading an organization that’s actually more optimistic about the future than the past, it’s fun to not be fighting it…. It was probably a lot of fun working for Apple in 2000 when they were moving from a computer company to a digital company. It might not have been as much fun working at Microsoft andwatching Apple do that. We like to view ourselves in a place that has five academic medical centers as that young Apple that’s sort of looking at things differently. We’ve had faculty members come to us and say, “Boy, it seems like your folks are having fun, you have some of the same external pressures that we do. Why are you guys having fun?” Well, it’s because of things like spending the weekend talking about drones and not about Obamacare.

Knowledge@Wharton: How much do you expect the doctors that you’ll be involved with over the years really to change? I’m sure you see it now, but their philosophy on being a doctor will be significantly different over the next 10 years.

Ku: Most people who enter into medical school, they want to help people, but medical training is so long, right? We have four years of medical school, minimum three to five years of residency, then one to three years of fellowship, and that really beats out that idealism that these medical students come in with. By getting these students in their first year and showing them that optimism and how we can change health care through design methodology, I hope that will keep within them during that long training process.

Klasko: What were some of the initial pushbacks you had? I imagine when we first started this, other than me saying “Go do it.” Because my job is to say “Go do cool things,” and then he has to go and convince the faculty that we’re going to do this.

Ku: I get a lot of funny looks. Most people think design is just making things look pretty, but that is the total opposite. Most of it is, how do we improve that patient experience in the hospital, in the emergency department, in the waiting room? So a lot of it is just educating my colleagues, my students, that design is fundamental in how we can reshape health care.

Klasko: And it’s the whole process. With your part of it, emergency medicine, obviously it’s the part afterwards in their recovery as well.

Ku: Correct — and looking outside of the walls of the hospital. Most of us are patients for a very brief moment in time. But how do we reach people at their house? We have a large telehealth effort that we’re using to do that. Looking at patients, a lot of them don’t want the traditional brick-and-mortar type of hospital experience.

Knowledge@Wharton: I’m guessing that, in some respects, this may go at some point to sustainability issues as well.

Ku: Absolutely. We have a huge constraint with cost, but it’s okay. With design, we’re working around how we can make affordable solutions. We look a lot towards the maker movement. These are tinkerers and designers who use low-cost technologies to make them affordable for most of us.

Klasko: Just getting to the sustainability issue, I think the evolution of health care is that, for a while, it didn’t matter how inefficient we were, because there was just enough money to cover it. Then we got into this lean, Six Sigma type thing, which was really just going in and cutting unnecessary stuff out.

I think we’re getting to the 3.0 version, if you will, which is really more “OK, so now that I’m leaner, what are some really cool things I can do to make patients save that really have a design piece to them?” For example, you can talk about falls. Well, there are lots of ways you can look at falls, but one thing for designing things is maybe a thin coating of something that could be added to clothing or hospital gowns, so that if people fall, it would be like a human air bag. Because at the end of the day, you’re always going to have people falling out of beds or whatever. This way, they’re not going to get hurt. So, we’re starting to think about design as really the solution. And to your point, design is not just a little “Oh, isn’t that cool, you made the gowns nicer.” Not only did you make the gowns nicer, but if you fall, you’re not going to have a hip fracture.

Ku: I love that they’re not open in the back. We’ve got to change that.

Knowledge@Wharton: Where do you see this going? Because in some respects, this is in its infancy right now, correct?

Ku: It is, but we are seeing a lot more in other sectors of business. There’s a recent New York Times article on design thinking within IBM. They’re hiring 1,500, designers and they’re banking on design thinking to change their culture. The Harvard Business Review dedicated one of their fall magazines to design thinking. I think this is going to be a way that we transform cultures within large organizations. I’m optimistic that we’re going to see a lot of innovation come through this type of thinking.

Klasko: And this is how we’re going to expand the cult, if you will. We started something called an Institute for Emerging Health Professions. The goal behind it is, if health care’s going to transform, there are going to be jobs that we need 10 years from now that don’t even exist today. And if you think about a university, if I start that today, between developing the curriculum and then getting the students, that would be 10 years.

So through the Institute for Emerging Health Professions, we want to be one of the leaders. We’re going to partner with some undergraduate schools to create new doctor corps who really want to go and expand this further and teach this, and our goal is to have this become part of every medical school curriculum. The first two years of medical school are repeating just about everything that you did, or that you could get in an online course. The last year of medical school is really just a lot of electives. To not be really imbuing design thinking, emotional intelligence, cultural competence, health care financing — our goal is totally, totally disrupt the curriculum for health care, because it hasn’t changed in 50 years. There’s nothing else that hasn’t changed in 50 years….

Knowledge@Wharton: And then the end result, if all of that is put into place and goes according to plan, is what?

Klasko: The end result – selfishly, for Jefferson — is that we become known as a national model for an entrepreneurial academic design model in health education, which is a nice brand to have. The end result for the United States of America is that we have doctors that get it. That when you talk to your doctor and they say, “Oh, I hate Obamacare,” why do you hate it? “Because it’s not what it used to be.”

I’m really excited about Medicaid expansion, because now I can think about how I can provide those patients that weren’t getting health care an experience, but it’s going to be different than the experience they had before because they can’t get into my office…. So I’m excited about solving that problem instead of either waiting for entrepreneurs to solve it for them or just complaining that things are different.

Knowledge@Wharton: Even the complaints that you may have heard 10 or 15 years ago, you’re probably still going to hear a few of them in the next few years. But it’s that process of building towards a time where maybe you don’t have as many complaints to deal with.

Klasko: But you know what happens? And I think Bon’s seen it too, is that there’s something in medical school called hidden curriculum. You take these optimistic, amazing, idealistic kids and by the time they graduate from a traditional medical school, they’re as cynical and jaded as the 59-year-old surgeons. We don’t have a curriculum that teaches them how to be that, but that’s what they’ve heard.

What’s starting to happen, thanks to Jefferson and Bon’s efforts, is that the students’ ideals are becoming infectious. What’s happening is that it’s hard to be around our students and not say “Oh boy, Dr. Klasko, you are so lucky to be leading — I just had a tough budget meeting, but you are so lucky to be leading a university during this time.” I am? Oh yeah, I am. What we’re starting to see is some of the faculty, instead of teaching the students to be jaded, those college-within-a-college design students are teaching the faculty to be optimistic.

Knowledge@Wharton: And then they don’t need the Red Bull.

Klasko: And then they don’t need any drugs. It’s really beautiful.

Loney: Is “cool” the word you hear from him a lot?

Ku: All the time.

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