 Hello everyone, and welcome to the second season of Designing on the Frontline from the Health Design Lab. Welcome from Cooper here. It's so great to see you all here. We know there are some people from last season and some new viewers today, so we'll just give a quick intro. The Health Design Lab is a place where doctors and designers come together to tackle some of the biggest challenges in healthcare. And we bring together diverse teams to co-design solutions. Back in the summer of 2020, the Health Design Lab first teamed up with Cooper Hewitt to create Designing on the Frontlines. And this is a collaborative discussion between creators in medicine and design who are exploring projects in healthcare and in wellness during the pandemic. Now it's been almost two years and we are coming back together to bring you some really cool conversations with some of our favorite people. Our speakers are advocates, designers, and doctors who share the common goal of improving health during the time of COVID-19. So a few quick reminders. Please place any questions for the speakers in a chat box. We'd love to have you turn on your camera if you'd like to. It is certainly not required. And the session is going to be recorded and the recording will be available both on the Cooper Hewitt website, CooperHewitt.org. And for podcast lovers, these sessions will also be released on Design Lab Pod with Bangku. Great. It's so great to be here. Welcome from Cooper Hewitt. Thanks, Morgan, for that beautiful introduction. We are really proud to collaborate with the Health Design Lab. We have just dropped the new edition of our book, Health Design Thinking, co-authored with Bangku, founder of the Health Design Lab. So we're really excited about that. Cooper Hewitt has opened our exhibition, Design and Healing, Creative Responses to Epidemics, which you can come see all year at Cooper Hewitt in New York City, or visit us online to see some of that content, which will give you a little background about that sets the stage for today's discussion of designing better services. So if you visit our exhibition, you get to come inside a miniature field hospital, which is a place set up to tell a little bit of the history of field hospitals and how they impact how healthcare is designed today. So it turns out that this goes back to the history of military hospitals in the Crimean War, if that strikes some notes today. These military hospitals were very crude. They consisted of tents that were directly on the ground, lots of exposure for the wounded soldiers who were in there to cold and wet and to poor sanitation. And so reformers, like the amazing Florence Nightingale, introduced new ways to design these temporary hospitals using light and sanitation and ventilation. And Florence Nightingale promoted this as a standard for how all hospitals should be designed. So those temporary structures really became the basis for how we understand a modern hospital should be today. During the COVID-19 pandemic, we have seen many field hospitals, temporary hospitals, mobile units of every kind. Field hospitals like this that was erected in Queens and the Billie Jean King Center was a temporary hospital that was really not used very much. At the same time, facilities like this, a vaccine center created in a black neighborhood in Maryland, was highly successful. And it was spearheaded by Pastor John Jenkins, who used the facility in his church to bring vaccines to the people in his community. And in our exhibition, we look at really experimental ideas for temporary hospitals, like this concept for a ICU in a shipping container designed by Carlo Ratti Associati in northern Italy, really right there in the ground zero of the beginning of the COVID-19 epidemic. And this concept, this is a working prototype that they produced and several of these working units were used around the world, was really about how to create ICU units that could be quickly scaled up in communities using pretty simple but high tech equipment. And so that's a little taste of the kind of service design challenges that have shaped temporary hospital design from the early 19th century to the present. And we're going to hear about incredible work being done in this area today by some amazing designers and colleagues. So the first talk is going to be by Boncu and Morgan Hutchinson, and I'm really excited to introduce them. Boncu is an emergency physician, professor, author, and host of the Design Lab podcast. As the director of the Health Design Lab at Thomas Jefferson University, he created the first design thinking program at a medical school. Bon and I co-authored the book Health Design Thinking, and Bon was a regular panelist on the primetime medical TV show Chasing the Cure with Amy Curry. And Bon's going to be in conversation with Morgan Hutchinson, who's my co-host of this program. She is an emergency physician who works at the intersection of human-centered design, clinical operations, and education in medicine. She's the assistant medical director of the Thomas Jefferson University Hospital Emergency Department, assistant professor of emergency medicine, and director of education for the Health Design Lab. And she helped create the COVID-19 mobile unit, which we're going to hear about more right now from Bon and Morgan. So thank you. Thank you very much. That's a fantastic introduction. So I remember after, at the end of our first season, one of the reasons that we decided to, you know, pause the show was because we decided to start making these new services. And so I think that we've thought a lot in the last couple of years about what is healthcare service design and what does that really mean. And Bon, this picture was your idea. I love it so much. What's the story behind that? I think we forget that healthcare is a service. Every day we are providing services to patients, family members, the community. And it's like the service that you would get at a Starbucks, for example, they are providing a service giving coffee, sometimes bad coffee to people. And, you know, we deliver services, products, and even experiences to our patients. So it's helpful for me to have this mindset in healthcare that yet not only are we providing healing, but we're providing a service to our patients and community. I think one thing that is pretty clear to me and to I think a lot of people is that the service of healthcare is not this beautiful service like the service of food, right? You know, we think about healthcare as this like sterile thing that you usually want to avoid. And so creating services and healthcare, you really have to think about that. What do the user experience and what do they want and what do they need? And we think about this from the perspective of, you know, human-centered design. I love this picture more again. Can you describe what this is? Oh, this is our testing site that we created. This is our first testing site that we opened in Northwest Philadelphia. And this picture was taken back in November of 2020. And it was one of our busiest days. We had this huge surge of patients looking for a test. And back then in Philadelphia, and even still to some extent, it's really hard to get a COVID test, especially when testing sites are so busy and when the rates of COVID are so high when it's needed the most. And so, you know, we think about the human-centered side of what a testing site should be. And I think some of the most important things to me and to our team were people want to be able to walk in. They want to be able to talk to a provider. They want to be able to access the site however they want to in a convenient way. So driving in, walking in, those are both some of those examples. And so making it open to as many patients as we could and creating that capacity, we saw sometimes during the pandemic where our sites got very busy like this day. And what we had to, what the mindset that we had was, you know, how do we create a good experience for patients in the community coming in? And what was difficult about the pandemic is all these new types of healthcare services were starting up. You know, we needed a way to rapidly test people. Then we needed a way to give a COVID vaccine. Then we needed a way to give a booster vaccine. So we thought a lot about, you know, what sort of experience did we want for the people coming in. So it was important that we provided both a walk-in experience and the drive-through experience like at our testing site and also at sites that were embedded within communities. And I think another part of that is thinking about where can we have the most impact, you know, like what part of the city needs our service the most? Because in various times in the pandemic, I think that all of us know, even those of us in healthcare, had a hard time scheduling a COVID test, had a hard time scheduling a vaccine and had a hard time getting into the clinics that are in our neighborhoods. But, you know, even though it's that hard for us as healthcare providers, there are parts of our city where they're very underserved. They don't have the access to healthcare services that we have. And they don't have the ease of access and the ability to kind of easily get in and get what they need. And so if you look at our city, this map kind of demonstrates where some of our sites have existed. We really looked at the parts of the city that had the highest rates of COVID, the lowest access to healthcare services and the most severe outcomes from COVID. So the most hospitalizations, the most deaths. And we looked in those areas for partners. And one of our partners is going to be speaking a little bit later today. But the question really was like, how do we design for inclusivity? And I think too often inclusivity is an afterthought. And it was important for us right from day one of how do we design our sites, both vaccine and testing to be ones that were inclusive. And that required us to think about how do we embed our these sites directly in those communities that were hit the hardest. When you think about designing new healthcare services, I think there are so many different ways that you can approach that question. And designing for the best billing system, designing for the best quality of healthcare and safety, designing for humans sometimes is left on the back burner. And that's what we really are trying to focus on is how can we design for humans while still providing all those other things, the best quality, the best safety, the same standard of care that exists in the hospital, but really like taking that service outside of the hospital. Maury Mooney have two minutes left. We got to get through these last three slides here. Yeah, yeah. Well, so this So we think about like, you know, in terms of human centered design we think about how to bring patients and community members into the question of how do we co design with communities. And I think that's been one of the most important parts of our strategy is really finding partners in the community who are advocates who are experts in the experience of people in their communities, and and working together with them to create the services that we're delivering. And it's to really treat our community partners as the experts, you know, they are the ones who know their community community did best and support them that we honor their expertise. And in this case, this is a clinic that we put on for the Latin American immigrant refugee population in South Philadelphia and one thing that we learn speaking with a bunch of community members was that you know starting early in the morning and creating in the area where a lot of people are working is is a really important way to address that question. And so we, we thought a lot about, you know, how do we pull all this together, how do we design love with love in healthcare. Too often the experience of healthcare is a very sterile and scary one. And I love the experience I have when we go into our, some of our favorite restaurants like South Philly barbacoa that makes some of the best tacos in Philadelphia so we wanted to make a loving experience when you got your shot so we had a couple of pop ups where we gave out free tacos, if you got a code 19 vaccine, and it was a real joyful experience for many of the folks who had attended. This was one of my favorite pop ups that we hosted and I think the sign above all of us there really kind of demonstrates a lot of the things that were human centered about our sites you know multi lingual come in we'll give you a free taco and here are some of the things that a lot of people were asking us you know you don't need an appointment you don't have to pay, you don't have to show insurance or ID and some of the details about what we're providing so. That's actually how we met our next speaker so I think this is a good time to wrap it up but it's been a pleasure speaking with you guys. Oh, Ellen you're muted. Hi. That was so great. There's some good questions coming in for you in the chat that we'll address later and I'm really excited to hear more about the kind of physical setup of your, your van and your. You know, like, space age buggy that you take around the city. We'll get to that a little bit later so more than why don't you go ahead and introduce our next speaker. So Leah you're one of the most cool people that I've met during the pandemic, and I'm so excited that you're joining us here today. Leah really answers the question of how services and can be inclusive and how we can really think strategically about, including some of our underrepresented populations in creating new services and healthcare. So we'll hold a PhD in sociology from Princeton University. She's the health and wellness director at point is a salute where she develops and manages point as wellness services including food access behavioral health and case management programs. She currently oversees point as is pro metora program. She leads the coven 19 vaccine promotion efforts and she contributes to arts and culture programs. She's also a writer and researcher on philanthropy in the nonprofit profit sector so Leah thank you so much for joining us it's great to you. Thank you so much for the invitation I'm excited to be here and to talk with these fabulous partners that that we are so lucky to have. I'm going to go and share a couple slides here. Just to tell you a little bit about point they some were located in South Philadelphia and Pennsylvania. And our mission is to promote the health and wellness of Philadelphia is rapidly growing Latinx immigrant population through high quality healthcare, innovative educational programs in community building and really core to our model is that we believe that a comprehensive strategy to promote community wellness must be grounded in the social determinants of health. For this reason, we offer integrated services that support mental emotional and physical well being from the individual to the community. And we, it's important to note that we fund our work primarily via private grants. And as an organization, it's really fundamental for us to be to be flexible and responsive to community need and to honoring and maintaining the deep trust that we've cultivated with the communities that we partner with by growing our work according to community priorities and keeping community leadership and expertise at the center of our approach. And this partnership with with Jefferson and our work on the code vaccine promotion and access initiatives is a really great example of that commitment. Promotoras or otherwise known as community health workers have been key to our model since our founding around 2008. And in our promotora program community leaders serve as health outreach workers in our core communities in which we work south and southwest Philadelphia to increase our reach into the community and tackle important health issues out of the clinic setting. So our promotora team addresses a wide range of issues including diabetes prevention, cervical cancer prevention, prenatal care, obesity, COVID vaccination, nutrition, mental health, a variety of topics. Historically, they've led workshops contributed to our clinic services and provided individual support and patient navigation and it's really central to our work at point days that our promotoras insights feedback to us about what's happening in the community directly informs our choices about where we go as an organization, what new services we develop how we adapt our existing work according to really what's what's going on at the ground level. And so, thanks to a grant from the National Alliance for Hispanic health into a starting in summer 2021. We expanded our promotora team from our eight core promotoras who had been with point days for a long time to 16 folks and these are all Spanish speaking or bilingual community leaders from across Philadelphia, and we invited them to co lead an initiative with us focused on COVID vaccine access and education. And together this team I'm a huge fan of this team Morgan and bond have both heard me just go crazy about how amazing these women are. They represent eight countries of origin, they live and work all across Philadelphia from far southwest Philly, all the way up to far northeast Philly so really spanning the farthest reaches of our city. And really importantly, instead of telling our promotora team how we wanted them to reach their communities with information about the COVID vaccine. We instead flip the script and we asked them to advise us on the best way to do this work we deferred to their expertise, our kind of core operating assumption in this project was that our promotoras are the experts in their own communities. They need to be we need to be following their lead in order to or to reach these communities from very marginalized folks who are experiencing structural marginalization and systemic racism in all aspects of their lives. We need to listen to them in order to serve folks with culturally responsive and real access to care. So we also really take compensating our team fairly very very seriously and we paid our promotoras $20 an hour. And essentially what we did is we worked with each promotora to develop a customized work plan and approach and schedule, according to their needs and to what would happen in their communities. So some of our promotoras were conducting outreach in their local churches, some of them are going door to door. Some of them were primarily doing their outreach via phone phone calls and texting and you know the million WhatsApp groups that a lot that a lot of these women participate in some of them were doing their work only on the weekends some of them were doing their work from 7pm to 10pm every night. So for them during the week you really focused on on responding to what would work best for each person and each community to create a customized approach to this work and to keep our our role and our kind of supportive role in the project, as flexible as possible. And so our staff, as the kind of supportive backbone of this initiative we helped make connections, we helped facilitate access to needed resources, and we really served in a support role to our team of promotora leaders so when they told us they needed information, we got it. When they wanted a flyer on a particular topic, we made it. When they told us they needed a vaccine clinic in a personal in a particular area, we worked with Jefferson and our other vaccine partners to make it so you know our job was to kind of facilitate access to resources and create a community of practice that would allow this awesome team to work with and learn from each other and have the kind of support structure that they needed to be successful during this really difficult time. And so just to talk a little bit about some of the successes that we've had with this project. We're really proud of this project. So in collaboration with our promotoras and our awesome vaccine partners. To date we've held 16 mobile vaccine clinics in Philadelphia, eight first for second dose pairs, and we have vaccinated more than about about 700 people and counting via those vaccine clinics. And we've worked with more than 42 bilingual volunteers to support these clinics coming from all of the area medical schools and beyond. And so each of these clinics as I mentioned was really driven by promotora leadership so including where we did the clinics when we did the clinics on what days of the week and what time so as Morgan mentioned, early in the morning and late at night specifically Sunday afternoons were a sweet spot for a lot of communities. And then we really deferred to our promotoras to lead to lead promotion and outreach for these clinics. And we leverage this close but flexible partnership with the Jefferson Health Design Lab as well as with other vaccination partners, who really provided a very streamlined one stop shop, very professional experience for our patients and community members who came into these clinics. So, you know the Jefferson team would would write up in their amazing van unload all the stuff we would bring a team of bilingual interpreters to support the vaccination process and usually we'd have one or two promotoras on site, basically making phone calls nonstop, bringing in their their neighbors their family members their friends, really making sure that that the community knew that the vaccine clinic was happening and that it would that we were there for them to serve them in language. So through this experience, we've done clinics in communities of Guatemala and indigenous language speakers. We've worked with newly arrived Honduran and El Salvador El Salvadorian immigrant communities. We've done a clinic at a Spanish speaking evangelical church that draws congregants from neighboring states, as well as clinics in the heart of South Philadelphia is Mexican community. One of the things that we're most proud of is that our patients and clients have really told us that they felt well taken care of in these clinics, they've been able to ask the questions that they have about the vaccine, either to one of our staff or to our promotoras and that's really a rarity, unfortunately, for many of the communities that we serve. And the fact that our communities experience care that is culturally responsive that takes that that is done with respect, and that is really oriented around their needs and their ways that they prefer to access services really means a lot. And so these clinics, you know a lot also happened around these clinics that we did. They're part of about 4000 or more hours of navigation that our promotora team and our clinic team have done to spread information about and promote access to the COVID vaccine. And through these efforts we've we've supported more than 12,000 people with information and navigation from mid starting in mid 2021 and I think what this really speaks to is the incredible reach that these community leaders have and these networks of community advocates have in our cities, you know we as a as a nonprofit organization would not be able to have that kind of a reach without the expertise and the leadership of our partners on the ground. And so, you know just another another plug for how amazing, how amazing these leaders are and how important it is to really recognize community leadership in all of its forms, even when it doesn't present to us in ways that we might be be used to doing with you know a lot of this work with our promotora team was was not high tech at all it was very analog. We worked with a lot of paper, a lot of paper flyers, a lot of text messages, a lot of WhatsApp groups, you know in the morning in the middle of the day at night. We were really embracing the forms of communication and the ways of working that our promotoras told us would work really was made this was what was what was what made this initiative so successful, and marrying that really grounded community expertise with the innovation and the innovative kind of approaches to care that the Jefferson Health Design Lab has been developing. So just to lift up a couple keys to success that I've mentioned over the course of the last few minutes. You know it's been really really important to have strong and responsive and flexible partners and working with Jefferson has been a great example of that, really highlighting community leadership and keeping that at the center of everything we do, making sure that we're paying folks fairly and compensating them for their expertise, developing communities of practice so that our distributed teams feel supported and they're able to learn and grow and develop throughout the process, and having you know a strong corpus of volunteers available to support and make sure that we actually had the manpower to be to be vaccinating folks that showed up. So moving forward, we're really excited about this current promotora model that we're working with. We're planning to maintain this model and continue to leverage our promotoras leadership to tackle additional urgent urgent public health topics in Philadelphia Latinx communities. We're specifically looking to focus on mental health and chronic disease prevention and management and we're really excited about the years ahead to continue and evolve these partnerships. Thank you so much Leah it's, it's always been a pleasure to speak with you about the work that you do and it's so absolutely important and critical to designing services and healthcare to have the right partners that are trusted in the community and who are already trusted communicators to members of the community. And that, you know that that part of designing new services and healthcare that is communication with the community and developing trust with community members is just so critical and I think that even within healthcare experts it's so important to develop systems where we can communicate with one another so we're providing the best standard of care to our patients. And that brings me to our next speaker. Sonya Stokes and Sonya it's a pleasure to see you here thank you so much for joining us. Sonya Stokes is an assistant professor of emergency medicine at Mount Sinai Icon School of Medicine. And she's a term member of the Council on Foreign Relations where she serves on the independent task force on preparing for the next pandemic. She's also served on the executive leadership committee and this is how we met one another for the emergency medicine all threats, a consortium of New York City based emergency physicians who work in collaboration with IDEO and the McChrystal group to improve readiness and resilience and frontline medicine. Sonya thank you so much for joining us it's a pleasure to speak with you today. Thank you Morgan and thank you to all the speakers today it's been a wonderful discussion to listen to and I look forward to the question and answer period. I'm going to be speaking about my experience with emergency medicine all threats or EMAT and as I'm pulling up my slides I will mention how I was led to this group was actually a nexus between my work on the front lines with my colleagues and emergency medicine throughout the pandemic as well as the privilege I had joining the Council on Foreign Relations Task Force on preparing for the next pandemic. This gave me an interest in where policy meets operations and that's where I see design having a very specific role in being able to influence this and a little bit more information about EMAT. So I'm bringing up a slide that was actually made in the early summer of 2020. And I focused on that because we can look at some of the information that is given here that gives you the context of how EMAT was born. Disparities in care during COVID we saw patients in some areas of New York City specifically are hardest hissed areas in Queens and in the South Bronx that saw a death rate three times higher than anywhere else in New York City. And tied to this were the metrics that we're all now familiar with with subsequent surges of COVID, where we see in our emergency departments, every single surge now, these prolonged wait times, patients that are crowding in our hallways, crowding in our waiting rooms, waiting for care. And this has been something that at least for every emergency physician that I know, and then certainly within our group at EMAT, this has been the prime issue for us since the beginning of the first wave in New York City that we will now be approaching on March 1, our anniversary of our first case in New York on 2020. And so with that, this was some of the underpinnings to gather us together as a group. When we were first putting together EMAT, it's a collective of our major health systems across New York City. And I would also like to add that actually Bonn is one of our members of our Executive Leadership Committee. And so what we were trying to do here is looking at our experiences from the first wave in New York City, looking at the metrics that we were seeing in terms of our morbidity and mortality from the first wave, and doing everything that we could possibly to prepare people across the US and in other places that we're experiencing their surges so that they didn't have to go through what we went through. And so this was in combination with IDO, the Crystal Group and Q, it was trying to approach the problem from the ground up, how do we look at our experiences, how do we frame it and look at it as a design problem. And so are there areas that we can actually approach and fix from that level so that the systemic issues that we continue to face. We do not continue to see that in future surges or any other future threat that we can see that affects our emergency departments. And so from this, we came up with a sort of a three pronged approach of how we were going to look at this from the very beginning and we had some goals that we were setting up and the first world was to make sure that we had a democratic approach to emergency care. And by that I mean, all voices matter. And so one of the biggest focus that we had in the beginning was making sure that in an attempt to be human centered that we make sure we start with the people who matter the most which is our patients. And so the patient voice project part of EMAT was the heart of that started everything that we were engaging with from the future on. We wanted to hear from the patients who were there in the first wave, hear what their concerns were, and then start from there and work towards what we can do to solve those problems that they were speaking about. And when we heard them speaking, we knew that this is what we've been hearing even before COVID. And certainly what we've been seeing throughout, which was that the things that matter to them were the things that were mattering most to all of us which were, we need more staff, we need better spacing. We need to be able to make our emergency departments designed in a way that can take these hits that we've been seeing throughout the surgeons. And so that has been a huge power for so many of the things that we've been pursuing that really were specific targeted solutions to these problems that the patients were highlighting that they were asking for please, please make sure that this is where we ground any of our changes in our health systems. And so this is what we've been attempting to do for to set the foundations to make sure that we can make these systems that are able to handle whatever threat that can come, be it a pandemic or any other type of crisis situation that we see in the emergency departments. Now, I do want to stop here and make sure though, in the time that we have limited to talk about this nexus between policy and design and our and this is where I think it has been really interesting for EMAT because what you see here is that last step that we need to take. And when we are trying to put together an approach towards redesigning our systems because we came up with some interesting solutions which we are still pursuing at this time. Some of them include data sharing. How do we make systems speak to each other from not just within a hospital but across health systems. And one of them was also trying to figure out how do we set up a criteria for surges. What do we define that in the emergency department. How do we actually specify what patient numbers or what patient acuity is going to be able to set our trigger so that we can utilize our design concepts to be able to accommodate any future surges. And the interesting part about this is, is that the conclusions that many of us have come to is, is that there needs to be lockstep of design and policy, because the two have to work together for you to actually have operational relevance for at least within our experience in the emergency department, because so many of what our solutions had, which were wonderful solutions in terms of data sharing platforms, wonderful solutions in terms of trying to create a system that is able to flex to surges of large volumes of patients all of a sudden coming into the emergency departments. You need to have the policy, the jurisdictional enforcement that comes not just at the local level but even I would say at the state level to help to build these systems that are truly resilient over time. And so this has been the part that I think is interesting with email that it's working not just in the design capacity, but how do we actually start to engage with our policymakers start creating actual hard policy and enforcing it, so that we can actually make some of these design solutions, which are, are not just reasonable, but they are really achievable and can truly impact in a positive way any future response that we can have to a future pandemic that we need to be continuing to work, not just on the design but on the policy part. And that's where I think that we are going to be seeing our focus in the short and long term as we approach how we are going to rebuild emergency medicine after COVID. And I will stop there because I know that we have some time constraints and I want to make sure that we leave time for questions. Thank you so much for joining us and sharing all of that it's it's really a pleasure to hear you describe the background of these projects, as I've seen them and been really impressed by the work that you've done to everyone in the group. Ellen I'll take you back to you to get us started with question. Yeah, thanks to all the speakers and we'd love to have you speak with each other and have a conversation here. I'm going to start pull out a question from the audience, which is how do you go about finding community partners. And this is a question for bond and Morgan but also for Leah. For us finding community partners that are motivated and engaged and really a strong, you know, a strong leaders in the community is not always easy but it is easy to create that network. You know, they're the world of community health in our city and I imagine in other cities is kind of a small world once you get into it. And everyone sort of knows each other. We actually met Leah and her team through south Philly Barbara coa Christina Martinez is a fantastic advocate in the Hispanic community and she and her husband introduce us to Leah and their team and they really just said, Hey Morgan, this is a great person that you should come and work with and they kind of went from there so it was very lucky to meet Leah. And likewise I think you know it is a small world and and I saw what Morgan and bond their team was doing because I live four blocks away from south Philly Barbara coa, and have worked with them for many years and so I got really excited about our cool van I was like this is exactly what we need to bring the vaccine out into the communities of Philadelphia. You know we vaccinate folks at our community health and wellness center but we don't have the capacity to bring teams out out into the neighborhoods. And so I was really excited to be able to make that connection through our colleagues Ben and Christina. And I think it's a great example of how kind of serendipity and the small worldness of this field and of our city in particular help us facilitate that those connections and I think it also speaks to the moment that we all were in. Then I think you know in those earlier moments of the pandemic in which there was a lot of creativity and a lot of like openness to partnership and collaboration that was happening. And so it was awesome, you know to connect with Morgan and we're almost immediately planning a clinic together and I think just, you know the opportunities to really jump on on those potentially productive partnerships was really special. I was striking that the promontories are all women. And is there a background to that is there a desire to include men as well as they're an advantage. I'm just purely out of curiosity about how that comes comes to be. Yeah, it's a great question in this case it was it was happenstance. We, we had a couple men who were potentially going to be part of our promoter team, and it turned out that that they didn't join us. But certainly, you know there are folks from from all genders who are doing this work in community. I think you know we have happened to be connected with a lot of really powerful women leaders in communities. I think who have become kind of like these centers of information and navigation in their particular immigrant communities, but it's certainly not something that's limited to a single gender. Thank you so much Leah and we have another clinic coming up this weekend so that should be a great event as well. Yeah, I mean that's the next question to Sonya from Nico, who asks, how do you bridge the gap between macro scale policy decisions, and designing day to day services in the ED and I think this is something I think about every single day so I'd love to hear your answer to it Well thank you so much Nico for that question and I'm going to just headline with my true response. I don't know the answer. I can tell you right now that the, that bridge that we are all trying to cross is something that is the, the ongoing challenges that we have whenever we're trying to take policy recommendations and then scale them across so that they actually have operational relevance, and my strategies towards this are I think one is that it requires partnership. So, and then to it requires stamina to be able to continue to lean on those partnerships and build things over time. I'm going to give a specific example of one. One of the major things that we learned that most of us in emergency medicine and Bonn and Morgan I'm sure you feel the same way but with a patient voice project we heard about the issue that was with staffing where a lot of patients were experiencing this, this fear, during the first period where it was very difficult for them to to see a provider and I don't just mean physicians I mean nurses and so knowing this and knowing that okay we need to respond with potentially trying to move forward with coming up with a set of policies that ensures we have enough staff to flex to search. And so this is something that we see in many other states that actually have rules about this right, for example staffing ratios and emergency departments in California those are actually state enforced laws, where one nurse cannot have more than four patients. I'm not going to tell you the number that we have here in New York City that's the average number of patients that a nurse will have, but our amazing nurses here in New York City they have been under a long before COVID and then certainly now throughout with, with just dealing with these numbers. So then trying to approach a solution where we know even in the Council on Foreign Relations Independent Task Force in their report on this, it was highlighted specifically, we need to do things that actually support policies that provide that those resources to our hospitals. Right so now we have policy that's written, right. And now we even have people working on our end saying yes we're hearing this from patients we're hearing this from providers, the link between that is partnering with people who are actually going to set the policy at the local and state jurisdictional levels has to be done. You cannot do any of this without enforcement is what my experience has been, at least throughout the pandemic. And so, creating those partnerships with people who are in those roles, who can help with the decision making and giving them the data and the, and the ability to have the leverage to say yes this needs to be done. That is the part that I the piece that I think is that bridge that you're speaking towards. I can tell you right now we haven't achieved it yet, but that's what we're continuing to work towards. That's such important work. Unbelievable. Juan, you have a question from Juha about happiness, and we just love what you're doing in terms of trying to create a service that's more human centered and makes people feel better about healthcare. Is there a way to measure that. You answer as this great question of measuring health, you know, we pay for measuring traditional health outcomes but what about the community goodness factor, the happiness quotient for these design injections and he probably knows that answer, I don't have that answer but you know I wish we could do a randomized control trial of here's a standard delivery of healthcare, and then one standard delivery plus design injections of joy and happiness. I don't think anyone will fund that, but we know that the experience a current experience whether you're a nurse, a physician, a patient, a caregiver it was terrible at many times during the pandemic. There were some very good points to it but you know we had you know people who cannot take a loved one when they died in the hospital we had a high number of clinicians burning out and never coming back to the field again so I would not underestimate the need to inject love and happiness into this experience of health and healing. Yes, there's some smart person in the audience that knows how to research that and measure that and fund the rate for that please put please email me as soon as possible. I would also love to see that I would for sure love to see that because wait bond can I just say one thing about how that goes very wrong which I'm sure that everybody would agree. Patient wait times right one of the biggest concerns that has been even before coven and then a huge factor that was from the patient voice project right. We know an emergency medicine that one of the strategies that has been used just looking at that data has been. Well, then we put an army provider that just quickly sees a patient and then puts in orders and runs away right. I bet if we could measure the actual happiness of that patient with you know because it seemingly helps with the wait times you seemingly see a provider right away, but you don't really you don't have that quality what the patients are asking for is actually no I need to talk to someone, and I need them to hear my concerns not just have somebody quickly see me go put in orders. But unfortunately so whoever is doing this who can truly engage and find a way to quantify the this qualitative experience please do do it, it would be great would be grateful even as providers, I can tell you that for sure. I'm curious and they do you have experience with kind of measuring this from your nonprofit expertise and your background and your PhD background and like mixed methods research. That's a good question. And I've, yes, thought about this and I have really mixed feelings. I think if I'm honest. I would not want to do a randomized control trial of the work that we're doing, even as a trained sociologist. And I think that's, there's just like a really it's super important like working in partnership with the communities that that we partner with to think about historic kind of exploitation and research and to think really carefully about how communities work in service of research and vice versa. So I would actually be at well I'm also an ethnographer so I'll show my bias that I would actually be more in favor of going all the way to the other side of the spectrum and doing a really rich ethnography of these interventions and getting really rich qualitative data, and then trying to use some kind of proxy measures for some of the quantitative information that we might need. And that's just to kind of like think about how can we really do research in partnership with communities. And how can we really kind of bridge the gap between needing really robust data to understand the impact of what we're doing and needing to do so in a way that's culturally responsive and respectful. That's another point that we and I think we've talked about a little bit and the question of, you know, the research ethics behind all of this is so complex. And I think that one thing we talked about is, you know, the promotores have so much information and so much important insight that they can share with us on behalf of the communities that they're serving. And I love this question of, you know, what's their feedback like what's the most interesting feedback you've gotten from the promotores, especially anything that you found surprising perhaps that you think might help us kind of, you know, improve the way that we integrate promotores into our community and into our health care. Yeah, I mean, I think two things really jump out for me. We did some reflection exercises with our promotora team over the last few weeks as we've been kind of like moving towards the conclusion of this first part of this initiative. And one of the things that they told us is how supported they felt in this project and how surprised they were that like both the point this team and our vaccine partners were so responsive to their needs and to their observations. So I think that really speaks to like the importance of thinking about alternate forms of expertise and who we're looking to as experts in these settings and I think it speaks to really what's something that worked really well in this collaboration, which is really, really deferring to community expertise. The other thing that I think is just really striking and has been striking for us throughout this experience is, you know, even after the COVID vaccines have been were available for quite a long time and the narrative on the national level kind of to if someone wants to get vaccinated, they've already been vaccinated. We were consistently hearing from our promotoras about the need for more clinics and the lack of true access to the vaccine for Spanish speakers and specifically for Spanish speakers, who were unable to access health insurance. And so just this real kind of like discrepancy between the national narrative on vaccine access and what we were seeing on the ground and what our promotoras were telling us. The truth was in the results right like we kept seeing robust turnout to vaccine events, even as you know, the narratives nationally worse we're saying that these that that demand was dwindling so I think just again it points out the fact that like what our team were able to see and tell us about were the realities what access really means on the ground, and how that can really look different from what what folks who aren't really embedded in communities might assume around what it means to, to provide health care to different communities. And did you know the answer. Oh, go ahead. Oh yeah, sorry. Of what the primary barriers were that the promotoras encountered and hopefully helped ameliorate. Sure. I think you know the main barrier I mean there were a lot of barriers I think some barriers were related to things like requirements for identification, being afraid to be asked for a social security number, things like that. Just a real lack of language access. You know if you even if you knew hypothetically that you could walk into a local CVS and get your vaccine, you would not be seen in Spanish you might not know who the pharmacist is. You wouldn't be able to communicate with them all of the information that they needed to fill out that form. So just a real lack of access. I think we also as Morgan mentioned times of day and days of the week like many of the folks who we work with work six or seven days a week, they might only have Sunday afternoons off. And those are the only time they have to be with their families. I think those are major barriers, you can also think about cases like this one. Say you just got to the United States in June 2021, and you are an asylum seeker you're a primary speaker of an indigenous language. You're not literate in English or Spanish, and you've never had another vaccine in your life. This is the first time that you ever would receive a vaccine. You don't have a vaccine hesitancy, but that's a really different situation right that's a really different task to understand the context that that person like their lived experience and talk to them about like what is this facts what is this thing why should we care about it why is it safe for you to get you know who is the person that's going to be giving it to you it's a really different communicative tasks and a really different lens from which to view this kind of like large public health vaccination initiative. So I think the folks who walk into a room and know that that's the case for many of the people around them and know how to start those conversations. That's how we start to move the needle on those communities. I think that gets into, you know, such an important point that we think about a lot which is, there's vaccine hesitancy which is I know all of the general basic information about how this is going to affect me in many different ways, and I'm still hesitant versus, I don't know the information that I need to just make a normal decision you know if nobody speaking your language if you don't know if it's going to affect your insurance or your costs like these are, these are things that we all kind of take for granted but it's an important part of what we've seen here in Philadelphia in the, in the number of patients that hadn't gotten vaccinated, and the creative ways that we can approach those populations and try to provide them what they actually need. And Sonya I'm really curious because this question of, you know what's the secret to the next pandemic approaching healthcare and the next pandemic as as a member of the independent task force on preparing for the next guest pandemic. What's the secret. I can do a follow up that says on my pessimistic side, we're not going to be prepared on my optimistic side though I'm going to highlight an article that was published, led by Tom Boyke in the Lancet that was looking at which countries did better which regions did better in terms of their response when we look at overall morbidity and mortality from COVID, and their conclusion was trust. And one of the things that I find very interesting about bonds work and even listening to Leah's work is is that this is what it sounds like you are all designing for you're designing for trust. And unless you're a con man, you can't just make that up out of thin air that takes time it's a function of time so the time is now right. And so the way forward to prepare is to start exactly what promoters sounds like it is exactly what bond is doing and also I will have to say Morgan what you've been doing. I need to brag a little bit about her because she's been involved in projects now that has directly helped us in New York City thank you so much for your work and what you guys did in the initial roll out of the vaccines the emergency departments, it helped us here. And so doing that at all levels, not just within communities, but across workforces across within our own industries we need to start working on that and so using the metrics that we're trying around building these systems these relationships over time. That's how we prepare moving forward. We are not going to be able to predict every, everything that comes down the line. And I believe that trying to do that alone, thinking that we're going to be able to stop it with a vaccine or a pill right away. That is a mistake that we should know by now that it begins first by building trust with each other. And that's it. Thank you that's a that's a lovely answer. It's very perfectly encompasses the imperfect situation that we're dealing with, but it's been a pleasure working with you and thank you Sonya so much for joining us today thank you Leah bond. It's a pleasure to be back with all of you and to be speaking about this here today. We would like to remind you all to check out this episode if you'd like to on the Cooper Hewitt website we're on design lab pod. We will be back in April with our next episode. Thank you so much to all the speakers into everyone that came today to talk and to share your knowledge and your insights. Thank you. Great questions from our very with it audience. Thank you.