The Design of Innovation: Taming the Beast in a Complex System

Prescribe Design & Chris McCarthy

Kaiser Permanente (KP) is a place where innovation is simply a part of its DNA. From its founding in the 1930s it was a radical idea that brought it to life. That spirit of innovation has carried the organization through both tough and awesome times. Although innovation was implicit, something extraordinary happened in 2003; both improvement and innovation became explicit. Each is different, mutually beneficial and allowed the organization to simultaneously create and optimize.

KP in 2003 laid an optimization foundation by teaching everyone the methods and language of improvement. Plan, Do, Study, Act (PDSA) is the experimental model taught in grade school. This simple, powerful method empowered KP employees to make and understand a change. This just so happened to also create a firm foundation for designers to test new ideas and do so in a way that remained within the lexicon and methods of what the organization already learned. Bold, creative ideas could be tested with confidence.

Also in 2003, KP experimented with human-centered design as a way of solving complex challenges. Those early experiments yielded high-value products and services such as the Journey Home System that optimizes a mom and her newborn baby’s stay in the hospital, and Nurses Knowledge Exchange that creates a totally new shift change experience for both nurses and patients. These early, widespread successes established design, explicitly, at Kaiser Permanente.

KP now has over a decade of experience in building and maintaining design infrastructure. And over the years two types of design emerged. Design Thinking is by the far the most widespread. Design Thinking is a set of tools that can be applied to many methods: PI, Lean , Six Sigma etc. It enables the improvement team to explore patient/customer needs and wants, and encourages a more robust exploration of ideas and prototypes. Design Thinking amps up other approaches.

The second is evidence-based human-centered design (EvHCD). EvHCD is a mash up of the art of innovation (design research and ideation) and the science of improvement (refinement and pilots). It is a SWAT team approach, administered by formally trained designers and strategists paired with subject-matter experts such as nurses, doctors, patients, and others, and is used for difficult, complex or nebulous challenges. Whereas Design Thinking is measured in hours and weeks, EvHCD is measured in weeks, months and sometime years. Both stem from the same foundations with the tools often being interchangeable. The main difference is time, complexity and expertise.

There are three powerful attributes of design that keep it thriving at KP. The first is the love of story. KP has a long history that is often told at corporate meetings and events. Patient/Customer storytelling is a natural extension and fits with the organizational DNA.   Storytelling, paired with quantitative data, is a powerful “changemaker”, and the technique is well loved in the organization. Most meetings open with a patient story.

The second is synthesis. Although there is little love for the synthesis process, there is a deep appreciation for what it generates. Design at KP asks teams to slow down and ponder. This is at odds with the general healthcare psyche that often demands instant solutions. Synthesis is key to new knowledge and new opportunities; and this depth of thinking is celebrated.

If there is one element that is sorely lacking in healthcare, it’s the ability to prototype. Prototyping is the third attribute that makes design stick at KP. Design is “know-how” and permission to rapidly create. It reduces idea inertia and paralysis; it celebrates the very act of trying. This is reinforced by the Plan-Do-Study-Act cycle. The everyday employee has had “making” removed from their skill set; prototyping gently returns this skill. Doctors, nurses and patients are methodically and over time, building prototypes (and solutions) that solve their local challenges.

For both Design Thinking and Evidence-Based Human Centered Design, KP created infrastructure that supports and nurtures them.

PeoplePeople: having individuals and departments whose expertise is innovation and design is perhaps the most important element in keeping design vibrant at KP. There are several full-time innovation and design departments spread across the system, including KP’s Innovation Consultancy and Innovation & Advanced Technology. Part of their services includes free coaching and consultation to anyone in the system. However the bulk of the work is to create “new, valuable stuff” from the complex challenges they are given.

access to innovation and design space is a natural accelerate to big thinking. KP has over 50,000 square feet dedicated to innovative thinking. Whether at the Garfield Center in California or the Center for Total Health in DC, employees at KP are encouraged to tap these creative spaces. For designers, having access and/or living in creative spaces are paramount to their ability to design.

propagating design across a system of 200,000 people is no easy task. At the most basic, is having easily accessible tools and training to add design skills to everyday projects. Every employee has access to dozens of design, innovation and creativity classes. Middle management and Executives are immersed in day long explorations of Design Thinking. For the designer, individual development plans are created to keep their skills current.

measuring people, projects and process are important elements. KP added innovation as a behavior for all employees in 2009 triggering a widespread pull for innovation knowledge. Projects metrics have been a part of the design process from the start (2003) with a growing sophistication over the years. Finally, measuring the design process itself is in it infancy, yet an important measure to understand the effectiveness of the various phases of design.

networking with other designers both internally and externally to ensure a rich exchange of ideas and techniques is the final piece of intentional infrastructure. With several internal groups and few external, including the Innovation Learning Network, designers and innovators have many options to stay connected and be inspired by the world around them.

Although this is the context that designers at KP live in, they have specific creative needs, not unlike in external firms. They need a place to be creative and connect; the standard issued cubicle is not workable in the long term for a stable, creative design team. They need liberated work schedules and processes; the 9-to-5 “be at your desk’ mentality undermines these abilities. Finally they need high impact projects that require design. Design is a precious resource, and should tackle projects that truly demand big, bold thinking.

There are many avenues that lead to great solutions at KP: performance improvement, research and development, ventures, and more. Design is one that is growing and evolving. It has established itself as a competency, able to provide deep value to the organization. KP design is (and has been) in a virtuous cycle; it takes on tough challenges, solves them, and adds more credibility to what it can do. The more cycles, the more stable and attractive it becomes, generating more trust and demand.

Kaiser Permanente can seem like a beast of system: its big, complex, and delivering on one of the most complex industries. However it is this very complexity that creates such an incredible environment for design to provide deep value in new and unexpected ways. And it can do this, because equally KP nurtures and grows design. And so, perhaps not so much a beast, but a thriving, innovation ecosystem.

Chris McCarthy is a Creative Leader and Healthcare Rebel.
Loves dragging the future into the now.
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