 Hi everybody, welcome back to Designing on the Frontlines. This is the hour that we take from every week to bring together doctors, designers, and all kinds of cool people to talk about what's going on designing on the frontlines of the COVID pandemic. I'm Morgan Hutchinson. And I'm Matt Fields, and we are two emergency physicians at Thomas Jefferson University here in Philadelphia, which is behind us. And we also work in the Jefferson Health Design Lab, where we get to geek out about design thinking and healthcare. We're here with our team and co-sponsors of this show from the Health Design Lab here and Cooper Hewitt from the Smithsonian Museum, Bon Koo, Ellen Lupton, Rob Beglesi, Christy Shine, Mary Ellen, and Michelle Ho, plus our students from our design track. It's awesome to have you all here with us. Now remember, everybody, please turn on your video. This is meant to be interactive and we wanna see everybody's smiling face. And please use the chat box to tell us who you are, where you're from, ask any questions or any comments, give any shout outs if you wanna say whatever you want. It's supposed to be a laid back interactive session. This week we have three awesome speakers. We have Dr. Aditi Joshi, thank you for coming from emergency medicine department here. We have Dr. Sheila Sonny, who's an interventional cardiologist in New Jersey, and we have designer George A. from Chicago. That's gonna be great. And again, we're gonna be taking questions at the end. Christy Shine will be monitoring our chat box and help us lead our Q&A session at the end. And if you've missed any of our previous episodes, they're available online at healthdesignlab.com slash D-O-T-F-L. Now we're gonna hand it over to Rob for some moments, some updates. Some music. Is it that time already? Hey everybody, my name's Rob. I'm one of the Health Design Lab team and your friendly producer for this show. For my bit today, I just wanna share a little bit about the music we're listening to today. Let's check that out, hold on. All right, so I had some, switched it up from like our usual chill vibes this week to a little more electronic. This is a really co-female team that's almost called Warrior. I felt like it was appropriate for today. And then I saw this on Twitter right before we started today. Here's our guest from a couple of weeks ago. Can y'all see? Mike Natter working on a really awesome piece called Don Doff and Draw. So you can kinda check him out in action. So amazing artist, cool guy and a physician and one of our previous guests. Make sure you follow him and check out his beautiful art. And that's it. I actually just saw that video yesterday as I was learning what Instagram Live was for the first time. I feel like the technology learning curve is huge these days. I'm gonna go ahead and introduce our first speaker, Dr. Aditi Joshi, our colleague and our friend here in the emergency department at Jefferson. She's the director of Jeff Connect, the telehealth program here at Jefferson and the director of the telehealth fellowship. Hi, thank you for coming on, Aditi. I think you're muted. I feel like that's what somebody said on Twitter. That's gonna be the line from 2020, you're muted. I know, that's gonna be like the main thing. So thanks so much for coming on. We're really excited to hear about what it's been like for you as the director of the telehealth program for the long term and then coming into this pandemic and like what your experience was like, you know, in that work and on telehealth and just personally dealing with this kind of time. Sure, thanks for having me. So I'll give you a brief background. I've worked in telehealth for about seven years. I joined a startup in 2016 and Jefferson started their program in 2015. And so our background, we have a program called Jeff Connect which is huge and all over the hospital. But the part that I'm gonna talk about today is our on-demand portion, which is our direct to consumer. You can think of it as acute care, virtual urgent care or something of that manner. It's staff 24-7 by emergency medicine physicians. And I took over as medical director in 2016 and came to Jefferson at that point from that startup that I was telling you about. So previously, you know, we would staff it but we didn't get a lot of patients. A lot of physicians didn't really wanna do it. Telehealth wasn't very popular. People didn't get it. They didn't know what they could use it for. People didn't think it's safe. I mean, anything you can think of, I've heard. And so we always had this idea that it is going to be useful in the future but it was a lot of barriers trying to convince other people that there was something to it. And so then, you know, 2020 happened and a whole lots of things bad happened but then this pandemic and like nothing has changed the way that people look at telemedicine except until this. And this has been a defining moment because there is, you know, our entire goal is to keep people at home, right? So I just remember in March, and this is in Philadelphia. Obviously my colleagues are here too. And so they can give you some idea of the other things that were happening. But I remember it was the week of March 9th and, you know, generally our shifts hadn't been overly busy. We didn't have a huge amount of people. So I could tell you, Flo, in March of that March 9th of last year, we probably had over the week about 50 to 60 patients over the week. And so that March 9th happened this year and we started to see just a huge uptick all of a sudden. And it was no accident, right? A lot of things were happening simultaneously. We and Philly knew that the West Coast had had a ton of cases of coronavirus. So it was gonna be coming to us. The hospital was planning to get PPE. They're restaffing. We were creating our own protocols of how we were gonna deal with it as an institution. We shut down five urgent cares, a bunch of the onsite clinics shut down. We stopped our elective surgery. So a whole host of things shut down. And because of that, one thing that they did, because we had it already set up, was say that anybody who needs to be seen for medical care or coronavirus screening is gonna go through our telemedicine program. So I went from having basically having to deal with maybe 20, 30 patients. And then we, I think, on that Friday had about over 150. And we didn't have the staffing for it. So you can imagine the amount of stress that was for our department and the 37 doctors who were able to staff it. So here's what we did because we realized that there was an opportunity here to keep people safe in the city of Philadelphia because we had this program. We had the ability to keep people at home and still be able to offer testing. So while we were, I'll tell you about the telehealth portion, but the one thing we also did is create a bunch of outpatient testing sites. So we sent three around Eastern Pennsylvania and Southern New Jersey. So Jefferson set those up. And the idea was that anybody who wanted to get tested at one of those sites would come through telehealth or they could call their doctor, but we actually set it up through telehealth. And we set up also a centralized place for registration so people could call there. And then so that weekend I spent basically training. So we had that set up. Sorry, so let me go back a second. And then what we had to do in the meantime was because we couldn't have one doctor staffing if you had 150 patients on a day at a time. And so we spent that weekend basically creating training videos. I created an entire portal with all of the training documents, all of the protocols, what you need to do to get testing information on coronavirus so any of the people who are working in telehealth could do it. And then on Saturday night I created two types of training videos and I trained 150 people. I made 150 provider accounts that Saturday, which was like the longest day I can remember ever. And so because the next day we got all of those people. We got staffing from family practice and internal medicine to help out our very overworked EM faculty. And I remember that was March 15th. And I can't tell you that day. I thought I was gonna cry just seeing all of the people helping. So did my colleagues who were working because I don't think they would have been managing that amount of patients. And that week though, the March 16th, we saw over 2,000 patients. It was something ridiculous over that 10 day period. And so since then that was probably a peak week. Since then we haven't seen as many. But in the time that I would consider surge where we needed family practice, internal medicine to help us with our staffing, which I'd say was at March 16th week to May 8th, we saw 6,500 patients and tested about 30% of them. Those are all people from home. Nobody had to come into a site other than the outpatient testing sites to do that. And so we feel we know that that probably helped tremendously, right? Because nobody had to come into the ER and no one had to go to an urgent care. Nobody had to go to any clinic. They could sit at home and get evaluation screening, information counseling on what they needed to do at home, what they needed to do for if they were critically ill. And we could actually screen them for that. Yeah, just remembering that, like it still stresses me out that weekend. Yeah, I'm like, my heart rate's like going up. Just like, I remember those days, like I think we talked kind of a lot during that time. And you're just like in the craziest, the most busy situation I think of any of us in the department, just trying to be the doctor and also manage this huge surge in your department and telehealth, and then you got sick. And then you got sick during that time. And so what was that like for you? So I got sick. So I said that Monday, the 16th, it was probably the busiest day we had. It was, numbers-wise, it was the busiest day. I got sick and spiked to fever that Saturday. And I was even telling Morgan right before this, I was like, thank God that happened then when we were fully staffed and I had trained everybody because I don't know what we would have done if I was like sick and couldn't do it. Saying that, it was telehealth, so I could do it from home, but it was much harder. You know, I was like just exhausted, like anyone can tell you who's had it. It was exhausting, had a fever. Eventually, like I started getting like sicker and looking at the screen made me nauseous. And so then I couldn't really do a lot of that work. So a lot of that time, you know, I have a fellow that helps, you know, our admin team in telehealth was incredibly helpful. And just in general, the EM faculty, if I needed them to help me, because especially the ones who had already been doing telehealth, they always stepped up every single time. And so I was really thankful for that. But a lot of the QA portion was still a little bit on me because when things needed, like when people needed questions answered, because this was what happens, right? And relevant to the topic of design, when you're the only person who knows a thing inside out and you have to scale up really quickly, it's real burden if there's nobody else who can do it or there's no centralized place for documents and training. I mean, I think I look back and thinking about the fact that it took this for me to create a training video and documents and the central document, that's ridiculous, it should have had that years ago. So now that I think about like when I'm coming, the new faculty coming in July, it's gonna be so much easier to train them, but I could have thought of this years ago. Yeah, it's crazy that, you know, a lot of things like that took the pandemic to really make like all the virtual things and all the things like that, you know, so mainstream, but that's such a great story. Thank you for sharing it with us. Yeah, yeah. One of the interesting things I remember being a physician, also working during the pandemic and also doing telehealth is, I remember I had, I got a cough and earlier on we didn't have rapid testing. So I had to be quarantined for a number of days and couldn't work my shifts, but because of telehealth, it actually was a really interesting thing where we actually were able to switch people from working in the department to working telehealth. So being able to provide care as a physician during periods of quarantine is just as important to balance workforce, so. True, definitely. We still have some of our high-risk doctors still just doing telehealth, right, instead of going back into the emergency room. Yeah, totally, it makes the department, it makes, you know, increase the staffing and lets us all kind of work together in a really cool way. I know, Aditi, that we're gonna have a lot of questions for you from the audience, so I wanna like save some time for that until the end. Thank you so much for sharing your story with us and stay tuned for some more questions. Yeah, thank you very much. All right, so everybody, now it is time for us to go to our first breakout room. For those of you just joining, we like to do breakout rooms as a way for everybody to get to meet each other and learn something about each other. So you're gonna be randomized into groups of four or six and when you get in there, feel free to just tell everybody who you are, where you're from and what you do. And then we like to give a prompt. So the prompt this week is, or for this breakout session is, what surprises you most about how the world has responded to the pandemic? So what surprises you most about how the world has responded to the pandemic? No, we're unmuted. We're unmuted, okay. That's the opposite of muted. 2020, we're not, you're not muted. Okay, awesome. Thanks everybody, that was great. I just met some awesome people and had a lot of fun. We were in the same breakout room. We were in the same breakout room, so yeah, that's exactly what happened in my breakout room too. But yeah, it's great to be back. So now I'm going to turn it over to our Health Design Lab Director, Dr. Bon Koo to introduce our second guest. Awesome, happy Friday everyone. I think there's someone joined from Australia, which is great, so good morning or out there, I think it's pretty early in the morning. So I'm thrilled that Dr. Sheila Sani is joining us. She's a cardiologist who practices in New Jersey. She did a fellowship in interventional cardiology at UCLA, so that means when you get your heart attack, she's the one who does that procedure and opens up our blocked coronary arteries. I got to know Sheila. We're a co-panelist on the Primetime TV show called Chasing the Curator that we did last fall and it was a show on crowdsourcing to help patients get a diagnosis. So every week, Sheila and I would hop on a plane from the East Coast, go to LA, film and take a red-eye back to the East Coast to work our day jobs as doctors. And as a doctor, who works in the emergency room, I've been wondering where are all these patients who have congestive heart failure, who have acute myocardial infarctions? Because we've not been seeing them over the past few months. And there's been a decrease in volume in the emergency room visits. And I'm also wondering how doctors like you, Sheila, are opening up your practices, and especially because you do a lot of procedures and how are you, what are things that you're doing to protect yourself, your staff, and your patients? So thanks, Sheila, for joining. And I'll hand it over to you. Thank you so much. It's a thank you bond for the wonderful introduction. It was so warm and a beautiful memory of doing Chasing the Curator. It's an absolute honor to be here amongst you designers and many different physicians. I have made some slides, you know, cardiologists can be formal, but I do wanna lead with what Vaughn just asked about because I don't touch on it in my visuals. And that is really a question. What happened to all of the heart attacks? We all know that heart disease is the leading killer for men and women. And about 800,000 heart attacks occur in the US per year. That's one every 40 seconds. But what we found nationally in ERs is that there was an eerie loneliness outside of the pandemic of patients not presenting with not only heart attack but they weren't presenting with stroke. And that's because of fear. And so I'm gonna share my screen now just to give you some context for how practicing cardiology transitioned and how along the lines of cardiovascular transitions and care patients were also, who are the consumers of that care, were also struck by so much fear and avoiding medical attention. So I'm gonna try this now to share. Can everybody see my screen? Yep. Great. So a little bit of an intro here we are with innovation in the delivery of cardiovascular care at the front lines. I'm an interventional cardiologist practicing in a community. So it's very different from an academic setup. Here, just to give you some background, I do a lot of consultation, patients coming in with new symptoms, a lot of explanation about what it could be oftentimes chest pain or palpitations. And usually there's some segment of ordering diagnostic testing, whether it's an echo or a nuclear stress test or some other advanced imaging, but mostly the stress test because that's the initial diagnostic of how the plumbing is working in the heart. And what you can see are there's EKG leads that get attached to a patient that will walk on the treadmill and I, along with the nurse, administer the test. So there's a lot of close contact. You can see I'm very close to my staff members when I'm reading and I'm very close to the patient. If any of those diagnostic markers, particularly the stress test, matches up with symptoms that make me worried, I can bring the patient to the cath lab and that's me dressed for my procedure that's called an angiogram. And I can actually check out the plumbing of the heart and see if there is a reason for the patient having chest pain. At the same time, this procedure could be done in an emergency setting, which is a heart attack. So how did this change then when the pandemic came? And in terms of what happened in New Jersey, on March 3rd, we had our first case. Shortly there, two days, three days later, the New York Times published the second case in New Jersey. And by March 9th, we had declared a state of emergency. But what does that really mean to physicians? In fact, I might not be an emergency room doctor, but I'm often at the front line of heart attack care. It doesn't stop. So declaring a state of the emergency in New Jersey didn't really give much guidance to physicians in the community. We were kind of left to continue what we were doing. So here I was. Tuesday, March 17th, which is a day that I do a lot of high-risk procedures that have taken months to schedule at a high-risk center. I see patients in the morning here. I'm examining a patient, no social distancing. I'm giving her a happy result of a negative result. And there I am after my third case late in the cath lab. But we couldn't neglect or avoid what we knew what was inevitable. And that night, with multiple meetings with other cardiovascular physicians in the area, as well as hospital administrators, we all got together and made some really important decisions to deal with this transition that was going to be transformative and immediate. And those involved completely shutting down elective procedures because we had to prepare. You know, the state of the emergency on March 9th really meant we need to get prepared. We shut down elective procedures, no more stress testing, no more echoes. None of that that you saw that I was doing, could we do any more, because they weren't urgent. And we virtually transformed our practice overnight into telemedicine. So here I am doing consultations. We went to, we were able to maintain 100% volume with our patients, I would say maybe 90%. But we were very strong in converting everybody to a telemedicine visit, as well as new consultations. But there were transitions that we had to make that we were unprepared for. In other words, patients calling me with new chest pain, I need to perform an EKG. So on the right, you see our staff members dressed in proper PPE, performing an EKG, about to perform one. But at the same time, a common symptom is palpitations and I need to perform event monitors. So in the center, you see two different monitors that I use, this one on the bottom, there was a point where we were leaving it in a shopping bag outside of our office. Patients were walking in with the mask and coming to pick it up and placing it on themselves when we were waiting for PPE. Once we got proper PPE, as showed by one of my staff members, we were able to place both of them on for the patients. And patients were able to mail them back or drop them back. So these were some rapid transitions that we were able to make that complimented our virtual medicine practice. But again, diagnostic testing, elected cases completely shut down. So patients were really in limbo. And what happened to some of the coronary patients that were waiting for procedures? I was managing them with medicine, with very close follow-up. And again, if they needed urgent care, we did have to refer them to either our office for an EKG or the emergency room. But you know, figuring this out has really been equivalent to trying to fly a plane while building it. Because the design innovation has continued and continues as we decide on how we're gonna reopen safely. Here we've put up some plexiglass between our front desk members so patients can feel safe when they're having to have that close contact. And here you see me with one of my nurses, we're both wearing N95s. We have a testing protocol in place where patients have to confirm negative status before testing. But what I was really curious about to hear from everybody from the design perspective, if we could create something like a plexiglass to come down where patients could be separated from the nurse or even other members of the office, that would be a safer way because what happens is when you do a stress test, you aerosolize, you start breathing very hard and you can get short of breath. So it was difficult for us to wait for the reagents and to make sure we could confirm negative status. And these are just some of the nuances of what we did. And again, the innovation simply continues. Sorry, Sheila, I was muted. Again, that's the theme of the show today. Thank you so much. That's really cool to hear about. I know that we talked a couple of days ago that it was really inspiring to hear that story and it's cool to hear all the details of it. I think that one of the things that's been really hard from the emergency department standpoint is seeing so many patients who didn't come into the emergency room and who didn't go to their outpatient physicians and who got worse and unfortunately had really serious complications. So that's really, really cool to hear about. Thank you so much for coming on. Like I said earlier, we're gonna save the questions for later. I'm gonna go ahead and hand it over to designer curator, writer, Ellen Lutton from Cooper Hewitt Smithsonian Museum to introduce our last speaker. Oh, she needed to, not just me. All right. I had to do it, right? I am so excited to introduce our design star of the day, George A. He co-founded a studio in Chicago called Greater Good Studio which specializes in applying human-centered design to problems for not-for-profit organizations in that city. Prior to that, he was part of the global innovation firm, IDIDO and he also spent time as a human-centered designer for the Chicago Transit Authority. I'd love to hear about that, maybe not today. His work addresses issues and problems like autism, criminal justice, education, public health and healthcare. And he's gonna talk about design and power today and how that's not necessarily a great combination. So welcome, George A. Thanks so much for having me. Can you all hear me okay? Fantastic. So I'm gonna share my screen and try and see if I can get myself ready. Are folks able to see these slides? Fantastic. So a little bit about the studio. This business has been in business for nine years now. So this is our ninth anniversary. We've been so excited that we still exist and we still actually are able to do this work. We work exclusively in the social sector which means all kinds of nonprofits, foundations or government. And we feel so honored to be able to do this work because we found that there was such a paucity of options for those types of clients to find work from designers who are often sort of relegating themselves to this odd phenomena where doing design work for the social sector meant doing like a hackathon or like a nights and weekends type of pro bono effort. And we felt like there needed to be a really concerted effort around how to use design services in a way that was commensurate with the scale of the problem that we're often facing. But what I've found is that actually as we've been doing our work and also as I've been looking further inward to my own training, I started to realize that actually that my own conventional training actually often makes me a bit of a liability in the social sector because so much of our social sector is so much more complex and is based on understanding history. Design tends to be so forward-looking in many cases. We tend not to look back and that can sometimes be a bit of an issue. So I wanted to share a couple of observations but specifically my observation that we've had as a studio around this. The people with the least power often closest to the problem. And in many cases if you're a professional designer you may have been on a sort of life track as I have been where there's a certain amount of insulation that may have actually ordered you from many of the lived experiences that would make being closer to the problem a real benefit. So what we find is that the proximity to problems can often lead to a certain amount of expertise that for me as a designer and many designers I know we often are have those that proximity at arms length or not at all. So we end up using all sorts of proxies but I tend to find that there's this challenge of understanding sort of not only power but also I really understanding the problem at hand with any real lived experience. But when we talk about power and certainly in design we found that there's a real sort of I think a gross misunderstanding of the term. I wanted to share just a little bit of what we've been learning about power as a studio. And this is one of the simplest definitions I could find for the term power since I know I think when people think about power it tends to be sort of described in a very like systems level type of issue like if something happens to global leaders and not to people and interpersonal but actually does. So the simple definition is this the ability to reflect an outcome and if you find that you are able to say things out loud and it happens the way you want it to that might be a measure of your own power. Alternatively, if you've also said things that you wish to be true in the future and it doesn't go your way that might be a measure of how little power you have. The other sort of phenomena that we've noticed along the way is actually how unevenly distributed power is. So has anyone ever been to a meeting or left a meeting and heard about something called power dynamics? Somebody might say, man there was some really weird power dynamics. I haven't found it to be all that instructive to know what you meant other than why that just sounds like a terrible meeting. So I've been using this term asymmetry because I think it describes the imbalance of that term of sort of how power was. And so for when you think about asymmetry we say that often power is lopsided as in like weighted towards one or very few people in the room at the time. Just to kind of make that point a little clearer I've used this triangle here just like I just made a triangle in keynote but if you think about if you've ever started a project then from the very beginning you know you were screwed like you know you're never getting out of this alive that is you at the sharp end of that power asymmetry. I kind of want to make it really clear to folks which means that there is somebody somewhere on the wide end of that symmetry whether you know them or not actually applying pressure to you. So I wanted to talk about some like classical asymmetric power relationships and there are many I could talk about this all day long law enforcement with detainees as we know as we've seen in the last few weeks some of you put enormous pressure on someone's neck from their knee you've seen disastrous results from that type of asymmetry. Doctors and patients, employees and employees funders and grantees, teachers and students landlord to renters local government community leadership in front of my staff even to a degree there's a certain amount of asymmetry all of you have perhaps over the listeners because everyone's giving me their attention. But I wanted to mention something about what we noticed as a studio is that while we were all like, yeah, if I demand because we wanted to be sort of in alignment with those on the right hand side of that asymmetry on that sharp end we actually can't get to do our work without aligning ourselves very much so with those on the wide end. So an awkward realization was how much we need to be further along that spectrum than we thought. So we found ourselves a little awkwardly way over here on that spectrum in a place that I didn't realize or really wanted to admit. So I think it's helpful to recognize that when designers show up they are often done in the service and in some cases the shadow of someone else's power asymmetry which means there's a risk that when we show up and do our work we actually might make things worse. And I think that is a conversation that's critically absent in a lot of designers who are very excited about doing work in the social sector but sometimes when they show up with their post-it notes and sharpies they may not realize actually they may be doing more harm. And just to kind of talk a little more about just how radically different the world is when you have access to power privilege and when you do not I want to share and just do a quick comparison of almost like a table here of four things that happen to humans but are radically different when you have access to it or not. So everybody here I think is familiar with making mistakes I would assume. If you make mistakes and have access to power privilege guess what we call it. We call it a learning opportunity and you can build the entire professional development curriculum around it. I'm sure we know of people who are on professional development learning opportunities right now because they've screwed up something in the past. Now if you do not have access to power privilege we might consider that an inherent character flaw and somehow unsalvageable for individuals who without that type of access like it's something that is somehow bereft which is very, very dangerous. Now let's think about another type of behavior that's common. If you want to seek for a better life for you and your family you might move around the world for that opportunity. For those individuals who have access to power privilege we call them expats. It is almost exclusively a white term which I never would have considered that more recently because I don't think I get seen as an expat despite my British accent. I get seen as this term an immigrant or a refugee. That term is completely different has very different connotations. Even though the behavior is the same the response to those individuals is very different. I hear sort of the sort of lunatic in the White House talking about a response to immigrants or refugees but I think the conversation will be different if we described individuals coming across the border as expats. So let's think about this thing called a crisis. For those who have access to power privilege and you combine the property and addiction we have a name for that response which we call the opioid epidemic something that was enormous but also a huge public health disaster. And we've seen that response to that to be sort of like a wide safety net of responses to say this is out of this community's hands. It's not, it's so big that we can't sort of just blame any individual. Conversely for a community without their access to power privilege, we had a very different response to the confidential poverty and addiction. We called it the war on drugs for many, many years and that response was brutal in its approach. And then lastly, if you compare time when you get used to things going your way time tends to have an expansive quality. You get used to planning things further and further out. Sadly, when you actually are not used to having things going your way you start to discount the value of planning in the future when you start having time be compressed. So I mentioned this to say that the experience of having someone live in the world where they have access to power privilege it practically puts them on a different planet than those who without that access. And unfortunately between the golf between the left hand side and the right side we might end up in a phenomenon where there are some individuals who are trying to save those on the right as opposed to simply really trying to understand them better. So with that, once they thank you that was a very quick sort of slides. I'm going to stop sharing my slides hopefully now if I can exit out of this. Right. And say thanks so much for letting me speak. Oof. Thanks George. Yeah, thank you George. I love that just right before the show you told us that you didn't have anything really prepared and didn't have any slides and then you just gave one of the most amazing presentations. That was awesome. Yeah, I know. I was like oh. I had to have my back closed. Yeah, and I love that term power asymmetry that is so true and especially with the pandemic and being close to it but often feeling powerless and exactly and also the concept of bringing together people who can affect change and people that people have power to. That's definitely a goal of the Health Design Lab is bringing together different people from the medical world, design world, all across collaborating so. And also to think about the experience of the people who are actually the end users and everything so that's like so cool. Thank you so much. It's great to meet you. So I'm going to go ahead and introduce our second breakout room. We again are going to have groups of four to six, five minute period of time. Introduce yourself when you get into the room tell everybody what your name, where you're from, what you do. The prompt for this breakout room is going to be what is the best good news that you've heard since the beginning of the pandemic? Welcome back everybody. That was a great, great room. We had a lot of good news, a lot of optimism that it's very important during this time. I know that we have three extremely cool speakers today. Thank you Aditi, Sheila, George, so much for coming on. We've been really excited about this episode. We actually had way more people sign up this week so I think that's just to say that people were really excited to hear from you guys. I'm going to hand it over to our colleague and my friend, our friend, Christy Shine, who's going to, you guys have known her well from the chat box and she's going to moderate a question and answer session for about five minutes. Great, thank you Morgan. So we had some excellent questions come up in the chat box and a lot of our speakers have graciously already answered some of these questions but for those of you who didn't get a chance to see it, I'm going to repeat some of those questions now and have our speakers answer live. So a question for Sheila. So what were the challenges with patients' perceptions and their level of comfort jumping over to using telehealth? Yeah, great question. I think even on the provider side, there were a lot of myth busters that had to just get busted overnight because we had no option. So I think in that way we were able to connect because patients knew they had to see the doctor, they had a follow up visit. Okay, let me try this telehealth thing once. We did have challenges with older patients needing help with digital connections. They would usually have an advocate, family member or a neighbor that was helping them. But there were a few that after the next, after the first telehealth visit, they just had a preference to be seen in person. They did have a comfort level that seeing the doctor would make them feel better and I found that in maybe less than 10% of patients, but there was still an overwhelming majority that was comfortable with it. But most patients connected first on with a telehealth visit. It's the second visit where they may have wanted to drop out. But in terms of HIPAA compliance, nobody was worried from that perspective that I experienced. Great, thank you, Sheila. And a question for Aditi. So Aditi, how do you think that we can carry forth the urgency that you mentioned that occurred in the COVID-19 pandemic with kind of making our training videos and creating manuals? How do we carry that urgency forward in the setting of the fact that we hope that we see that this eventually tails off? So I honestly think it's going to be coming back around and I think the second time will be a little bit better prepared, which is great. I think this was just a different type of situation because for years we've been trying to get some footing in telehealth and there just wasn't the interest. So it wasn't that we didn't want to do this or this wasn't something we thought of, there was just nobody cared, right? And so then what ended up happening, and this is another part that made my life overwhelming was that people from all over the country were like, oh my God, can you help us? Can you get us help us? Can you tell us what platforms to use? How are you training everybody? How do you get patients to use it? Like how do you make sure you're safe on telemedicine? And I was like, I honestly, I would have loved to help you with this. I've been trying to help and get this to be something, but I had no time for it now. Now, like after the fact, there's like, I feel like we're in the low portion. Now we can do that, right? And so we've been trying to make this a little bit more formalized because there is a lot of that question. And like Dr. Sonny was saying, she was saying that people want to go back to in-person, but they may not, not 100% of people probably go back to in-person. There's going to be that portion of telehealth that's going to have to be there. And so now we can plan that out a little bit better. So that's what we're trying to do. And I think that urgency made it possible for us to create the need. And so now we can think about that in the future. It's like an opposite thing that happened is what my answer is. And what do you think about all of those different people who have come together now? Do you think we'll see networks forming of people interested in telehealth, like banding together? Do you think we'll see individual groups forming? What do you think telehealth looks like for our future? Absolutely. I think it already has happened. There is a network like just everywhere. People's interest is peaked. We're doing it more in our medical school as students here can attest to. I think what's inevitably going to happen is just going to be another way that you're providing healthcare. It's just going to be one of the options. And so if we think of it that way, it's not going to be any different than how we do any other thing, which is what we've been saying for years. And so now it's like the reality. We were forced to do it. Patients now understand it. Physicians understand it better. And so that makes it easier to make it part of healthcare. It's not going to be a hundred percent. We're not looking for that. We're not going to say we're doing virtual medicine forever, but that's just going to be a portion of it. So, yes. Great. Thanks, Abibi. And George, questions for you. How might we shift the power asymmetry that we're seeing now and then sort of a little more controversial? Does the power lie with the people who ultimately pay for design services? Yeah, I mean, I think to a degree it definitely does, but I think that that's why Behooves is so much to that thoroughly the thesis that people are bringing to us as a studio. I often find that there is a real, unless I say a fetishization over certain solutions that a client might come to us with. And what we've been finding as a really early indicator of whether or not this is going to work out is whether or not we can dissuade them of how fixed are they in their idea of what the solution might be and say, are you still open to learning something new from the people you are insulated from? And we find that when we do our design research, we might in some cases actually find that a client very well might be part of the complicit issue and we have to let them know ahead of time. Like it's somewhat predictable that we've found that that to be true. So we say, I don't know if I want to do this project. So like if I found out that I was part of the problem, I'm not sure if I'd really enjoy that. So I would be okay if you didn't want to do this project with us because we kind of have a pain that they have to work with. But if you're willing to find out what is really holding back the people you're trying to serve and that regardless of your implications might be impacted by this change and you're willing to learn, we will be your partner forever. So one of those moments is really at the very beginning as projects are being framed pre-contract before you sign to really assess. And what we find is that there's a destructive quality. You can actually disrupt how pay or symmetry happens when you say no. And I think to date my studio has a reputation now. I think we've had a pressure by 30 breakup emails where before project starts we've been able to turn down things and say I don't want to do this. And like it's not you, it's me. We just can't participate in this project. And that practice, I think of 30 times and because we practice every week going through this gut check with our initial projects that we come through, our studio has a lot of practice, probably more practice than any other that I've ever seen or worked in. And I think that that's the kind of practice that is really slowly missing because you would assume you have to take every project you can. I don't think that that's true. I mean, certainly there is a certain requirement of making money, but if the assumption is you have to make money and then occasionally do good, they think that is a flawed thesis. What we tend to find is that you can have impact if you say resolute on your values and have the money be a function of that work. So and what becomes really troubling is that the more powerful the people you speak to the more likely to have insulation. So in the last few months we've been connected to the Gates Foundation and I mentioned to them as I talked to the US team I'm mentioning how, you know, you guys have so much power, the risk of us screwing up with you is now 10 times worse than it was if we just walked away with a regular client because you have 10 times the impact of anyone else. That is terrifying to me. So I don't know if I really want to have a conversation with you because if you say yes to something and we screw up we might have like nationwide, a real nationwide problem. That is that really haunts me. So I want to be very conscious and explicit about how and when we work with individuals particularly as they get larger because our reputation is growing which means we're getting on the radar of more and more powerful people. And in doing so we have to know that more thoroughly what exactly is the reason behind this? Why do you want to do this project? Why now? And how are we going to become complicit in the impact that this project will have both intentional and unintentional? So I don't have like a power-destructing formula to say but I do know that it really starts at the very beginning to find out what is the rationale behind this project? And then I do, I think our studio's best work but elevating the voices of people with that much power. If we can do that honestly and we can do that with a lot of accuracy and with respect well we can only do it though with those who really want to listen. So we do, I do a lot of my part up front to work out will they listen to new voices? And I think our studio is a very good job of doing that elevation. I think that's also like methodology around doing that disruption of power is power-destructing happens. It's such a great question. I mean, that's a method and we have some practice but it's fraught, absolutely fraught with danger this work. And a question that came up that can be answered by any of our experts today which is how do you think the pandemic has changed the perceived power of physicians? I'm not a doctor and I don't even play one on TV so I'm going to leave this one alone here. I'm going to talk about one specific, oh sorry. Go for it, go for it. I'll speak about it in one specific manner because I think that this is relevant to the whole talk about telemedicine. If you're at home with somebody and we always teach how do you do a physical exam with somebody? How do you get them information? How do you counsel them on what they need to know? And so a lot of times we will engage them in that process like this is how you do, like this is what I'm looking for in an abdominal exam. This is what I'm looking for when you're taking your pulse and counting it out for me. Whatever it is I'm doing to get the information that I need. I think that is, if you're talking about power to some degree because what I'm doing is instead of saying I the doctor have to have that information and do it myself, I am giving you part of that responsibility and power on yourself to be part of your own healthcare. And this is the information that I have that I am going to give to you in this one on counseling on this video. So you have it, so you know what to do and what to look for. I'm not sure if that's like going to over, like I think this is the way that the entire healthcare system is functioning eventually because you realize that, you know, patients do want a little bit more ability to have that flexibility and information. And so I think that in that way that transfers some of that power, that paternalism, patriarchal paternalism power. All right, well, thank you. Thank you, Christy. Those were some great questions. Thank you to all of our panelists and to everybody for being part of such a great discussion. It looks like the hour has gone by too quickly, as always. We're very punctual here on Designing on the Frontline, so we will not keep you past six o'clock. I just want to close it out by telling you you should all join us next week. We have a great group of people next week as well. We have health economist Norma Pardone. Also we have internal medicine doctor and host of the podcast The Nocturnus, one of my favorite podcasts, Emily Silverman. And we have, and actually saw in the audience today, we're very lucky to have with us today and next week, the designer and director of Go and Vote, Yuhan Sona. All right, thank you guys so much. All right, everybody have a good weekend. Take it away. Thank you. Thanks, everybody. Thanks, everybody, bye.