 Hello, everybody, and welcome back to Designing on the Frontline. This is our 10th episode. I would like to welcome you all, for those of you who have been to other episodes, welcome back. Thank you for joining again. For those of you here for the first time, thank you for coming. I hope you enjoy it. We have a great lineup today. I am your host, Morgan Hutchinson. Hey, and I'm Matt Fields, and we are both emergency medicine physicians at Thomas Jefferson University in Philadelphia, where we also get to hang out in the Health Design Lab, along with our colleagues who are here with us, Bon Koo, Christy Shine, Rob Eglisi, Mary Ellen Daly, and all of our students who are visiting for this show. Thank you guys for joining. And also from Cooper Hewitt, we have Ellen Lupton and Pam Horne. COVID is still surging. We have 75,000 new cases, and the number of deaths is still going upwards. The race to get a vaccine is continuing, but we are not close yet. Hospitals in many states are getting close surge capacity, and we are still looking for PPE as many are in low supply. The world needs better design now more than ever. Yeah, Morgan, that's totally right. And the mission of designing on the front lines is to bring together great minds to design better healthcare. And it is so awesome to say that today is our 10th episode. I can't believe we've already had that many great episodes, but sadly, we are approaching the end of our first season with only two more episodes after today. So everyone, please be sure to join us for that. We hope these webinars or shows or whatever we wanna call them have helped to inspire you as much as they have and making us realize that we can reimagine healthcare. Absolutely. As we're planning for another season in the future, which will be determined later, we want to know your feedback. I'll be sending out a survey. I'd love to hear from all of you, those new to the show, and who have been on the show for a long time. Please let us know what you think. Today we welcome three excellent speakers whose work and response to the pandemic have uniquely improved the way we design for better health. Dr. Stesha Doku is an anesthesiologist and a web designer. Rachel Smith is a UX designer and the co-founder of the masks for docs. And Dr. Anzinga Harrison is a psychiatrist and she's the CMO and co-founder of Eleanor Health and Dition Medicine. Okay, everybody. So you guys know the rules here, right? We need your videos to be on. We wanna see your lovely faces. Please, everybody, give a shout out in the chat box. Tell us who you are or where you're from and just say, hey, check in with us. And remember, we're gonna have a Q&A session at the end. So put your questions in the chat and we will get to those. If you've missed any previous episodes, healthdesignlab.com slash D-O-T-F-L, we have them uploaded there and you can watch them over your weekend, binge them, whatever you wanna do. We have one themed five minute breakout room where we'll be broken up into groups of five random individuals where you'll get to introduce yourself and meet somebody new. And so with that, I think we're gonna go ahead and get started with the show, Morgan. We are gonna skip music minutes today because Marvin Gaye speaks for himself and we're gonna go straight into the design find of the week with Colleen Clark, designer. Hello, hi everybody, happy Friday. And I'm really sad about the last two episodes. Just wanna take a second and thank everybody from the healthdesign lab and Cooper Hewitt for putting this on every week. This has been just such an amazing community. I'm going to share my screen real quick. So, Bon and Ellen did not put me up to this. I will start with that, but this week, I wanted to highlight a case study from their book. That's around page 176-179, I believe. And it is the accident emergency A&E case study that was in London. And the problem that this case I was looking to address was there's a lot of violence and aggression in the emergency room. And it was very costly as you can imagine and also creates a negative experience for patients and staff. And so inspired by Dr. Boyd's talk last week, I wanted to just highlight this because she posed the question of what if we got rid of security in the hospital? And if you weren't part of the episode last week, definitely go check it out online. Her and all the other speakers were great. So in terms of trying to tackle this complex problem, the first solution was to come up with basically like a wayfinding journey map process map, a guidance solution. And so it was an information package that really helped patients figure out kind of where they were in the journey in the A&E, which is our equivalent of the emergency department. And there also was an app and digital component as well. The second solution was really trying to work with the staff and get them to kind of think and reflect on different interactions. I forgot to say that first solution, it actually, 88% of patients said that by having all that information in such great design and visual for them, it really helped them feel like they understood the whole experience and what to expect better. And then for the people solution, about half of staff reported having threatening body language kind of decrease. And then this third component of their solution was creating a toolkit that was created as a bunch of guidelines that are free. They're completely online and range from things like the built environment to thinking about how to improve your service in an emergency department context. And what is just so cool about this case study is that not only does it go from ideation to evaluation, but they actually show like design works. I mean, I know I'm preaching the choir here, but it's really great. I highly recommend you check it out if you're an institution or if you're just curious or looking at tackling some of these issues. And so I just wanted to go ahead and say, get health design thinking if you haven't already. Also check out design council reports. Online, if you're not familiar with them, they were involved in this case study and then also I wanted to highlight good services. This is also another great book that really breaks down how to create a good service and healthcare is definitely a service. So back to you, Morgan. Thank you so much, Colleen, for an excellent design find of the week. It is now time to introduce our first speaker, Dr. Sesha Doku. Sesha is a doctor of anesthesia that is the kind of doctor that makes sure you stay asleep throughout your surgery, which is arguably the most important kind of doctor. She is also an experienced designer, web developer and photographer. She's created many tools to help doctors learn anatomy, procedural skills and the management of difficult airways. In a pandemic situation where the disease can be spread by small respiratory particles, anesthesiologists are particularly at risk for getting this kind of disease. Sesha has previously developed an app called Metavita to help doctors monitor patients during and after surgeries. She joins us today to share her work and to tell us about this app and how it can help doctors and their patients stay safe during the COVID-19 pandemic. Sesha, thank you so much for coming on. Perfect. Thank you so much for the introduction and thank you to the Health Design Lab team as well as Cooper Hewitt for allowing me to be a part of this conversation. So I'm going to share my screen so you guys can see my slides. Let's see if this will work up. Are you guys able to see this? Perfect. Alrighty. So as Morgan mentioned, I'm Sesha Doku. I am an anesthesiologist as well as a web designer and developer. And so I primarily focus on the design of interfaces within healthcare and medicine space because those are the two areas that I fit into. My friends sort of make fun of me and say that I'm a conflict because as an anesthesiologist, I'm constantly trying to put people to sleep, but as the web designer, I'm constantly trying to keep people awake. So the next, see if this will go up, there we go. So the next thing I sort of want to talk about is that intersection between medicine and design. So there's a sweet spot, right? There's an interaction that we're all thinking about and that we all want to make sure is happening or occurring for us. For me, I focus primarily on websites and interaction. And in a time like this, during a pandemic, it's even more important that we have good interfaces primarily because a lot of times now people aren't able to go and physically see their physicians. They have to have websites that are or applications on their phone that are easy for them to interact with. And people ask me, how did you end up being both a designer and a doctor? Actually started doing web design when I was really young because I was interested in computers. So I created my first website actually when I was in sixth grade. And at that time, if you guys may remember, websites sort of looked like this. They weren't that great looking. There was a lot of patterns that are really hurtful to the eyes now. But I remember thinking to myself as I was going through my health training that I really wanted to see medicine catch up to where other industries were in terms of their websites and their applications. Music, film industry, all those areas were getting really interesting websites and applications. And I felt like medicine wasn't quite catching up to where we needed to be in terms of the interfaces. So that became sort of my focus. So that interaction that I was thinking about was that I noticed there was a little bit of a gap. Designers were carrying a whole lot about whether things looked really good if the technology was really cool but didn't completely understand how healthcare worked. And so they sort of stayed away from the field. And I realized that healthcare workers really cared a whole lot about how things worked and the data and they really wanted it to be accurate. They didn't care a whole lot about how it was presented. So that interaction between form and function was just sort of separate than they should have been. So I sort of said to myself, I think that effective healthcare interface design really should work well because of how it looks. And so that idea that form and function work together gives you a credible website that people actually want to interact with and that they trust the information that's coming from or want to interact with. So these are my principles of healthcare interface design when I'm thinking about a project. There's six of them. The first one being that I want to minimize choice. I don't want it to be very easy for people to make a mistake or to go down the wrong path. The second one is that it needs to be educational. If you are using a website, I want to be able to learn something about my patient or learn something about medicine when I'm doing it. The third one, which I think is probably the most important is that it has to be easily adoptable into current workflows. So sometimes the reasons people won't use new technology or new applications is because they don't know where quite it fits into what they already do. So making it easy for them to establish muscle memory and using an interface can be really important and getting them to use it in the long run. The next one that I'll mention is interoperability. And I always mention that one because I think this is the hardest part and I'll show you when I go through an application that I made, figuring out how to use data and making sure that that data is easy to use, easy to translate can be a very difficult thing because not all of our devices, not all of our websites all use information in the same way or they don't code data all in the same way. The fifth one is that healthcare design of interfaces needs to be consistent. Every single element needs to interact with every other element and it needs to be easy to find. If every time someone has to look for how to identify what patient they are actually taking care of on a page and can't find it easily, it makes it really difficult for them. And then of course it needs to be safe. At the end of the day, we are dealing with patients' lives and their healthcare and it has to be easy for them to trust what you're doing when you're using an interface. So this is one of the projects I wanted to share with you. Morgan talked about it a little bit. So I in residency created this real-time anesthesia monitoring system. And the concept is that as anesthesiologists we're actually taking care of multiple patients at a time. And so having a real-time application to send whether it's updates or be able to look up your patient and know what's happening with them at any given time is really important. And I started thinking about this again once the COVID pandemic hit primarily because there has been a change in terms of the way that we operate. So I work at a surgical center and at any given time I'm actually taking care of about four patients. So I have four patients who are receiving anesthesia. And I can do this because I do have a team that I work with. So there's nurse anesthetists, there's resident physician, there can be anesthesia assistants. All of them are the people who are right at the bedside taking care of the patient. And I'm helping if there's critical moments like putting a patient to sleep or waking them up. But as a result, I can't be in multiple places at once. And my application allows you to actually be able to see what's going on in a patient, for a patient in another room. But also as another sort of caveat to it is that it will allow you to potentially risk or decrease the risk of opening doors and infecting people if there's COVID. Let me go back one slide. There's a little video here. I'll start playing it so you can see sort of how the application works as I'm talking. But the idea is that at any given time if I have multiple patients under anesthesia I might wanna know their heart rate, their blood pressure. I wanna be able to see the trends of the patient. And every time that I go into the operating room if the patient hasn't been tested for COVID because it's an emergency, there's a risk of infecting people who are not wearing an N95 or risking affecting staff who might be passing through. So we try to leave the doors closed as much as possible. And sometimes that may mean giving advice to my staff in the operating room but still having a feel of what's going on in the operating room. So from the video, you can probably see that there's a way to get waveforms. You can ignore the EKG here. This is just some simulated data. So that patient is not real or would be dead. That doesn't look very good for them. But the data at least allows you to really see and take a look at what's happening at any given time. And that can be very critical for predicting what patients may need additional care at some point in which patients are okay to continue their surgeries at the time. And this is just showing that you can sort of change the alarms for this application. So I'm gonna show you just a couple of additional, go back one, a couple of additional just screenshots. So there's alarms that can be delivered in real time. So those alarms would allow you to know if there's something that's going on with your patient. And the thing that sort of kept us from being able to take this a step further was the interoperability. A lot of the applications that we wanted to create, we couldn't grab all the data directly from the EHR or directly from the monitor. So it became a little difficult for us to take this application a whole lot further. But it is something that I started to revisit because of the pandemic and the need for remote monitoring. So my last slide is have a picture of me being in my PPE on a day-to-day basis. I hope that this was helpful if you're thinking about interfaces and medicine and design and how those interactions might be improved as you move forward in the future. Thank you so much, Dasha. Thank you for presenting that and thank you for talking with us today. That was very interesting. We've got a ton of questions. Some of them very specific and some of them more broad. I think that one of them you just addressed a little bit, but how does this functionally, like how does it link to the patient's monitor? Is there a separate wearable device? Is there, are there HIPAA issues? Can you talk a little bit about that side of it? Yeah, sure. So what we were building was actually connecting or grabbing data directly from the patient monitors because if we tried to get it from the EHR, a lot of the EHRs don't work with other devices or sort of open source software. So we discovered that we actually had to grab the monitoring information, basically through a little portal directly from the patient monitor. So whether it was an EKG monitor or an oxygen sensor, we had to get it directly from there. But as a result, trying to figure out how each of the different systems worked was very difficult because each device had a different way of processing the data and it made it very, very difficult to pull all the data at once. So a lot of the data we used just to demonstrate was simulated at this point. Awesome. So often we've found like that there are such great solutions like this that there are lots of barriers to actually implementing them. What do you think would be like that incredible thing that like gets us to the next level? Like what do you need? What are the next steps? That's a good question. I think almost at this point, we sort of need legislation that says that everyone has to be on the same page in terms of how they process health data. And without doing that, it makes it very difficult for everyone to be willing to work together. I think because there's a lot of people who are doing projects, but doing them separately or closing off their data or the way that they process data, that makes it so much more difficult for people to create on top of or extend already existing systems. Absolutely. Well, thank you so much for speaking. Your work really sort of encompasses everything that we are going for and that ends the show. So thank you for speaking with us and for joining today. And I shall hand it over to Matt. Yeah, great. Thank you, Stesha. Now that you've got our minds going and got us all inspired, we are gonna jump into our first breakout room or our first and only breakout room for this session and we're gonna be broken up into groups of four to six. This is a chance to meet everybody and get to know one another and introduce yourself. And remember, if for some reason you get kicked off Zoom, that wasn't intentional, we love you all. Please just go back to the linking, jump back in, it's a Zoom glitch beyond your control. And this week we have a prompt, which is what expectations of normal am I letting go of in the pandemic? What expectations of normal am I letting go of? All right, so that's it. Rob, can you take us into our breakouts? Oh, and it's too fast. That was a great breakout room today. And I met such interesting people from, I met Michelle Flood, who's one of our speakers next week, you guys are in for a treat. If you wanna join us next week, we have, I met people from New York, from San Francisco, Nancy, Demela, Kit, Michelle. And it was just great. I hope you guys all had a good time too. But it is time for our second speaker. And I'd like to introduce Ellen Lepton, who'll be introducing our second speaker, who's a senior curator at Cooper Hewitt Smithsonian Museum and who is a co-author of Health Design Thinking. Thank you. I'm really excited to introduce Rachel Smith. She is a senior UX designer at Nordstrom Rack and she has her own creative agency called Knife's Design, which helps folks with their small businesses. She's very community-oriented. She's here with us today because she founded a design community of over 1,500 people who designed for impact. Those are my dogs, sorry, speaking of impact. Especially in the COVID-19 arena. And she co-founded Masks for Docs, an organization that helps makers and volunteers supply those much-needed PPEs to healthcare workers. I can't believe this is still a problem that we can't get PPE. So thank you, Rachel, for helping to solve that. Welcome. Thank you so much. And Ellen, what an honor. I've had your books on my shelves for years. So thank you for having me here. Thank you, Health Design Lab, Bon and everybody. It's an honor. And yeah, let me go ahead and share my screen. Let's see here. Can everybody see this? Great. Hey there. I'm Rachel. I'm a Latina senior UX designer at Nordstrom and I'm the founder of two global organizations responding to COVID-19 design problems, which is why I'm here today. So thank you again for inviting me on to be a guest. Within the organizations that I've helped to create, globally, we've been able to distribute over 100,000 pieces of personal protective equipment to healthcare workers worldwide. We've helped to create infographic posters to hospitals to showcase how to properly put on PPE. We've assisted small businesses with marketing needs who have been impacted by COVID. We've also helped those displaced by recent layoffs with resume mentorship guidance and so much more. And here's an image of some of the PPE we distributed through our organization, Master Docs. Oh, let's see here. So I remember sitting on my couch on March 15th, feeling helpless while scrolling through the coronavirus news, seeing what China, Italy and other countries were going through and the effects it was having in their communities was absolutely devastating without a second thought, I purchased a domain instead of a website and Slack account all in one night which is designed to combat COVID-19.com. Basically, this overwhelming urge hit me and I thought to myself, I'm somebody who used this design to solve her problems. I'm sure there's something I could do to help solve for this. And I absolutely knew that I couldn't be the only one feeling this way. So what I did is I went on Twitter and overnight tweeted my followers and I said, hey, I'm starting this community. Anyone who wants to join, please do. Overnight I had about a hundred followers join. In a week, we had a thousand to date. I think we just as of last week hit over 2,000 volunteers in our community. And that's when I knew I was onto something bigger than what I had originally anticipated. We've had folks join globally from Indonesia, UK, Canada, Africa, all stepping up to help design solutions for those affected by the pandemic. This group has been able to create PPE distribution models delivering over a hundred thousand pieces of personal protective equipment to healthcare workers worldwide. And this screenshot is just an example of what we have going on in our Slack channel. Folks can come into our Slack saying, hey, we need to have a call for volunteers. We have an idea, let's get started. And this is where organic networking and conversations start to happen. We've also created infographic posters for hospitals in Canada, assisted small businesses with marketing needs, have helped those displaced by recent layouts with resume and mentorship guidance, and so much more. Here's an example of one of the projects that we've created within our community called COVID Heroes. Additionally, we have partnered with other organizations such as Fight Pandemics, Read Build Black Businesses, connecting them with our extensive global network of designers, engineers, content writers, project managers, and more. Anyone who has an idea, if you are here to help folks affected by COVID or the current climate, we have the folks who are able to assist you in that. One major moment that really sticks out to me in developing Design to Combat COVID-19 was the formation of Master Docs, which incubated out of this organization. So tech CEO Chad Loeder came into our space asking about problem-solving for the PPE shortage. We initially started thinking about posters or web campaigns or how can we possibly raise awareness about donating excess PPE to medical workers. However, it just evolved into so much more. This lack channel for the project grew into the hundreds and we ended up building our own grassroots supply chain network to provide PPE from local communities to hospitals. So being a UX designer, I had to think of various ways we were going to be able to send people to the site. We had two main routes, folks who wanted to donate and folks who wanted to help. And this is just a small example of flows we built overnight to help folks get through the Master Docs ecosystem. The Slack channel for this project grew into the hundreds of engineers, designers, and 3D printing enthusiasts wanting to solve for supply chain issues. We ended up building our own grassroots supply chain network to provide PPE from local communities to hospitals. Master Docs now has its own website and Slack channel with over 5,000 volunteers and 100 global chapters delivering PPE. And here's an example of somebody, one of our volunteers 3D printing these amazing face shields that we've been able to send out to healthcare workers worldwide. Today, the group has delivered over 100,000 pieces of medical equipment to folks globally and they are now starting to move into other facilities such as homeless shelters, nursing homes, and grocery stores. Healthcare workers are safer, our volunteers feel a sense of purpose and I can't help but stop to think of myself. We really need a difference in a time where kindness is absolutely crucial. And here's a video of one of our volunteers dropping off at UCLA. This experience has deeply impacted me. For the majority of my career, I've really tried to work with organizations that are in line with my personal views. However, there's something really different about creating design solutions that directly affect people's health, well-being, and safety. I know for certain that it's at the core of my being and there's an entire network of people out there who are willing to help you make a difference, which is absolutely incredible and what we've been able to see within our community as well. Here's an image of some of the impact that we've created through Mass4Docs. And a huge takeaway for me is something I had to learn to be okay with is being okay with ambiguity for things that pop up in the moment. That what you originally planned, whether to tell people, hey, there's a PPE shortage, let's do a campaign. No, like we had to absolutely pivot. Sometimes your original plan, you're gonna have to just learn to deal with ambiguity and just go with what works in the moment. It means also helping folks step up and ask, where can you help? Yes, you're a designer, yes, you're a developer, but are you able to pick up the phone? Can you contact local hospitals or healthcare facilities and simply ask, do you need assistance? How can we help? So these are some of the things that we really had to learn to work with in the moment. Since the launch of Design to Combat COVID-19, we began to form partnerships with other various causes globally. It was stated earlier that building partnerships is absolutely crucial and I 100% believe that. We're all here for the same reasons to help people. We really need to join forces if we share knowledge and expand our networks. We'll be able to overcome any roadblocks while providing purpose and hope for our future generations. If you have questions about Mass4Docs, if you have supplies that you wanna donate, there is a search happening in Florida, in California, in Brazil, worldwide. If you have supplies, go to Mass4Docs.com if you wanna help to donate supplies. If you would like to volunteer, we are still looking for community builders. You can start your own chapter to help deliver PPE to your local communities or if you wanna donate monetary funds, you can go ahead and go to Mass4Docs.com and they have all the information there. If you are our designer, a content writer, an engineer, or you just have an idea of how to help and you wanna provide assistance, you can come to Design to Combat COVID-19. We have a community of over 2,000 folks who are willing to step up and help you. Or if you just wanna chat with me, you can go to rachelsmithdesign.com to learn more about me. On Twitter, I'm O'Rachel Smith and I just wanna say thank you to Morgan, Bond, Matthew, Ellen, Robert and the design on the frontline team for having me. What you're doing is incredible work and I'm so excited to have been a part. Yeah, Rachel, that was just amazing. Thank you. And I really appreciate how you kind of told us a story of creating what you created and that you started by buying a Slack channel and a web name. That's so interesting. Can you just say a little bit to this process of if you want to create an online community like what you would recommend people to do? Sure, to be fair, this is my first online community and it seemed to have worked out pretty well. You're doing it all right. Thank you. Yeah, what I really did is I created the website and I created a very simple call to action or CTA, just a singular point to say, hey, if you wanna enter, go ahead and come in here. And if you go to Design to Combat COVID-19, what we do is you take a quick survey of things that you're able to help with or if you just have an idea and we bucket that and we'll pair you with the networks that we have, we'll pair you with our partnerships or we're very open. My admins and I, if you just wanna talk to us directly and brainstorm, we're open to it. Our community is here to help. They are very passionate about, you know, solving for these problems and we're open and ready to listen. So. That's really amazing that what you've created also has this personal response to volunteers because when I look at the scale of your organization, I'm just assuming it's like a kind of, it's an AI-driven bot that connects volunteers with what you might wanna do. No, it's humans. But how do you manage that? And you're also a senior UX designer at the RAC. How can you be involved in this global organization with 1,500 volunteers and then all these clients, right? Yeah, yeah. The hospitals and businesses. So we have volunteers that do assist us in the Slack channels but if you come to the site, what we use is a platform, a third-party platform that basically buckets everyone into their expertise and then we have our volunteers kind of comb through and help out and, you know, it is a volunteer position. So if folks want to join whatever time they're able to give, we will gladly take it. But yeah, it is a lot of work. But, you know, everyone here is willing to help and that's the beautiful thing I found that I was, you know, I shouldn't have been surprised by but when I first launched it, I was like, I'm gonna do this thing. And just the overwhelming support I've had from the design community to also wanna step up has just brought everybody together and has made our organizations and our partnerships just much more powerful and being able to create impact. So it's been incredible. The more, the better. That's amazing. Do I have time for one more question? Of course. Morgan, Morgan says, yes. Do you ever feel like you have too many volunteers that you can't keep? I'm not like at working in a museum. Sometimes it's like, oh my gosh, these volunteers wanna help but then you have to, you know, make sure you have meaningful work for everyone. Of course. Yeah, so as a UX designer, I would definitely say I like to hone in on details and I wouldn't say I'm OCD, but I'm very detail oriented. So it took a lot for me to let go a bit and say okay to help, but really the folks that I've had folks just step on be like, hey, like I see you need assistance. Like what can I help you with? I'm like, thank you. Yes, please lead these people or go ahead and take initiative of these projects. And it's honestly, I trust them. They're hearts in the right place. We have meetings to kind of come together and align, but it's just letting go and accepting help and understanding that we're all here for the same purpose to help make impact. Well, I hope you run for president someday. Oh my gosh. Thank you for everything you're doing for the world. Thank you. Yeah, thank you so much, Rachel. It's very wonderful to have you on the show and this is part of the reason that we created this show in the first place was that, you know, I hate to say it, but doctors and designers sometimes are not the best, you know, administrators and we're all used to doing things with our own hands and making things ourselves, but the people who have been the most successful, I think are people like you who are like, you know, like you said, able to make the website do the phone calls, bring people together. Actually, Corey Kilbane just commented in the comments and I was just thinking about your work here in Philadelphia. He's been making masks as well and face shields here in Philadelphia for many different hospitals. So it's very wonderful to have you. Thank you so much. And Matt, I'll send it to you. Yeah, that was great. Yeah, thank you, Rachel. That was wonderful. And so I'm excited to introduce our third speaker, who is Dr. Enzinga Harrison, who is a psychiatrist and is also the CMO and co-founder of Eleanor Health, which is a value-based provider of comprehensive outpatient addiction treatment with a focus on evidence-based approaches. Enzinga is noted for her ability to educate on addiction and explain difficult concepts with ease and humor, something we all need and I wish I could do better. She does this through engagements and through her podcast in recovery, which feels calls from individuals struggling with addiction. She also devotes much of her time to combating systemic racism and social justice within healthcare and its impact on mental health. Enzinga, it's a pleasure to have you here. Thank you. I was like gonna be so fast sharing my screen and then my mute button disappeared. Hopefully you guys see me and hear me and see my slides. I have two colleagues or maybe three on the line. One is Bo and I told him I would get through 14 slides in seven minutes and he didn't believe me, so start the clock. Thank you so much for having me here. I'm sad that I'm just joining the first design lab with only two episodes left, but I definitely went on a Netflix type banger the last few days and it's been amazing. So I wanted to talk about designing virtual MAT for opioid use disorder and also designing culture in a syndemic. So just to start out, we're in a syndemic which is a synergistic epidemic and it started with addiction as an epidemic and then COVID came and laid on top of that and then George Floyd was killed by the police and our racial unrest laid on top of that. And so I wanna talk about designing at the center of this kind of trifecta of big events starting with why we created Eleanor Health in the first place. So 80% of people with opioid use disorder do not receive treatment. And the reason I put in that circle addiction and not opioid use disorders because I've been practicing addiction medicine for nearly 20 years and we've been in an addiction epidemic long before the opioid epidemic hit the mainstream media. You can see the circle over to the right, 20 million adults have substance use disorder in any given year. And when you look at how that breaks down, alcohol is first, a different illicit drug use disorder follows that. Marijuana, prescription pain pills, cocaine and then heroin and other opioids are actually following up the rear. The reason opioid use disorder has captured our hearts and minds is because it kills you today. These other drug use and alcohol use disorders kill you over time, but it's more salient very much like COVID when your loved one is here today suddenly sick and then suddenly gone. And so in looking out at effective treatment for opioid use disorder, we created Eleanor Health because in talking about designing experiences, then the typical addiction treatment experience is disjointed. It doesn't take care of substance use disorder as a longitudinal chronic medical condition over time like diabetes or hypertension. Instead it tries to treat it in these brief acute episodes of three-day detox a one-week residential stay, a 30-day residential stay and the care in the middle is missing and disjointed. And this is why we have the substance use disorder outcomes that we have because typical fee for service doesn't pay for all of the things that you need to do to keep a person's substance use disorder and remission. And so we created Eleanor Health with this idea that one, we have to stop mistreating people. So you see our vision there to help people affected by addiction live amazing lives by giving a great experience. And so the triple aim says, if we can treat people right and give great experience and treat in the evidence base, we can improve the health of population and do it at a decreased cost. And so these are the guiding principles that we designed Eleanor Health Around to provide care in the clinic, virtually and in the community in a value-based way. And that's a double entendre, value-based by our reimbursement mechanism but also value-based in that just because you have a substance use disorder that doesn't reduce your value as a human. And so we just are a year and a couple of months old. So we started the company in May, 2019. We opened our first clinics in September, 2019 in North Carolina. We're growing explosively. We're up to five clinics. We're also in New Jersey. And just as we were feeling like we're getting our feet under us on designing this care beyond the clinic using technology as an extension of our care. So we take care of people like I said in the clinic via technology, but also we send our community health workers into communities to take care of people longitudinally. As we were just getting our feet under us, then here came COVID. COVID has had a dramatic effect on individuals with substance use disorders. So the first initial effect was that when social distancing orders came and you couldn't congregate more than 10 people at a time, then addiction treatment is very heavily group-based. And so we actually saw addiction treatment providers closed down for three weeks, four weeks, five weeks as they tried to figure out how to make the transition to virtual care. And all of those people that they were taken care of were forced into potholes. And so we were tech enabled. We were doing about 10% of our care virtually before COVID came. And over three weeks, we just had to quickly buy more tech, build more tech, design more processes, figure out a way to capture people who were being pushed in potholes as other treatment providers had to take time to navigate this. In three weeks, we went from 10% virtual care to nearly 90% virtual care. And that involved designing our virtual induction. So induction is getting a person with opioid use disorder started on Suboxone. And before COVID, this was illegal to do virtually. So the Ryan Haidt Act says that you have to see a person physically in person, face-to-face, before you can prescribe a controlled medication, which Suboxone is. And so although we were tech enabled, our tech MAT was for follow-up. We call the people we take care of community members because you join our community. And so it was for community members who were already with us. We had done their induction in person, and then we could do their follow-up MAT visits virtually. Well, COVID came and because of the clampdown on addiction treatment providers that could even provide virtual care at all, the Ryan Haidt Act has been waived. And that gave us the opportunity to start welcoming new community members into our community and doing their inductions virtually. We had to design it from scratch. And so in 10 days, we started with these guiding principles, which are the guiding principles we have for all of our care. We decided we cannot let that degrade just because we're in the virtual environment. We provide same-day MAT, a delightful experience for our community members so that they will stay with us because retention predicts outcomes for substance use disorder. Being able to piece together our process in a way that didn't drive our team members crazy and then reducing harm for substance use. And so we don't require complete abstinence for our community members to continue their relationship with us because that would be like requiring your diabetic patients to keep their blood sugars in control. It doesn't make any sense. And so we had to figure out how to solve for needing vitals, needing blood pressure, being able to see pupils, being able to monitor like for our medically complex patients for our pregnant patients, for our older patients. We do what's called observed induction where you do a test dose and then you have to follow them over a couple of hours to make sure you can increase the dose. And we had to solve for drug screens in the virtual environment. And so we put together this process to match our same-day commitment using just very heavily virtual, helping our members download Zoom, helping people get Gmail accounts separate from their work account. Like it was very work intensive. We kept all of our people. We didn't lose any people in the fray. And we surveyed our folks to say like after COVID, which who knows when that will be, how will you want your care? And so whereas addiction treatment was in the very minority, very minute part of it, virtual before COVID, our people are telling us 85% want some portion of their care to be virtual at their finish, but that same percentage wants a mix. So very few want pure virtual care, very few want pure in-person care. And so now we're like, so we have to figure out how to scale this. And just when we thought scaling virtual was gonna be the only thing we were dealing with, how do we scale remote vital signs, remote cows, remote physical, remote urine drug screen? And so vital signs, there are some solutions. Remote cow screening, we can do cameras that Zoom so we can see all the elements we need to see. Remote physical exam, you can get attachments for your cameras, but that works if a person's in a clinic, not necessarily if they're in their home and you've never seen them. So how to conceptualize that. Remote urine drug screens, there is no smart urine drug screen that you can just use the cup and your smartphone will send me the results back. So Rachel, I may call you and see if you have any volunteers that wanna help us with that. But just when we thought that's the only things we would have to be solving for, here comes George Floyd, Amon Arbery, Breonna Taylor, Rayshard Brooks, killed by the police and the additional pressure that that put on our community members, on our team members, on ourselves. And so I love this quote from Dr. Wisdom Powell that I actually was on a panel with her yesterday and heard from the first time and was like, that's going in the design lab. This country treats black men and boys as a problem to be solved rather than a wonder to behold. And using that, we knew at Eleanor Health where we take care of the whole person, we care for our people deeply, that's our community members, that's our team members, that we could not stay silent and we also could not only make a statement. And so as we were navigating our anti-racism response, we actually made a fair number of mistakes, all that pinned on trying to move too quickly. And so what I wanted to give this group today is thinking about designing anti-racism infrastructure for the companies that you work for, you have to know that racism is a trauma. Racism is a chronic trauma that lays is pervasive and invasive in all of the experiences that we have as black people. And then when incidents like George Floyd, race art Brooks, Breonna Taylor happens, that is a cute trauma that lays on top of the chronic trauma and reactivates those wounds. And so when you're building an anti-racism program, you have to be very cognizant of the four R's and I'm just gonna skip straight to the last one, which is resisting retraumatization, which is what we were accidentally doing to our people by moving too quickly, despite the greatest intentions. And so luckily we had some black team members who tried to foster a culture of speaking up and being seen and being your whole self at work that said, this is actually difficult for us. And what we realized we needed to do and I was like, duh, I'm a psychiatrist. I know this, right? Is the three stages of how we approach trauma. One is creating a safe space. Two is grounding and physiological regulation, letting those emotions come down so that you can get your thinking back. And then three is jumping into action. And what I've seen from all of the companies online and I've heard from colleagues and friends who are calling me saying, oh my God, this is what my job is doing. Oh my God, this is what my job is doing is skipping over the first two sections and jumping into action before it's safe. And so looking at creating a safe space that's physical space, emotional space, social connections, we need companies to invest in this during the workday. So at Eleanor we created Black Eleanor, which is a support group for anybody who identifies as black and it happens once a week during the day and it prioritizes over the other work that we have to do because that is important work also. Number two is grounding. So you have to create space from distressing feelings. So this is giving time and giving grace. So you really wanna have your black voices be directing the timeline on which your company and access campaign. And then finally we get to move into action. And that's where we empower the voices of black folks and where we engage our allies and you need a consultant because this is hard work. And so with that, the other two speakers inspired me and I put my two kids in wearing their masks. So you see one sporting Eleanor health and the other with some traditional Nigerian fabric and that's it. That was wonderful. Thank you, Nzinga. And I wanna ask a cool question then we'll go to all the group at Kristina to fill some other questions. But I actually wanna ask you about something else I saw that you didn't cover here but I saw in your podcast I'd actually wanted to get your insight in which is that I saw you had an episode of looking at racism as an addiction. And that was really interesting to me because I was like, wow, that's a, I think the more we rethink about racism, the more I think it reaches more people and has more effect. And I'd love if you'd comment on that statement. Yeah, definitely. So the podcast is in recovery with Dr. Nzinga Harrison shameless ad there. And so we talk about all things addiction and the definition that I use for addiction there is anything we continue to do that causes us negative consequences. And so despite the negative consequences we continue to do and we talk about all kinds of things. And so what I did was conceptualize America as the person and racism as the addiction. And I think we can all agree that although racism brings such devastating negative consequences, systemically and structurally this country continues to engage in racism. And so the other part of addiction is that although there are negative consequences as humans we don't continue to do things that are purely bringing us negative consequences. There has to be some benefit for us to continue that behavior. And so it was the challenge to America to look at what is the benefit of racism? Who's benefiting? What structures are benefiting? What institutions are benefiting? Because we have to figure out how to get those benefits in other ways if we really want to address racism in this country. That, thank you so well said. All right, so I'm gonna jump over to Christy Shine who's gonna give us some questions from the group. Wow, thanks so much, Matt. I have to say this was a great group of speakers today. I am so inspired by all the empathy and creativity that's come out of this group today. We've had a wonderful, we've actually had a record number of questions. So that just is a tribute to our speakers today. So I'm sorry we're not gonna be able to get to all of them but I definitely have questions for each of the speakers. One great question that was just asked if we can go back for one second and Zynga, what strategies do you have to prevent adverse childhood experiences that are amplified during this pandemic from perpetuating and becoming at the root of addiction and violence and obesity and self-injury? Yeah, thank you so much for asking this question. So the Kaiser's ACEs study showed exactly that. Part of it is education. So the overwhelming majority of people have never even heard of the ACEs study and certainly don't know that. And so the ACEs study is 14 different childhood experiences that go on to predict chronic medical illness in the future of all sorts in every organ system. And so I think what I did was actually take the ACEs to my husband and say, these are the ACEs. Four of these increase our kids' chance of all kinds of chronic illnesses when they grow into adults. And so we need to try to figure out how to keep our kids' ACEs score as low as possible. And then one of those is divorce. And so I said, so you have to act, right? So we can stay together. But I think part of it is education. Part of it is poverty, housing and security, mass incarceration is all of those huge societal ills that we have to start really taking care of so that our kids are not having those experiences. Thank you so much for sharing on that. That's great. Going back for now, going back to our first speaker and speaking to Stesha Dooku, a couple of questions from the audience. One question that came up from Nancy and our audience said, what other team members did you need to create the app? Did you need engineers, developers and how did you go about finding those individuals to be part of this team, to get your technology and your vision out there? Sure, that is a great question. And something like this certainly does require quite a number of team members. I did a lot of the development and design on my own. However, I was working in a lab that had biomedical engineers primarily who were able to help me figure out how to use data from the monitors. It was called the MDP&P Lab based in Boston. So I did a lot of the designing and development part of things, but they really helped in figuring out how to, as far as we could get, do a processing of the data for interoperability. And if I had a chance to sort of expand the team, I would get additional biomedical engineers, additional designers to think about how else they can be formatted. So most of what we did was created for a smartphone application, but I can see someone being able to pull this up on a computer or any sort of interactive device, whether it's an iPad or a computer to be able to use, but primarily engineers, designers and developers for this type of application. Great. And a question, now going back to Rachel Smith and your work and your project, I love. You made a statement that you said you wanted to make a difference at a time when kindness is crucial. And I was wondering if you can comment on for you personally, what is sort of underlying that statement and could you talk about how empathy sort of was a driving force in your grassroots organization? Of course. Thank you so much for that question. Yeah, you know, thinking about the statement where kindness is crucial, you know, these times are just different for everybody. The question we asked earlier was what's the new normal? I think everyone is just trying to learn to adapt, to pivot, to understand what their day-to-day is and kindness just helps alleviate worries. Having folks be on edge to be completely honest is something that's happening all the time. So if we can do something to help each other and support each other, why wouldn't you go out of your way? If you're able to, to alleviate some of that, it kind of does go a long way. One thing I am mindful though, however, and something I had to learn for myself as well in a term I learned was called empathy exhaustion as well. So yes, being empathetic is something that we always do as designers, but it's also taking a step back and understanding, okay, before I can take care of anybody else, can I first and foremost take care of myself? So it's making sure if you need to turn off your phone, if you need to go ahead and meditate, do some yoga, take a day or two, I definitely encourage you to do that. There is always going to be help needed in the world, but if you wanna take care of anyone first, it's always yourself first and foremost and your mental health is always number one. But yes, kindness goes a long way. Well, thank you so much, ladies. I, again, I'm so impressed with all of you and I'm gonna throw it back to Morgan for our final wrap up. Thank you guys so much. This has been an incredible week of speakers and getting to know many of the members of the audience right now, some of them have been speakers before, some of them are going to be speakers in the future and a lot of them have just been here for conversations like this. This is exactly where you guys should be and the people we should be speaking to. I'm so glad that we could get you all on today and thank you for joining us. We have an excellent show next week. I hope you all can join as well. It's 724, five o'clock p.m. We have Andrew Ibrahim, who's a surgeon and the CEO of Asia Pay Network. Michelle Flood, who is in my breakout room today, who's a pharmacist and a designer in Ireland. And we have Robert Faber-Cann and from Dover Design. So thank you all so much for joining us and we hope to see you next week. Thank you guys, it was so great. Thanks, everybody.