 Hi everyone and welcome to the 11th episode of Designing on the Frontlines, the show that brings together doctors, designers, and cool people to talk about some of the important issues around the pandemic and around current events. I'd like to welcome you all to the show, we are co-sponsored by the Health Design Lab here at Thomas Jefferson University Hospital and Cooper Stewart at the Smithsonian Museum, and I'm Morgan Hutchinson. Hey guys, and I'm Matt Fields, and we are both emergency medicine physicians. We also get to hang out at the Health Design Lab here at Thomas Jefferson University in Philadelphia. We're joined by our team and co-sponsors from the Health Design Lab, Boncou, Rob Puglisi, Christy Shine, Mary Ellen Daly, and all of our students who came from the lab. Hey guys, thanks for coming. And for Cooper Hewitt, we have Ellen Lupton and Pam Horne. And oh, Morgan, did you mention, I'm really sad, this is our next to the last episode. I didn't. I didn't want to start on bad foot. Oh, okay. Yeah, unfortunately. But it is Friday, the 24th of July, crazy. That is our second to last episode and COVID is still rising in our state here in Pennsylvania, Philadelphia and across the country. But Matt, what were you pointing out? I think this. The one place for COVID hasn't been rising is New Jersey. Yeah. New Jersey always gets bedwrapped, but pretty well COVID relatively. Anyway, we've got three awesome speakers today. So I want to get started quickly. I want to let you all know I'm about to post a survey about the show into the chat box and then I'll send another link to it later on. Please let us know what you think about the show. If this is your first show or if you've been to many other episodes, we would love to hear from you. Today, we've got three excellent speakers. We have Michelle Flood, pharmacist and designer, Dr. Andrew Abraham and Robert Fabricant. We also have Kimberly Dowdell and, and Priya Mishra. We also have one team breakout room in between speakers. So get ready. All right, everybody. Remember, we want to see your lovely faces. So please turn your video on. Just press up, you know, there's that little button up in the top right corner to turn your video on so we can see you. Use the chat box to tell us who you are, where you're from and shoot out any questions for our speakers. We'll try if we have time to do a Q&A session, but we do have a lot of speakers this week. So we apologize ahead of time if we don't get to that, but still ask your questions because people can answer them within the chat. And if you've missed any of our previous episodes, go to healthdesignlab.com. Let's get right into it. First, we have music minutes with our producer, Rob Belisi. Whoa, I'm first. That's crazy. All right, everybody. Today's beer is brought to you by note. Just kidding. But isn't this can beautiful? I just want to show everybody this is from a brewery right around the corner for me called Tired Hands. Why is Zoom doing that? And it is a delicious sour, sangria ale. And it's very strong. So if I start babbling, just tell me to shut up. Today's music was brought to you by Mavis Staples. Who here actually knew that Mavis Staples is still making albums? So she came out with an album in 2019 and it's called We Get By. And somebody with as much history and knowledge as Mavis knows how to read the world at any point in time. But man, does that album really make a lot of sense these days. So I suggest you go out and you listen to it. It is like medicine for the soul. That being said, I'll turn it over to you, Morgan. You're muted. Sorry. All right, we'll go straight to our Design Find of the Week with Colleen Clark. Colleen's also muted. There you go. Yes. Hey, everybody. I think I also need screen sharing capabilities. If I can be granted that by the powers that be. But here's to see everyone. So sad there's less than two hours left of this awesomeness. Thanks everybody who makes it happen. Let's see. I continue with the screen share. All right. Am I there? Nope. It was up for a second and then you went away. Okay. Here we go. So thank you. Sorry for bearing with me. So today's Design Find has to do with back to school. This is something that is kind of on everybody's minds. And I have to say, I don't have kids. So I haven't, don't have firsthand experience, but I know this is a really important topic. So considering we don't know what's going to happen. And for everybody around the world, I'm sure it's different in your neighborhood and wherever you live. But two researchers, one from MIT and one from Harvard decided to tackle this question. What is it going to look like and who's involved in the decision making process and how can we make it as equitable as possible. So they came out with these two reports and once I'm done sharing I'll link it in the chat so you can go check them out. I highly recommend it. I'm still digging through it. But the first report outlines a participatory design framework to help communities negotiate the challenges of schooling. And it also has colorful storyboards of ideas that came from all of their brainstorming and design sessions. So these were just, this is a list. I won't go through all of them, but these were some of the seven key insights that they listed that I thought were really interesting. And they also were referring to Marie condoing school priorities, which is kind of like a playful way to put it. The second report was actually this whole framework for how to do suret. So part of all of this they invited teachers, parents, administrators, all kinds of people to do three design surets and then they also did one design suret with eight graders. So real quick for those who don't know what to design suret is because we have a wonderful group of multidisciplinary attendees. So it's just an intensive multidisciplinary design workshop that involves a lot of different stakeholders exchanging ideas normally pretty quickly, a lot of ideating. They tend to be a lot of fun. I don't know what, and there's a lot of different definitions, but this sort of is the one that kind of summarizes it. So in the design suret with eight graders, you all know, if you've seen my previous finds, I love sharing things that involve kids and designing with kids. But they had them do a design suret for about an hour and this is some sketch notes from some of their ideas. But some of the students ideas included things like e-sports, first, recreation leagues with teacher and student teams, and then also hosting class on Minecraft and Fortnite, and then also proposing designing or designating home as a place for curriculum, and then school as a place for relationships. So that I thought was really interesting how like dividing those physical spaces for different things. So this is one of the quotes that came up that I thought really would resonate in terms of COVID and healthcare spaces as well that you want to let people access those spaces to the ground innovate. And so these reports really, really emphasize that and also the importance of flexibility. I won't go into this in my last slide. These are the last two main takeaways and when you click on the article you'll see. So these aren't my words, but I just thought these were great. Values eat logistics for breakfast and for ownership to equity. So that's a whole power and participatory design and how we can move towards equitable solutions in this really, dare I say it, unprecedented times. And so a lot of us from the frameworks from the school and involved people in the school community, I thought it would be really interesting to try to take some of those and apply them to healthcare. What would a healthcare sure it looked like around this topic. All right, back to you, Morgan, if I'm passing it back to you. Thank you so much Colleen and I am not on mute this time so that is the good news. Awesome design find excellent music thank you guys so much. And it's time to get into our first speaker. Michelle flood is a lecturer at the School of Pharmacy and Biomolecular Science at the Royal College of Surgeons in Ireland and she's a visiting researcher at the Design Institute Dell Medical School UT Austin. I'm interested in how design can support resolution to more complex issues in healthcare and and leads an interdisciplinary group of researchers addressing challenges and preventive care, medication safety and medical education. Welcome Michelle. Hi everyone, and my name is Michelle and I'm delighted to join you from Dublin in Ireland where it's just after 10pm. I'm mainly a lecturer in the School of Pharmacy as Morgan just said, a visiting researcher at Dell Med and I'm also teaching and learning research fellow, focusing on interdisciplinary and policy for higher education in Ireland so three jobs at the moment. Just by way of background, and just why is this random person ringing in from Ireland at 10pm. I am a pharmacist originally, and I worked in primary care for a number of years before moving to academia. When I was moving towards academia I started to wonder, you know, are we really training people to meet the needs of patients. I mean I could resolve complex medical issues but it was medicines issues but it was, it was difficult to understand what to do with patients who were lonely, or patients who you didn't have access to care. So I got interested I suppose in medical education and my PhD is in education. I still did some health services research, and I kind of started to look towards design. Where can you call me designer I will not call myself a designer, as you can see, but I like to use design principles to try and address some problems I find that useful. And then, I suppose, closing out that loop, if design is useful for health professionals, how do we teach it or what should teaching design to health professionals students look like and I kind of work within those three domains. And I suppose it's the question around medical education that took me to the States in 2018 to the amazing team at the Design Institute for Health at Dell Medical School, and I was really lucky there to work with a great team. Fulbright is very much based on the exchange, so I brought my expertise in education research, and I've set up a longitudinal study, following their first cohort of design track students, and over the first few years of their career. So I've spoken with them at baseline so before they started, I met them this year again to understand, you know, what had their design track choice. And then for them as they progress through the rest of medical school, I'll follow them up again in two years just to see has it impacted on their practice at all. So, as far as I know, it's the first kind of study of that sort. And I brought home with me a huge experience working on many projects so we worked on the Austin State Hospital redesign with the team there and telling health projects and some screening programs and also contributed to the educational program. The time it worked really well when I came back to Ireland and a great funding column just opened up. So just by way of background, the Euractus committee, so government committee in the future of health care being formed, and there's a cross party agreement so all political parties, you know, they're not on the best of terms normally have agreed to a long term vision for help. It's called sloncher care so sloncher, you might know it from drinking but actually needs help. And it's looking towards and designing a universal single tier health and social system where everybody has access to service based on need and not the ability to pay and that's something I'm obviously very in favour of. The 20 million euro funding was opened up for projects that were going to use innovative ways to support preventative health and social care. And I was already involved in an international project looking to implement brief interventions across all health professions, education Ireland so most of the technical people will know what a brief intervention is. And it's a structured short conversation with the health care professional, and that's done during a routine visit so just like an extremely test like a book that you're screening for example. And it, they're really effective, they're really cheap, but they're not really done. So anyone that knows Stacy time will probably know as well he hates waiting rooms so I learned when I was in the States that actually waiting is a waste. So what I wanted to do is try and say look well I want to bring together the government policy with my experience in working in brief interventions with what I'd learned from the States and look at a kind of what is a complex problem so my proposal is with how we could leverage waiting time and routine health care delivery and primary care to overcome barriers to brief intervention delivery so how might that work. So, I was very lucky to be able to assemble an amazing team of, you know, quite a quite diverse backgrounds, a lot of, you know, kind of design colleagues but also by statistics, organizational health psychology, and a partner at commercial partner and I would be very comfortable with that to try and secure some funding so we were lucky to get the equivalent of about $390,000. I were one of these dots 122 projects were funded across the country of Ireland so our solution was that we would try and digitize the first part of a brief intervention to overcome a lot of health professionals feel uncomfortable raising the question of say alcohol smoking you just, you know, kind of feel you don't want to raise an issue that's kind of, you know, nagging or potentially unpleasant so you can automate that so the person can do that while they're waiting. We then facilitate a structured conversation with part of the brief intervention after that but the health profession already has the information from the patient, from the initial consultation, and then instead of just saying oh you should go to yoga or you should see an alcohol support group, actually linking into services specifically in the area by a printed ticket so that came together to our health care project and is a collaboration funded by the Government of Ireland that's launching our project and a collaboration across four universities so it's a great project. But coronavirus arrives back in the middle of when we were supposed to be rolling out so it made us fundamentally question. You know what is it to do design research really like what does it does that matter is that important and but just to give you a little bit of an overview of Coronavirus in Ireland. The first case here was in on the 29th of February 2020. And it was someone returning from skiing in Italy it's very common thing to do to go skiing initially from Ireland is quite nearby. The schools and colleges closed the week my project started so we had to shut down and we had to all go home and my two staff just started. Businesses and venues closed from 24th of March to the end of May and we're now thankfully there was 20 new cases today, only in Ireland it's really, you know people really got on board with the measures and it's quite contained. Thankfully nobody has passed away today. And there's five patients out of five million that I see today so it's improved by a lot. We were lucky in that our T shock which would be the equivalent of I suppose your daughter was a doctor and a medical doctor so he and our person represented on the right is Dr Tony holden he's a chief medical officer and we're very well respected for a very strong leadership during the pandemic and recently the past week or so our contact tracing app was launched and more than 30% of the population have already downloaded it so that would be like more than 100 million Americans downloading the app. And our health service has made the code open source so you know there was some good parts. Unfortunately, there were some bad parts as well we were had a very high rate of nursing home deaths which is common internationally but it's something that's going to be subject to public inquiry, because it was so high. I suppose what the in terms of these kinds of academic health design research projects that should really be being done in the field. And things change fundamentally I don't have time to go into it with the original concept of health air that I or was supposed to be Ireland but also an airplane analogy which is now totally black in the water. No one wants to hear about air travel right now so we have to kind of change that as well. People are waiting either it does not wait so facilities are asking people not to congregate so you know, it's returning to normal. We have to decide if we should stop or keep going we had the option to pause the project. And then we have to really think about, you know, was what we were doing even important. This week I think this quote really captured our perspective and this is from paper by a team in Oxford and UK. I have to kind of realize that I think from now on things are going to be quite different, particularly for academic researchers who are used to dealing with, you know, kind of structured methods and modalities of research and also ethics committees and things like that you already be. It's quite difficult but it's really kind of groundless and, you know, look, you know finger and definitely not going to be perfect anymore. We as a team are challenged to what we could do differently. And we took the time to engage more deep in academic research which is something I found sometimes design doesn't necessarily do for different reasons sometimes purposeful. And we move towards even simulation facilities where possible so I'm looking to work in an institution that is the best simulation facilities in Europe. And this is obviously not a, there's not a research picture this is just a standard picture but we can do quite a lot in simulation. So, again, this is our clumsy solution and we have to evaluate how our imperfect responses can actually add knowledge in a different way and I think that's just a fundamental way of thinking. And I just want to say one more thing before I go because one of the things I've learned a lot from being at these sessions is a lot about the, I suppose, on the untimely killing of Mr. George Floyd and it's also been interesting to understand I suppose the reach and the impact of that so you guys might not be aware of, you know, the impact that it's had worldwide and I have really appreciated everybody and sharing their stories. When I was in the States and I suppose kind of knowing a lot of new friends who are still in the US was very disappointing and very kind of unusual for me to hear that unfortunately a lot of Irish Americans are can be part of the problem and it's something that when I saw this poem I was like I think I'll share the link to the artist reciting it because I'm done with time and she doesn't look at these words. But this really spoke to me because you don't get to be racist in Irish. We come from a history of emigration and oppression, and it's been something that, you know, has kind of really stood out to me from the different at all. So, it's a really, I suppose, powerful poem from my perspective, and I'm just like everybody to know before going to the stories that we've done with you. So, that's it. Thank you so much Michelle that's excellent I love about waiting as a waste and and the concept of design research we sure hope it's important because that's a, that's pretty much our jam around here so thank you so much for sharing it's great to, it's great to speak with you. Let's see I'm going to turn it over to Matt for the breakout room. Okay. Thank you very much and thank you Michelle that was wonderful. So we're going to go into a breakout room where we get to break up in groups of four to six and have a chance to meet with each other and get to know each other. And say who you are where you're from and remember if you get kicked off of zoom sometimes that happens we don't know why just rejoin. This week's prompt alright so this week's prompt was inspired by a book that I recently discovered that was written by the very famous and sadly late Michael Sorkin as many of you know Michael Sorkin was one of the world's most important architect designers educators and intellectuals of our time. He sadly died this year at the age of 71 due to complications related to COVID. He wrote a book entitled 20 minutes in Manhattan in which Sorkin he described in great detail, great detail has an observation during his daily walk from Greenwich Village to his Tribeca office. And in so doing so it kind of peels back layers of history feeds of engineering artistry, just from that increased time and thinking and observing which is so important to design. So our prompt this week in honor of that is have you noticed something during the pandemic that you didn't notice before and your own surroundings and your own home and your own work, maybe or even in nature, or with people that you interact with even your, your pets, maybe, or maybe even with yourself. So, kind of a broader question and a bit deep but I think hopefully very insightful. Alright. Welcome back everybody. I hope we got to all meet somebody new and learn about some cool stuff. So, we're all back. Let's recall back. Alright, so next I'm going to turn it over to bond coup who is the director of the health design lab. Can you just our next speaker. We have two speakers that will be hearing from. And the first is I Kimberly Dowdell she's based in Chicago she's an architect at HRK. There she is the director of business development. And her mission is to improve the quality of life for people living in cities so that's a that's a lot of us here and she's also president of the National Organization of Minority Architects. We also have Andrew Ibrahim he's a good friend of mine. He's also at HRK where he is the chief medical officer. And in his spare time Andrew is a surgeon at the University of Michigan. Andrew thinks a lot about bridging the gap between architects and architecture and healthcare so I'll hand it over to you Andrew. Awesome. Thanks so much bond thanks for organizing this and having us here I think being four or five months in it's there's been a lot of moments to slow down and pause and think what is COVID trying to teach us and how do we think about that through a design lens. So, when we look at the burden of COVID. This is the updated data in the United States from the CDC just today that we're consistently hitting 60 70,000 new cases were well over 4 million total. And this really just hits the tip of the iceberg in terms of the burden of coven but what has been really alarming to me and really stood out is not just that there's a burden, but that it's a very uneven burden. So in almost every category we look at across any measurable outcome. Blacks and minorities do worse in almost every category. So this was the headline of the New York Times that showed blacks and Latinos getting the coronavirus at three and four times the rates of whites. And what's interesting here is Native Americans had even a higher rate than all of those groups and weren't even represented, almost underscoring the problem of our inability to understand disparities in light of COVID. If you these same patterns persists when you look at who was able to get treated at hospitals who died from COVID who had an outcome that was improved. So these patterns persists, but even if you go outside the walls of the hospital. The patterns are still there too. So this is unemployment rates by race before and after before and during COVID and the same patterns are there. In other words, the burden and who COVID has affected is disproportionately uneven in a systematic way. So my home base has almost always been in the medical field and spend a lot of time training with patient safety experts. And when we saw problems consistently repeat themselves. This was the phrase that we most often heard every system is perfectly designed to get the results that it gets. And so when you see those patterns over and over from COVID, you have to step back and think, what is it about the way our health care delivery system is designed that it's so unfavorable to the same people over and over. But as I showed you it's actually not just about health care, but the implications are much broader. So I spent a lot of time picking everyone's brain at HOK, and they were calling me to to ask for health advice and if I had inside secrets about the vaccine development or something, which I don't, but keep calling it's fun. But I had a really thoughtful number of discussions and as I talked to my colleague Kimberly here from in a second. The phrase that really struck me which I think should be something that we all take away from COVID is that at the core of equitable health are equitable cities. In other words, if we don't design cities in a way that are equitable, it is unrealistic of us to think that people are going to have equitable health outcomes and health care experiences. The pandemic stresses the system and it just underscores and highlights it and makes it available to us, but it's there. And it has been there and COVID has just highlighted that for us. So I know a lot of people on this call can do a lot to talk about hospital design and things within health care deliberately. I'd love to take this opportunity to hand things off to Kim to think a little one step back about what is it about cities that are not equitable that is having enormous impact on health. Yeah, thank you Andrew. And, you know, I would, I would echo everything that that was just said and just, you know, really underscore how, you know, the disparities again that are being magnified by COVID right now. You know, I've been there for a long time and unfortunately will be here if we don't act. And, you know, I think everyone knows that the above the Hippocratic Oath and to do no harm and I think, you know, there's a there's a similar sort of call to action for architects that people don't talk about often so I'm just going to share it with you all in case you don't know and it's to protect the health safety and welfare of the public and so I think architects have to, you know, to do a better job of calling out these disparities and leveraging design as a tool to help to close the gaps and one of the gaps that comes to mind specifically is the wealth gap. There's a study from 2013 by Dr. Edward Wolf that shows that the median net worth of a white family in America is about $117,000, but that same number for an African American family is about $1,700. And so that I mean just to talk about that disparity and how that translates and to obviously fewer resources, which means, you know, less access to the things that people need. And that translates into, you know, unfortunately, lower life expectancy. So, unfortunately, in America, you know, your life expectancy to some extent is tied to years of code. And, you know, so many neighborhoods are either mostly black or mostly white and there's not a ton of, you know, of mixture at this point and certainly there are communities that are Latinx and Asian and there are communities that do have good mixture but you know what we're going to see as we go forward and Andrew if you could take it to the next slide is that, you know, our cities are going to become more dense. In fact, in the US right now, there are about 310 million people living in cities. But by 2050, there will be 439 million people living in cities. So we're going to have a much more dense environment within which to live, work and play. So architects, and really it's not just about architects. I mean, we're, you know, we're one of the great professions as I like to, you know, to call us but I mean obviously medicine and law and, you know, our teachers and, you know, there's so many different professionals that come together to help make the fabric of our cities and architects we have the privilege of shaping the future of them, you know, with their design work. As a density being, you know, what it is and what it will be, you know, I think that we have to be very cognizant of the work that we're doing and how it contributes to, to help to help outcomes. And then if we go to the next slide, in addition to density diversity, or, you know, heightened diversity in the US, you know, will become more apparent and if you look at the numbers at the bottom of slide it talks about what I what I just mentioned in terms of the people, or the population growth but if you look at the charts for the bars there, you know, whites in America are going to get reduced from 65% of the population, which was in 2010 so 10 years ago, but by 2050 it will be 46%. And then we'll see a larger population of Hispanic or Latinx people, and then African Americans are staying around the same at 12%. Asians are increasing a bit 8% and then others are doubling essentially. But the point is, you know, with cities becoming more dense, and more diverse. And I think we have, you know, we have our work cut out for us as a society. It certainly has designers and, you know, healthcare professionals and, you know, the whole range of people who are going to be working on the future of cities. But I think we have to take these numbers pretty seriously and know that if we can really work together to create, you know, better health outcomes, better economic outcomes, more, you know, essentially more harmony. I mean, I think that if we, if we don't, you know, take these numbers seriously and understand the demographics and how they're shifting and understand how density is increasing, then I think that we could potentially have, you know, just greater problems versus fewer. So how do we design better solutions to the problems that we have down because essentially they'll only be magnified. I think that COVID really helped us to see what the problems are. So now we have a great opportunity to address them. So that's what we have. So, Bon, I know there are so many good speakers here and questions and things. We thought we'd cut our time a little on the shorter side so we could engage questions or however you want to do that. Great. So I had one. Thanks for that presentation. What are some ways that maybe cities and architects or healthcare systems are working together to address the COVID-19 pandemic? I've seen some stuff out there. Have you, is your firm doing work in this area or other firms that you know of? So we, I'll speak more for the University of Michigan. We started almost really an entire portfolio of research work. We historically have always done clinical outcomes and we've gotten very good at measuring outcomes and claims data, insurance data. And we started to look at racial disparities but in a much different way. So could you, you know, when you certainly defer to Kimberly's expertise in this and housing policy, the U.S. unfortunately has a history of housing policy that was explicitly favoring segregation that was designed to actually segregate people, whether redlining or the way FHA allocated loans or the way housing projects were established. They were explicitly designed to segregate people. Now those policies theoretically should have been overturned by the Fair Housing Act decades ago, but you actually can still see a lot of those patterns persist. So we've restarted a whole new line of work to take all the clinical outcomes that we measure all the time and connect them back to those neighborhoods, but not just to those zip codes and neighborhoods but actually trace them back to the policies. And then you can actually start to identify 30, 40, 50 year legacies of segregation policy and racist policy that we're not initially obvious. And I think in doing that work as we started to think about it, one of the things that became clear is that you can have a system with no racist in it. But if you have racist policies and having to address the legacy of that, then the system is systematically unfair. So we're starting to try to make those connections. Yeah, that's, I mean, that's absolutely correct. In fact, there's a great book if anyone wants to to read up on this more it's called the color of law. And it just talks about the different policies that, you know, that essentially were designed to create this inequity that we're, I think we're all suffering from today because, you know, even though it seems as if a certain population of people are, you know, heavily impacted, you know, we're all tied together in our cities and in our, you know, our states and the country as a whole. And so I think it's imperative that we, you know, that we do create, I think cross cross sector solutions to to a lot of the issues. I mean, that's one of the things that we're looking at at H okay just, you know, working with with cities or with, or with our counties and, you know, not for profit sector leaders to to really create kind of try sector actually. Also looking at academia like how do we partner with different with different entities that have different perspectives on these really complicated issues because we realize we can't design solutions on our own and it's really going to require, you know, a lot of different perspectives and a lot of experience from, you know, different areas of expertise to to really move the needle on these inequities. Great. Thanks so much. I really, really appreciate the presentation. I'm going to hand it over to my colleague Ellen Lupton, who is the senior curator at Cooper Hewitt Smithsonian Design Museum in New York City. Thank you. I'm really excited to introduce Robert Fabricant and Pragya Mishra, who are joining us today from Dahlberg Design. They are applying human centered design to global health care, social impact and international development. Robert has written a new book called user friendly, which I highly recommend, and they're going to talk to us about the global health practice at Dahlberg so welcome Robert and Pragya. Ellen, thanks so much. And I've had a chance to sneak into a few of these sessions so far. So it's great to be sharing some work as a designer who's been doing this work for for a number of decades now. The most exciting thing is to find myself in a community of practitioners that aren't designers that aren't coming from that background to understand and learn about how they see the world in their work and think creatively about how it could be a pathway or a tool for greater impact. And I know a lot of people on this call feel this way. I'm going to give you just a couple minute background to set the stage because we're going to be talking about a bit more of the global health context, which some people here may have had a chance to get a little exposed to and some haven't. So I'm going to set a little bit of the stage of and then pass off to Pragya who leads a creative director and leads our health practice to walk you through an example. And I think it relates to some of these themes as we think about equity. We find ourselves very often at that intersection of trying to figure out how you strengthen institutions and build capacity, both at a small and large scale and the pandemic has certainly brought that to the forefront. So Pragya, if we can go to slide two, I think Pragya is sharing her screen in the same spirit as I said in the introduction. Mia and a colleague joined a firm called Dalbur because we were looking at how to cross pollinate design and into new fields and new issue topics. And a lot of what we saw was a huge creative capacity around the world from the projects we were doing. That wasn't really being nurtured and brought into these social and civic issues and so we decided to build a practice that's fundamentally dedicated to that. So we have a now a global design studio. If you go to the next slide Pragya with small teams in Mumbai Nairobi, we're starting up at Dakar now New York and London. And we bring together people and really try and cross pollinate the work into the community based organizations we work with the governments, the NGOs, and the funders that we tend to work with as well as within our own practice we have organization rather we have data scientists we have quantitative researchers we have strategists we have people in finance and policy so we try and put all that together if you go to the next page it won't surprise you given that footprint. And the fact that you know for example my team was the lead design partner to the Global Health Bureau at USA very early in the pandemic we started to move into action. And so this gives you some idea probably might be worth going into presentation mode. We jumped into some very quick response activities it was everything from creating infographics to circulate in half a dozen languages in India to explain basic health and sanitation practices working with the Indian government on their WhatsApp service to get information out to people in Kenya, Ethiopia and Tanzania launching an initiative called project safe hands it again tries to get sanitation and other tools into very dense low income community so we move quickly. And there was a lot of very hands on design work to do but along the way, we kept coming back to well, how do you, how do you coordinate this with governments, how do you do this in a way that strengthens strengthens capacity, not in this quick response, but as the broader effort around response rebuilding reconstruction rethinking the social contract how do you make how do you help that happen and we know we knew from other global health work that there was a need for a different kind of collaboration, both within and across governments and so that's really where this project picks up with some work in West Africa that that Prague and Trevor who's also on the call lead so probably if you want to pick it up that would be great. Thanks Robert. Hi everyone, I'm Pragya and I now that Robert's given us a little bit of an overview of what we've been engaging in and COVID-19 let me take you guys through a closer look of this one particular engagement where we used human centered design to support public health emergency operation centers in West Africa and I know that's quite a mouthful but essentially public health emergency operation centers are this construct that was started in 2013 when the Ebola outbreak happened and these centers exist across various countries in the West African region essentially for the purpose of making sure that resources as well as technical expertise is available to these countries for responding to pandemics and any other threat to human health and I think it's important to highlight that over time from Ebola to now COVID-19 as time passed it would be realized that you know EUC in general can lack internal procedures so it was all very spontaneous when these EUCs came together but now in hindsight that we've had some time to think about it it's been pretty apparent that sometimes there's capacity missing sometimes there's lack of technical expertise there's not a very robust health system in many of these countries so you know how do you make sure that when a pandemic strikes you're not only within a country managing it but you're also coordinating with each other and communicating with each other so across the region you can sort of have a more coordinated response and this is especially important because as you all know you know pandemics don't have boundaries and there's a lot of movement of people as well as goods across the borders so it's become really really important for all of these countries not only to be focusing nationally but also across talking across the table to each other and you can see on the side with those six countries that we're focusing on for Mauritania, Mali, Senegal, Gambia, Guinea and Guinea-Vissal and within these I think one of the biggest things that we saw was to make sure that we get all of these collaborators and stakeholders together including other regional actors who are quite strong in supporting these countries and you know working through these pandemics like Africa, CDC, WHO, and our focus was essentially to bring them together to think through how we can build some sort of a collaboration or regional platform that can help in exchanging information and supporting this outbreak together in real time and this was especially important and time sensitive because given the time right now you know there's a very urgent need for this and we approached this through the lens of design by starting with talking to each of these countries that you see coordinators we also spoke to a lot of regional stakeholders for understanding what the real system issues are and what the context of this pandemic is where there are key challenges and gaps to actually think through and then we went into thinking about what some ideas and design concepts for filling some of those gaps could be and how could we make it a more strategic approach where we prioritize something for more near term execution and then we can also have a broader vision in which we align our efforts across all of the existing partnerships and interventions already taking place in this space and all of this to say that this was done in eight weeks and now we're actually going into the phase of implementing some of these ideas that came through and that's really exciting because through design we've been able to make the EOC coordinators speak to each other, regional stakeholders also contribute to how some of this stuff should be shaped and then we've been able to now pilot some of these ideas with them so that's been a pretty exciting phase for the entire team that's working on this project and let me share a few high level takeaways that emerged from our research but essentially there were a few key places where I think all of the EOC coordinators needed a few more interventions or maybe some sort of support or even more capacity and this was around training, communication and coordination in terms of training specifically making sure that updated most recent information is available and in easy access for the EOC personnel to update themselves but also in terms of communication and coordination making sure that information is being shared quickly and cutting through all of the red tape that's available so that they can coordinate with each other and then in terms of knowledge, I think one of the biggest challenges that these guys have faced has been through attrition, a lot of the staff keeps coming going in and out and doesn't necessarily, it's hard for EOCs to sustain a critical amount of experts and people so how do you quickly bring staff on board, how do you orient them, what can you tell them quickly about the pandemic so that they can respond and then lastly which I'm guessing would not be a surprise to anyone in this group but you know data for decision making and making sure that you have assets available so that alerts can be found, things can be done in your time to take the most informed decision possible where all the things that were sort of got up and I think from that one of the things that we realized that these were a lot of priorities but we needed actually the countries to come themselves together and speak to each other and define what they want to prioritize immediately what is it that immediately would get them going and support them in their initiative against COVID-19 so for the first time since the outbreak has happened we got these six countries to speak together through a co-creation workshop well remotely but essentially the purpose and objective of this workshop was for them to reflect on all of the challenges that they had surfaced through our research but then also sort of co-create and decide for themselves what would be the best suited intervention for them to actually get some of this going in terms of action or some actual idea or concept and I think this was actually quite valuable to the EUC coordinators because they essentially got a chance to speak to each other, connect with each other and then also you know debate what the key idea should be and how they should design for themselves which was a great value and from this workshop two big things emerged and two ideas emerged in terms of concepts, the first one was around their desire for a real-time data sharing and communication platform and while the best version of this or the most ambitious version of this would be some sort of an integrated fancy technology-based platform the near-term MVP version of what they wanted was essentially something with the tools that they're using that can serve two purposes one open up channels of direct communication between countries but to also you know enable them to cut through the red tape and exchange information so we are actually piloting this now because this is something that needed to be done really quickly and urgently and we're already starting to kick this communication platform off next week I think August 10th, so this is something that will happen soon enough, the other thing that they expressed was their need around building some sort of a trainer kind of platform and again this was important for them because they want to keep updating themselves with all of the available knowledge as we are learning more about the COVID outbreak and about the disease itself and they want to make sure that they can then sort of pass this on pass this expertise on to their own staff, to their own countries so essentially this is something that already WHO and Africa CDC are doing a lot off and our role here will be to essentially collate a lot of these materials and then make sure that we're making it available for them so I know I went through a lot really quickly but essentially I think we wanted to share this because one of the key ways in which design has been helpful here is to provide these six countries some sort of co-creation tool that can help them in very dynamically creating prototypes that don't work in making it iterative not waiting for the perfect answer which is jumping in and lowering the stakes so that they can trust each other, co-create with each other and design can work as almost like a glue or a facilitator so I think that's been valuable and we will continue to work on these ideas and work with these teams across for the next six months or so but thank you Thank you so much. I think we have time for just a couple of questions. There's a lot of really interesting conversation going on in the chat about why can't we have an EOC or an emergency operations center in Philadelphia or in the US like we seem to be so lacking the very tools that you're developing in West Africa so do you have any advice or thought about how to create that kind of flow of information and co-creation you know beyond the state of New Jersey Actually that's a really good question and I think in the US the problem has been reversed where there's almost a problem of plenty where I just read an article yesterday in one of the health journals about how Africa CDC had this one body to design which was supposed to design what the vaccine access for COVID-19 could look like and now they've posted around they've made four other panels for this so there's a lot of confusion on like who should make decisions and how the vaccine should be distributed so yeah like there's that but there's also definitely a need for you know employing non-traditional methodologies like design to make some decisions sometimes because I think what that can do is lower the bar and make it okay to do quick and dirty things but fail fast but yeah The emergency encourages a little bit looser activity. Do we have time for any more questions? Morgan and Matt I think that we don't we are actually going to ask Michelle flood one question. I know we're getting really tight on time here but we want to go ahead and ask her questions so I'm going to turn it over to Christy Shine for an audience question Great Michelle thanks so much for your chat. So you mentioned that you're working on the how might we statement of how might we leverage waiting time and routine health care and one of the audience members Natasha Goodwin asked do you think that this project can be broadened to tackle the problem of waiting in general so for example not just wait times at a clinic but waiting for a diagnosis and how could you see that applied? Yeah well it's a great question and the best answer to that really is the clinics that they have established already at DelVette so I'm not sure if you guys are familiar with them but they've really reworked care provision and care delivery so that when a patient comes into the clinic the care is actually oriented around them but you can do that with a green field site where you don't have existing structures you know that it's not a problem but the patient comes in for a two hour visit the clinicians and the clinical team are all kind of working together as a group so with one visit you could see two, three, four, five clinicians so you don't have to wait for the physical therapist to refer you to the surgeon and you come back and you go again everybody is there together so the physical therapist will just step out and say hey you know to the advanced nurse practitioner or surgeon could you pop in and see my patient there in whatever room so I think that was a really clever way to sort of eliminate waiting through the ever use of both space and time now like I think a lot of established services are a long way from that because it's very very hard to restructure but I think that's a great example of where it's been possible with the green field you know kind of site when you're establishing and scratch but absolutely I would know there's different ways to extend that I'm so sorry we're over time because I went on for way too long so I don't want to be taking up more time with questions that is totally fine we're so glad to have you Michelle and everyone thank you Robert, Kimberly, Andrew, Pragya and Trevor for all joining us today and thank you also to Rob, Colleen and Christy for helping us facilitate. Next week is going to be our last episode and we are so sad but also so excited to hopefully see you guys all back with us. Next week we welcome our guests Mia Osaki, Dr. Ijoma Ozodo and Natasha Margot Blum so it's going to be an awesome conversation and we hope to see you guys all there. Thank you everybody. Thank you so much.