Better health by design

Despite our best efforts, we have curated a health system, like author Mary Shelly created Frankenstein in her novel of 200 years ago – by bringing together bits and body parts and expecting them to function as a synergistic whole – when it is in fact a complex system, an ecology.

Healthcare is arguably the most complex system of human kind and it is anticipated to get worse - the level and rate complexity is predicted to grow. New thinking and approaches are needed to generate sustainable systems change and provoke human centred technology and product innovation that solves real problems for patients and improves the quality and experience off healthcare.

While the value of collaborative design in public sector innovation is gaining momentum globally, including health system reform, there are limited robust systemised examples in Australia that bring together patients and families in genuine partnership with clinicians and other service providers, executives and administrators to drive sustainable service improvement, systems change, research and technology innovation.

Emerging trends in healthcare

The ageing demographic is a global mega-trend. The world’s population is expected to increase by one billion people by 2025. Of that billion, 300 million will be people aged 65 or older, as life expectancy around the globe continues to rise. Additional healthcare resources and service innovation is needed globally to deliver the long-term care and chronic disease management services required by a rapidly increasing senior population.[1]

A burgeoning middle class is another global mega-trend fuelling increasing demand for more health options. It is predicted that 65% of the global population will be middle class by 2030. The majority of the world’s middle class will live in cities and become increasingly sedentary which will inevitably lead to greater incidence of obesity, diabetes and other costly chronic health conditions.[2]

There is a growing global burden of chronic diseases which comprise the largest component of the health and economic burden of diseases in developed and developing countries. The World Health Organization predicts that chronic disease prevalence is expected to rise by 57% by the year 2020 and will account for almost three-quarters of all deaths worldwide.[3]

To fight the growing burden of chronic diseases, many countries are shifting focus from the treatment of diseases to preventive health care. Australia reportedly spends more than $2 billion on prevention each year, or around $89 per person. This is equivalent to 1.34 per cent of all health spending and 0.13 per cent of gross domestic product (GDP). While Austalia spends close to the average of all OECD countries on health care in total, it is substantially less than Canada, the USA, the UK and New Zealand.[4]

One size fits all to personalised care

These factors are driving non-health based industries to become increasingly involved in the development and provision of preventative innovations and management solutions such as retail, telecommunications, technology as well as a growing wellness and fitness industry.

Genome sequencing in the development targeted drug therapies are fast becoming a reality and there is potential for computer simulated clinical trials to hasten the existing clinical trial processes which often take many years to get from the laboratory bench to the bedside.

Transactional to predictive and proactive care

There is a growing shift from transactional, fragmented care towards more integrated, holistic patient and consumer centred care.[5]

There is a growing consumer demand and recognition of the inefficiency and ineffectiveness of fragmented care driving the shift from transactional, disjointed care towards more integrated, holistic outcomes for individuals and their families.

This extends to to the design of our urban environments and the importance of clean air and water, fresh local produce, social interactions and cultural offerings with access to green space and where its easy to walk, cycle or swim.[6]

Institutionalised to decentralised care

Consumers are also increasingly demanding greater independence in managing their own health and wellbeing. The World Economic Forum predicts that within ten years the doctor and the patient will not need to be in the same place at the same time in many circumstances.[7]

Paternalistic to empowered care

Progress in Patient and Family Centred Care Practices are driving improvements in information flow, streamlining patient care in hospital and enhancing communication between hospitals and community-based health providers. Patients are also increasingly demanding quality service independent of time and place.

Technology is driving personalised care

The emergence of mass data, the Internet of Things, informatics, analytics and advances in data/cyber-security are driving our ability to share information, collect, analyse, compare, share and reuse data, across the continuum from prevention through to tertiary care improving clinical and the translation and impact of research.

The pace of developments in technology is rapid, ubiquitous and exponential, such as robotics, wearables, nanotechnology, 3D printing, virtual reality, augmented reality. Innovation and interoperability between these systems is predicted to transform diagnosis, treatment and the experience of healthcare.[8]

The value of Collaborative Design

To improve the experience and quality of of care health services must locate patients and families at the centre of care, however, this must be done in genuine partnership with clinicians, other service providers, health executives and administrators.

EXAMPLE: The Mayo Clinic – Center for Innovation. The Center’s role is to transform the experience and delivery of health care with a patient-centered focus.  It offers a multidisciplinary team to turn innovative ideas for medical practice into practical solutions that change how patients receive health care. [9]

Strengthens organisational relationships, wellbeing and culture.

Collaborative Design builds trust and mutual respect among partnersand values interdependence towards a shared purpose – which is highly unifying. Empathy is central, which motivates individuals towards meaningful action and to move beyond assumptions they didn’t even know they had.

Evidence demonstrates a number staff benefits in relation to purpose and wellbeing:

•          engaged employees are significantly happier, have lower levels of stress and are less likely to be diagnosed with depression than those who are disengaged [10]

•           employees who can link their work to a larger purpose are likely to have greater levels of interest[11]

•           those who pursue goals that match their personal values and interests are more likely to attain those goals.[12]

Builds on existing strengths.

Collaborative Design acknowledges and builds on existing core operational strengths, positive qualities and past successes. A positive culture and upward cycle is built when prior experience sets the foundation for future activity and when future activity builds upon and reinforces prior experiences.[13] The process of Collaborative Design manages expectations and allows for limitations and complexity to be acknowledged and valued.

EXAMPLE: The Waitemata District Health Board (WDHB) in New Zealand have developed a co-design approach specifically for the health environment to improve patients’ experiences of services as well as the services themselves. The WDHB have developed a co-design website which describes a six stage process and and guiding principles and how to apply the process in various scenarios such as; developing a new service, improving an existing service and solving a particular issue. The website hosts a range of tools and a guide to navigating ethics as well as ways to amplify sustainable change. [14]

Intrinsically Sustainable.

As Collaborative Design brings together to patients and families in genuine partnership with clinicians, other service providers, health executives and administrators to design improvement and builds on exsisting strengths it is intrinsically grounded in what is desirable, feasible and viable. [15]

EXAMPLE: A network of 11 European partners, entitled Sharing Experience Europe (SSE) present a series of case studies and tools in the Design for public good report, to enhance the understanding of design for public sector innovation and facilitate the integration of its methods into mainstream practice. The Design for public good report describes the three step ladder for effecting change in the public sector and highlights best practice examples.[16]

The Collaborative Design approach applied at the unit level or at scale across a hospital or health region has potential to generate sustainable systems change, flexible infrastructure development and provoke and embed human centred technology and product innovation that genuinely improves the quality and experience of healthcare.

 

Trish Hansen is the Founding Principal of Urban Mind, a strategic consultancy, leading purpose driven systems change for collective impact,  through collaborative design. This work is inspired by her work as a former senior clinician as well as her personal experience of breast cancer.

 

 

 

[1] United Nations World Population Prospects 2017 https://esa.un.org/unpd/wpp/

[2] Global Economy & Development Working Paper (100). February 2017

https://www.brookings.edu/wp-content/uploads/2017/02/global_20170228_global-middle-class.pdf

[3] World Health Organisation. Nutrition Health Topics – The global burden of chronic disease. http://www.who.int/nutrition/topics/2_background/en/

[4] Preventive-health-How-much-does-Australia-spend-and-is-it-enough Department of Public Health, La Trobe University

and the Australian Prevention Partnership Centre

http://fare.org.au/wp-content/uploads/Preventive-health-How-much-does-Australia-spend-and-is-it-enough_FINAL.pdf

[5] MaRS Discovery District, Dr Zayna Khayat

https://www.marsdd.com/news-and-insights/transforming-health-shifting-from-reactive-to-proactive-and-predictive-care/

[6] What works wellbeing- places, spaces and social connections https://whatworkswellbeing.org/blog/places-spaces-social-connection-and-peoples-wellbeing-what-works/

[7] World Economic Forum, Value in Healthcare: Laying the Foundation for Health System Transformation.

http://www3.weforum.org/docs/WEF_Insight_Report_Value_Healthcare_Laying_Foundation.pdf

[8] Ten ways technology is changing healthcare http://medicalfuturist.com/ten-ways-technology-changing-healthcare/

[9] The Mayo Clinic – Centre for Innovation http://centerforinnovation.mayo.edu/

[10]  Rath, Harter, & Harter, 2010

[11] Wrzesniewski et al.,1997

[12] Sheldon & Houser-Marko, 2001

[13] Scott DeRue & Kristina M. Workman. Driving Leadership Development with Positivity, 2013. White Paper. University of Michigan, Ross School of Business.

[14] http://www.healthcodesign.org.nz/about.html

[15] IDEA Human Centred Design Toolkit https://www.ideo.com/post/design-kit

[16] Design Council UK Design for Public Good report.  http://www.designcouncil.org.uk/knowledge-resources/design-public-good

"It's the vibe" - How Mindsets Shape the Prosperity of Cities.

The imaginary dictionary of all urban things often refers to growth in relation to swelling populations, unruly sprawl and less than mediocre commercial development. However, the science of the human mind and brain might offer deeper insights into growth in relation to our urban mindset, resilience and ‘the vibe’ of a place as drivers of prosperity.

Stanford Professor Carol Dweck has led ground breaking work on human mindsets which is echoed throughout classrooms around the world and provides insights into how individuals might foster success. Dweck’s work demonstrates that an individual with a growth mindset exhibits curiosity, courage, and confidence, embraces challenges, sees effort as the path to mastery and finds inspiration from the success of others.

Grit is important too. Psychologist Angela Duckworth’s work on the psychology of achievement sheds some the character of grit and resilience, and while it’s much more than “pulling yourself up by your bootstraps” it proves to be an important cog in the engine of social mobility.  Duckworth’s take home message is simple: define your higher purpose, then persevere.

Confidence is another factor and the balance with capability is crucial. In these times where self-confidence and posturing often exceed competence, perhaps there is something to be learned from grace and discernment, being true to oneself and creating clear boundaries.

On the flip side, Dweck also demonstrates that an individual with a fixed mindset, exhibits the opposite — avoids challenges, gives up easily, sees effort as fruitless, ignores feedback, is threatened by the success of others. We tend to associate a lack of confidence with being discouraged, fretful, hypersensitive and annoyingly indecisive. It’s all about the ‘F’ word. Fear. Fear of failure, fear of being judged, fear of not being taken seriously, fear of being rejected.

Failure can however have a function — its asks us if we are serious, if we want to go again, but being a little wiser. It’s arguable that it’s only when we scrape ourselves up, from the floor of failure and go on, that we really benefit. If we don’t, it haunts us. It becomes a reference point for almost everything else we try, and with what we know about how our brain wires itself, it becomes us. We become so risk averse we are at risk. We languish.

The astonishingly good news is that we can rewire and change our brain. Neuroscientist Baroness Susan Greenfield, among others, has enlightened us to plasticity of the human brain and its astonishing capability to reorganise itself by forming new connections between brain cells, whenever something new is learned and memorised. Intelligence can be developed. Mindsets can be changed.

So, what does a capable, confident and resilient city look and feel like and how might we rewire urban ‘neural’ pathways; the urban mind, for a better future?

Let’s consider purpose. Defining one’s individual higher purpose or raison d’être, requires a deep and often lengthy search of the self and begins with acknowledging one’s identity.

Cities and places have 3.8 billion years (or thereabouts) of natural biological and geographical history. This deep time offers an immediate potential source of shared place identity. The rich culture, customs and traditions of Australian Aboriginal people, as well as contemporary narratives, coalesce with diverse migrant stories and experiences to blend and shape our connection to place.

In the quest to define the identity of a city or place, branding strategies can often result in municipalities allocating a politically-driven aspirational and gentrified city tagline such as ‘Smart City’, ‘Creative City’, or ‘Open City’ — but unless it comes from deep within the cultural bones of the people, it’s not only meaningless and naïve but it reeks of desperation and lost opportunity.

Some cities are busy posturing in the endless quest for global attention yet grappling to get a grip on the basics of inequality, homelessness, addiction and violence. Other cities and regions, however, are deeply focused on the question, “How might we sustain ourselves in this wondrous place?”, and gently curating the conditions conducive to ‘the good life’ enabling prosperity for all its people and the planet.

It has been a year since Adelaide and South Australia were thrust into absolute darkness amid a wild and squally tempest. It is glorious to think that in our darkest hour, literally, in the aftermath of the state-wide power failure, it seems we stumbled upon a defining moment — a pivotal re-boot, a shift in mindset and some seemingly crucial rewiring has taken place in the transition from “just keep swimming’’ to “infinity and beyond’’.

 

Exploring our Urban Mind - How do our mindsets shape the places we live?

While strong links between thoughts and actions is beginning to be understood on an individual level and to some extent within families, teams and workplaces, what might it mean on a collective scale for neighbourhoods, places and cities?

It is understood that the connections and pathways between brain cells are unique to each of us and generated through one’s perceptions and experiences as well as the making of meaning, and contribute to forming our individual identity.

So, while much about the human brain, mind and consciousness remains a mystery, on an individual level we theorise that our mind and consciousness are emergent properties of the brain, arising somehow from the connections and interactions between the various component parts, the 100 billion brain cells (neurones) and the bridges (synapses) that link them via chemical messengers (neurotransmitters).

This gets even more interesting when we scale up to an urban level – to a neighbourhood, a city or a place. It follows, at least metaphorically, that our collective conscience; our urban mind, emerges from the connections and interactions between individuals, and informs everything; how we treat each other, how we interact and collaborate, how we govern, what we eat, grow and produce, how we live, what we tolerate and protect, what we design, build, destroy, mine and manufacture, what we celebrate and what we grieve.

It’s the ecology of our urban mind; the various elements and characteristics such as our values, mindsets, creativity and culture, ideas and thinking as well as the quality of the connectedness we have with each other and the places we live, that generates the systems, structures, policies and processes that influence all else; the quality of our air, water and food, the design of our built and urban environments, our public spaces, green infrastructure - even how we interact and treat each other.

We find ourselves here, 13.8 billion years after the birth of our universe (or thereabouts), having evolved the necessary intellect to better understand our beginnings, to ponder our purpose and predict various aspects of our future. Yet, arguably, we haven’t evolved the moral maturity or shared ethical compass to sustain ourselves in this wondrous place. We have created complex and disruptive times for ourselves. Conflict, inequality, poverty, disease, climate change, civil unrest and the subsequent mass movement of people are ubiquitous global issues.

According to the World Health Organization, mental health issues caused by city living will be a major burden in urbanised countries by 2030. In a world where everything is connected and one’s disadvantage impacts directly on another, this will influence all of us.

These phenomena have evolved from our decisions, actions and behaviours, informed by our mindsets, culture, thinking, values, perceptions, beliefs and motivations as well as our connectedness, or arguably our lack of connectedness, to each other and the places we live.

So, what might the science of the human mind and brain tell us about the urban mind; mindsets, confidence, gratitude, mindfulness, purpose, kindness and generosity?  What does a curious, collaborative, capable, confident, purposeful and kind city look and feel like and how might we rewire urban ‘neural’ pathways; the urban mind, for a better future?

These are important questions for many cities globally but especially for Adelaide and South Australia as we rewire the economy from old school car manufacturing to sustainable future industries that make our world a better place. If our troublesome past and the science of the mind and brain tell us anything it’s that ‘how’ we get there matters. Compassion, honesty and substance take mighty courage in this complex world but surely, we now have evidence enough that the alternative is senseless. 

Art and Architecture - prophets of prosperity.

Art and Architecture – the prophets of prosperity.

The art and architecture of a city emerges from its people; directly of course by the creative practitioners but under the significant influence of others; developers, entrepreneurs, politicians, public servants, academics as well as the public and the labyrinth of systems that they all generate.

So, what does Adelaide and South Australia’s art and architecture say about us? Is this our finest work? Is this us at our best? If the answer is yes, then perhaps we’ve arrived. This is as good as it gets. But, if the answer is no, then why not? What’s holding us back? If poor outcomes are the result of poor process and not a lack of creative capability or ambition, then what might we do better?

Of course, it’s not quite that simple. Art and architecture are among many interrelated indicators of the creativity and prosperity of a city. Cities are complex systems. Complex systems have memory – the past matters and it influences the future. In complex systems, success and failure cascade; creativity begets creativity, decay begets decay. Everything is connected.

Yet, despite our best efforts, we tend to curate our cities like author Mary Shelly created Frankenstein in her novel of almost 200 years ago – by bringing together bits and parts and expecting them to function as a synergistic whole. It’s fragmented.

Collaboration as opposed to fragmentation is holistic and cultural, not just another form of project management. It creates an ethos where people can risk innovation and throw their thoughts openly on the table. There is a mutual recognition and respect of interdependence. Collaboration forsakes the simplicity of control for the complexity of influence. It is based on genuine partnership which surpasses hierarchy; activity is relational instead of transactional or job driven.

This in reinforced by the science of positive organisational psychology, which tells us that provenance is important. A positive culture and upward cycle is built when prior experience sets the foundation for future activity and when future activity builds upon and reinforces prior experiences. This requires trust, respect, compassion and a culture of mutuality and reciprocity, where individuals experience mutual giving and receiving, caring, and safety in challenging times.

How we treat each other is fundamental to the quality of what we create. Both ‘how’ and ‘what’ have an impact; immediately as well as a legacy.

Which is why wellbeing is a driver of curiosity, which in turn drives creativity, that drives innovation, that drives prosperity, that drives resilience. So, it follows that one of the greatest influences of not only the quality of our art and architecture, but also our urban environments and ultimately our prosperity is our social capital – the strength of our connectedness and the quality of interaction with each other and the places we live. We will be defined by it and will not prosper without it.

It can’t be faked or feigned or forged – at least not for very long. How we treat each other and how we are prepared to be treated defines who we are.