An Immersion in Innovation Culture: Memorial Dives Deep

“Success depends on both what you do and how you do it.”

-Tom Kelley, IDEO General Manager

The Art of Innovation: Lessons in Creativity from IDEO, America's Leading Design Firm

              Memorial Health System has long recognized that equally important to finding new solutions in healthcare is understanding the process that leads to those solutions. Underpinning this theory is the belief that good ideas don't just drop out of the sky at random, but are likely to emerge from a culture which fosters innovative thinking and creativity as a core element of its identity and operations. IDEO, a leading design company, holds this philosophy as the pillar of its work. Known throughout the world, IDEO's consultants have worked on such diverse projects as designing Apple's first computer mouse to reinventing the dressing rooms at Prada's New York store. Perhaps the only thing that rivals the ingenuity of their designs is the way they think of them. Their most riveting “product” can't be held in your hand or touched, as it's the methodology itself behind their designs. And experience is the best approach to understanding it.

In the fall of 2002, IDEO brought that experience to Memorial Hospital and Health System. Contracted to help with the development of the hospital's new Heart and Vascular Center , IDEO consultants began observing the current   hospital environment to find insights into how the Center might be best designed. A series of three two-day gatherings, dubbed “Deep Dives” by IDEO came next. It's primarily from the last of these Deep Dive experiences that the following account is drawn. It's our hope that these insights will be used to replicate elements of the process of innovation in many future Memorial projects and in the very culture of our lives.

A typical Deep Dive is two to three full work days of intense mental production coupled with hands-on building and modeling. A Dive covers all these elements, though some may be emphasized more than others depending on the nature and progress of the group. Central to the Dive experiences are the concepts of observation, brainstorming, and prototyping —activities that contain some of the other steps as transitional and organizing elements.

Observation: How Do Things Work Now? How Do People Experience Them?

“I look deeper and see things I've never seen before…how people really interact with each other.”

-Bev Teegarden, Memorial Health System

Executive Director of Cardiovascular & Critical Care Services.

A large part of IDEO staff's preparation for the Deep Dives was observation. They shadowed heart and vascular patients and doctors; they stayed in a patient room on the current unit one night, and documented life in the hospital through pictures and stakeholder input. “They became a part of our culture for a week,” says Bev Teegarden, Executive Director of Cardiovascular & Critical Care Services. She points to the importance of their fresh vision in identifying important areas of focus in later brainstorming, such as helping patients find their way. “They took pictures of things and saw things we look at every day that we never saw. We never saw that in the parking garage at the thing where you get your ticket, about eight different signs said, ‘push here…push here…push here'—and we look at that every day.”

During the third Deep Dive, as a way to address “wayfinding” in the hospital, participants followed IDEO staff unfamiliar with the hospital as they went on a “scavenger hunt,” looking for certain departments or employees that had been randomly assigned them. Memorial staff, who might know how to find the locations, were forbidden from offering any advice, though they were encouraged to take notes and pictures that might provide insight about what helped and hindered their “hunter's” journey. Groups watched as IDEO staff approached signs looking for department names, only to find that the department they were looking for wasn't listed, or approached employees who were particularly helpful or merely ambivalent. In this way staff “saw” the experience of patients and families entering the hospital from a fresh perspective.

“We believe it's not enough to ask people what they think about a product or idea,” writes Tom Kelley, IDEO general manager, in The Art of Innovation . Though IDEO staff certainly do a lot of asking, they also assume that careful observation can lead to insights that may be different than asking. In his book, Kelley uses the example of restaurant patrons who say the meatloaf is “fine,” even though it may need something else that they can't quite articulate. “Fine” isn't a response that offers design value, and “fine” isn't “excellent” either. In addition, consumers or patients may not know what the specific problem is in a product or experience, only that they didn't like it. To get at why a blind man visiting the hospital had a hard time finding the ninth floor, it might be necessary to observe him getting into the centrally located elevators that only go to the eighth. Observation allows for greater specificity, often identifying the root cause of problems or snafus, rather than simply the fact that such problems exist.

Observation provides opportunities for solutions as well. Kelley writes about the development of Precor's Elliptical Cross-Trainer exercise machine now found in health clubs everywhere to illustrate this point. A man named Larry Miller videotaped his daughter running one day and recognized that the path her feet took as she jogged was elliptical. He began prototyping his idea with the thought that people should be able to make that elliptical motion without the impact of their feet hitting the ground. Similarly, at Memorial's last Deep Dive, one staff member adapted the yard markers on a football field or highway as visual cues on hospital walls that would let a visitor know how close or far they were from where they wanted to be.

A central learning of the Deep Dive experience for Teegarden was in the area of observation. When asked what the Dives taught her, she replies: “The importance of really keeping your eyes open. When I walk down the hall now and I look in the waiting room, I pay attention to the way people are sitting in that waiting room.” She notes what kind of activities families engage in while waiting, and how the room itself facilitates those activities. “I look deeper at it…and I see things I've never seen before…how people really interact with people. It's a totally different level [of observation].” She laughs and adds that her new way of looking isn't limited to her working hours. At a local home store she noticed how employees greeted her “genuinely” as she came in, and how, when several people approached the counter at once, more cashiers came on duty right away. “I never would have noticed that before.” Her point is that models for making people feel comfortable and work efficiently can be found anywhere if we're able to observe them keenly and adapt them to our own environments.

> See Chapter 3 in The Art of Innovation for more on observation.

Brainstorming: How Could Things Work?

“Every big advancement starts with a wild idea…”

-Dan Neufelder

Memorial Hospital , Executive Vice President & Chief Operations Officer

IDEO considers brainstorming an art, and as such it takes practice. A critical part of the Deep Dive, brainstorming isn't something that can be done once and mastered. Sometimes it's better than others, and with constant use new brainstorming skills emerge.

In the third Memorial Deep Dive, participants and IDEO staff had one brainstorm on the first day around questions that included:

•  How will someone know about the Memorial Health System before coming to the heart and cardiovascular center as a patient?

•  What other ways, besides signs, can Memorial signal that certain spaces in the center are used for certain things?

Brainstorming suggestions for the first question incorporated everything from a community mural to the fact that Memorial's cafeteria might be transformed into a first-rate restaurant so appealing people would want to eat there even when they weren't in the building for something else. Or maybe people scheduled for a procedure would receive a welcome bag with a checklist of things they should bring with them, information on their procedure and the medical staff performing it, as well as information about visiting hours they could pass on to family and friends—all before setting foot in the hospital. Participants addressed the issue of designated space by suggesting the use of different lighting or colors. Children, who might not be able to read signs anyway, could know a space was for them by the hopscotch board painted into the floor or the thick, textured carpeting that they could play on. Other ideas abounded—“The floor will make noise!”...In lounge spaces for the center, “all the furniture will have a heart sewn into it!” As each suggestion came up, participants were asked to write it down and draw it on a Post-It note that was then displayed in the front of the room. In under an hour, the group had over a hundred ideas.

Of course not all one hundred of these suggestions may have the same merit. But that's not what brainstorming is about. According to Kelley, brainstorming should be the “idea engine” of a culture. It's a time to think spontaneously and generously, and it should be done again and again. He laments that brainstorming in some circumstances is little more than a buzzword that people don't always take seriously, believing that they've done it once, and once is enough. Yet the practice requires commitment and openness to really work. It helps, as well, to have a few rules. What follows are tips offered by IDEO staff during Memorial's Deep Dive and suggestions culled from Kelley's book.                                                                                                        

Sometimes people come to brainstorming with reluctance about their ability to be “creative,” but Kelley insists that brainstorming can be done by everyone, though it's apparent that some may be better at it than others. Still, even the most artistic brainstormers face a learning curve. According to Kelley, brainstorming is something like exercise. If you want to keep in brainstorming shape, you have to do it regularly. He recommends getting groups of people together frequently to brainstorm around an issue that's been bugging them. Families, friends, co-workers—the theory is that the method pays off for the people who do it most. In this way, brainstorming can become a way of life.

Several participants at Memorial's Deep Dive commented on the benefits they could see from IDEO's brainstorming methods. Many of the brainstorms touched on issues not just specific to the Heart and Vascular Center , but the Memorial system itself. When asked about how some of these broader ideas might later be refined, Dan Neufelder, Executive Vice President & Chief Operations Officer of Memorial Hospital , says, “Every big advancement starts with a wild idea that's thrown out at the wrong place at the wrong time. These are things that you tend to remember and you start to

look for opportunities to make them realities. We've talked a lot about our web strategies…but in some respects, with the role-playing here, we've really developed those ideas more fully in the last two days than we have in hours of information-systems type meetings. I think that everything that you do impacts everything that happens. Nothing ever gets lost.”

Maureen Green, Techno-Wizard of Memorial's HealthWorks! Kids' Museum, says that the staff she works with uses brainstorming all the time, but they could stand to benefit from incorporating the brainstorming rules IDEO staff laid out. She also pointed to the reward of simply getting people who work together to think as a team in different ways, or even just to see each other. Green used to work in the computer room of the hospital, where staff “work very small shifts—a lot of them work by themselves. So, getting them all together on one day could really be helpful…Except for the half hour overlap of shifts, they never really get to talk to each other.” Other employees note the positive outcomes that come from an institution-wide acknowledgement that the kind of creativity prioritized in activities like engaged brainstorming is valued. “Creativity and medicine don't [traditionally] go hand in hand,” says Colleen Sweeney, who also works at HealthWorks!. “But Memorial has just found a way to make it work, to bring it in—and that's what's so refreshing about working here.”

Prototyping

“In a few days you have a gross rendering of what it could be…”

-Beverly McKenna, Program Development Specialist

Overlake Hospital Medical Center

Tom Kelley calls prototyping “the shorthand of innovation.” In Memorial's Deep Dives, prototyping involved putting brainstormed ideas together and “building” or “trying them out.” Participants who brainstormed the reception area of the Heart and Vascular Center actually tested their ideas by cutting up foam board and marking off the children's space they had talked about, the private areas where doctors could talk with a patient's family confidentially, the library or “resource room.” They grabbed a cart from the cafeteria and used it as a stand-in for a “moving store” they had envisioned that could travel throughout the unit offering videos and other amenities. Then the group role-played in the space, staging the entry of a “patient” and her family, assigning participants these roles as well as those of doctors and nurses and other people who might be found in the real Heart and Vascular Center .

As his group prototyped the experience a patient might have from their diagnosis to when they enter the hospital, Neufelder said, “Right now at this stage, it's very intriguing…because you're not sure how this thing is going to come together. It's kind of like controlled chaos…and it's really an explosion of creativity. I'm anxious to see what the next half hour is going to bring.” He describes prototyping as a time when the past brainstorming and experiences of the Deep Dive come together as participants work to make them “reality.” And though the prototypes are little more than found objects and rough, homemade representations of what could be, they do give an impression of the real. “Prototyping shows you, in a very short period of time, whether something is going to work or not,” says Teegarden. In brainstorming, her group had decided to put a children's area in the front of the center's reception. As soon as they begin to prototype, marking off this area with tarp and tables in relation to where the main entrance would be, they saw that the space interfered with the flow of patients and felt awkward. “I think it gave us clear insight into what needs to be iterated,” says Fred Dust of IDEO about the prototyping session, noting that prototyping can be a “working out” period, where ideas are displayed in a context as close to their future use as possible.

At its heart, prototyping is an act of highly visual brainstorming. By making something—whether it be an object of an experience—you can “see” it in a new way. It suddenly appears more tangibly before you, making your goal closer at the same time it elucidates issues that weren't obvious when it was merely just a good idea.

> See Chapter 6 in The Art of Innovation for more on prototyping.

Teams

“We created it. You feel a sense of ownership from that.”

-Judy Cassity, Memorial RN

Cardiac Intermediate Care Center

IDEO places a premium on strong, flexible teams. Kelley points out that the image of a “lone genius,” an eccentric intellect toiling away in isolation, is largely myth. What many people don't realize is that Thomas Edison worked with a fourteen-man team, just as a large group of artisans worked with Michelangelo on the Sistine Chapel. Teams generate more ideas, and have more fun while they're at it. During the two days of the last Deep Dive Memorial staff worked as both a large team and a series of smaller brainstorming teams. The IDEO staff guided the Deep Dive through their collective team resources, a group of roughly five facilitators for each Dive. In chapter five of The Art of Innovation , Kelley describes the characteristics of great teams:

• Dedication to “achieving the end result.” They believe that their work is important.

• They often face a “slightly ridiculous deadline.” Kelley argues that unrealistic time pressure can make a team feel good about getting anything done. It might contribute to a sense of bonding as well.

• Irreverence and lack of hierarchy . They joke and play around to relieve stress. They're all in it together.

• They are well rounded and respectful of their diversity . Individuals of a great team know they were selected for their ability, not “seniority or political skills”—and so is everybody else. They have admiration for their team members.

• They are “empowered to go get whatever else” they need . Great teams know they don't have all the answers, and they're willing to look for them.

Memorial staff involved in the Deep Dive noticed the team element of the experience sharply. They commented on the enthusiasm that came from pulling together from different segments of their “usual” departments and roles to work with each other, the varied IDEO facilitators, and participants from outside the Memorial System. “One thing I like is that there's no hierarchy in this process,” says Neufelder. “There's only creativity, and everyone's idea is equal to everyone else's.” Teegarden admitted to some uneasiness about how her clinical staff might perceive the Dive experience. An affirming component was to see the openness with which they met the process. “That's been refreshing, really good for me to see, and I think good for the staff to see that they can interact with anybody on an equal level…and feel good about it.”

The team mentality of widespread equality contributes to a participant's sense of being important to the project—a critical buy-in. “They [IDEO] guided the process, but it's our own ideas,” says Judy Cassity, an RN who works in the Cardiac Intermediate Care Center . “We created it. You feel a sense of ownership from that.”

Phil Cartwright, an architect from the Troyer Group, a firm hired by Memorial to design the Heart and Vascular Center , says that the Memorial Deep Dives engage staff on a different level than what he's seen in the architectural charettes he's been a part of. “The biggest benefit besides coming up with some really unique ideas is that it [a Deep Dive] generates excitement. There's a lot of personalization. Everyone feels like they're involved—a lot of ownership gets generated that way.”

Ownership was a word that Deep Dive participants mentioned repeatedly. Because everyone's ideas were important and the structure worked to recognize the “group” rather than individuals, there was a clear sense that everybody shaped and took responsibility for the project. This is an outcome of having a great team.

> See Chapter 5 in The Art of Innovation for more on teams.

After IDEO Goes Home

Memorial has always prioritized the learning inherent in an experience along with its outcomes, an approach similar to IDEO's philosophy. As the Deep Dives have unfolded, Memorial leaders—always with an eye for replication—have asked themselves how the process of the sessions could be put to larger use long after the Heart and Vascular Center is complete. “We want to capture the learning,” says Neufelder, who mentions the possibility of adapting processes from the Dives to address other upcoming issues at Memorial. He talks about the elements of the Dives that strike him: the “total immersion” factor of focusing on a project intensely for two to three days at a time, the creativity with which the project is addressed, the inclusive nature of the event.

Other Memorial Deep Dive participants muse about the same question: Could Memorial come up with its own “Dive” experience? “On one hand we can take all the principles and can make them happen,” says Teegarden. “But I think the part that IDEO brings is their broad experience from all these avenues. And no matter what we do…we're still healthcare focused. We still see our world from our own eyes and we look at it everyday.”

Many participants commented on the skills that IDEO facilitators brought to the event, and the way they modeled creativity to help everyone “get” innovation. “The process itself is not hard,” says Beverly McKenna, Program Development Specialist at Overlake Hospital Medical Center , who came to Memorial to experience the Deep Dive. Like Teegarden, she immediately recognizes that certain aspects of the event could easily be incorporated into future projects. “The piece that seems difficult,” she adds, “is those young kids [IDEO facilitators] who have a very innovative side to them, who are creative and can synthesize this information…the way these guys think and push the envelope—that's just so unique.”

Yet, initial hesitations about whether Memorial could “Deep Dive” without IDEO were often overcome. Teegarden points to a specific learning brought to her in the last Dive, in which many of the participants were from outside the Memorial system. She says at first she was a little skeptical about whether the outcome from the Dive would suffer because there weren't more Memorial people involved, particularly clinical staff. Instead, the group was remarkably productive. “What that showed was that we can bring people in from the outside and make them part of this process. I think by the end of the day it was hard to tell who was from Memorial and who wasn't…By the second day, with the prototyping, they were building our project with as much enthusiasm as we were.” This could help with future projects, she suggests. By bringing in people with varied backgrounds to talk about Memorial projects, ideas could gain variety and freshness.

One IDEO facilitator says that simply in having participated in three Dives, Memorial has built up its resources for the future. “I think [the key for other projects] is just involving the people who have taken part in the past Deep Dives,” he says. “They become ambassadors for this way of working…I think people who take part in this process will definitely come away with a good idea of how IDEO works.”

Certainly, Memorial has already taken steps to preserve their insights into the IDEO process. This learning history is one of them. “If someone came to me with a challenge, and I thought we needed to do a Deep Dive on it,” says Neufelder, “we could read the history and address other problems.” Additionally, Memorial's strong record of using the lessons of experience to shape the future speak well for its potential to master the processes of the Deep Dive—in many ways, Memorial already does. New learning from the creation of innovative projects like the HealthWorks! Kids' Museum has already found a place in Memorial culture. And Memorial's efforts to prioritize the building of teams is nothing new. An impressive foundation is already in place to sustain the processes IDEO uses to find and implement innovative solutions

Deep Diving Everyday

The Deep Dives allowed the Memorial community to experience IDEO culture. The challenge remains to continue embracing elements of innovation. For that reason it's vital to focus not just on Deep Dives, but how the principles used in the Dives extrapolate to show us broader lessons about cultivating new ideas.

It's no surprise that IDEO emphasizes healthy environments and work activities. They believe that spaces should reflect the philosophies of their institutions. A place that claims to value hygiene above all else undermines its priorities when it regularly lets the soap dispensers in its bathrooms sit empty. This is an obvious example, but the enormity of possibilities behind such a theory becomes more apparent when IDEO as a company is used to illustrate it. Kelley offers examples of IDEO culture in his book. Because the company wants to de-emphasize hierarchy, there's no system of awarding “senior” members with nicer offices, and people rarely wear “business clothes.” They value design innovation, so employees are encouraged to innovate IDEO's work spaces. As a result, some employees hang their bicycles from the ceilings of their office, set up design exhibits in hallways, cut into wall dividers. IDEO wants to underscore office mobility, as employees move around depending on what team they happen to be a part of at the moment. For that reason, offices parts can be mobile—desks, walls, anything. They even shrink wrap whole bookcases and wheel them down hallways to new locations, so no one ever has to go to the trouble of taking a framed picture or knick knack off their shelf when they relocate. IDEO staff have been known to go out to the movies in the middle in the afternoon, because it fits with their belief that fun is important and ideas come from everywhere.

IDEO prioritizes Culture, Teams, and Methods. In creating healthy office space that staff feel they own, IDEO reinforces a culture of innovation. Their staff of highly talented, diverse people has autonomy, work flexibility, and the tools they need to implement ideas. Their methods reinforce teamwork and creativity, by bringing people together in a casual non-hierarchical to share insights that can be both genius and silly. It's this triumvirate of values that has fostered IDEO's success. Memorial too, prioritizes these things, and in seeing how IDEO works it's likely that the conscious recognition of deliberate Culture, smart Teams, and creative Methods will continue to grow within our own everyday routine.

Few companies are willing to take the kind of risks IDEO has, if indeed that's what they are. Arguably, they could simply be the components required for innovation. In fact, Kelley uses a term that will ring true to the Memorial community— abundance mentality . An abundance mentality coupled with IDEO's challenge to look at both the what and the how of success could be a powerful impetus in moving Memorial even further along in its journey of change.

> See Chapter 7 in The Art of Innovation , as well as examples throughout the book, for more on IDEO culture.

Resources

Kelley, Tom with Jonathan Littman. The Art of Innovation: Lessons in Creativity from IDEO, America's Leading Design Firm . New York : Doubleday, 2001.

IDEO . Home page. 20 Nov. 2002 . IDEO. <http://www.ideo.com/>.