The Mayo Clinic is a place where peo­ple never give up. Noth­ing is really im­pos­si­ble

Dubliner Lorna Ross uses her back­ground in de­sign to help de­velop in­no­va­tive pa­tient-first ser­vices

The Irish Times - Tuesday - Health - - Front Page - In con­ver­sa­tion with Gemma Tip­ton Por­trait Brenda Ftizsi­mons

Igrew up in Dublin and went to NCAD back in the 1980s, and af­ter my de­gree I stayed on to set up a fash­ion com­pany, Fran­cobolli. It seems a long way now from my ca­reer at the Mayo Clinic, but each step has been a cru­cial part of what got me where I am to­day.

The first tran­si­tion for me was when we got to a cer­tain size and had to ex­pand. I went to the bank to try to get a loan, and had the pe­cu­liar ex­pe­ri­ence of them say­ing, “Yes, but you’re not really busi­ness peo­ple,” even though we’d been run­ning the busi­ness for two years. I re­alised we’d never had a busi­ness as­pect to our ed­u­ca­tion, and it was a vi­tal skill.

I got on to the de­sign man­age­ment course at the Royal Col­lege in Lon­don, but it can­celled it that year be­cause there wasn’t enough up­take. The col­lege of­fered me a place on its new ex­per­i­men­tal in­ter­ac­tion de­sign course in­stead. Ini­tially I turned it down as I knew noth­ing about com­put­ers, and I thought it sounded ter­ri­fy­ing, but the of­fer of a full schol­ar­ship helped to per­suade me.

I hated it in the first year. I’d come from fash­ion, us­ing my hands, build­ing things. A lot of the other stu­dents had come from graphic de­sign, and I felt like an id­iot. It was really in­tim­i­dat­ing.

Then, in my sec­ond year, I had a break­through. A vis­it­ing pro­fes­sor gave us the cre­ative brief to re­design the tele­phone. I strug­gled, I had no clue, and we got right down to the dead­line, so I thought: what do I know? And so I went back to cloth­ing. I de­signed a tele­phone as a wear­able glove.

When we came to the cri­tique ses­sion, I was se­cretly hop­ing we’d run out of time be­fore they got to me. When I pre­sented, ev­ery­one was really quiet, but af­ter­wards in the dis­cus­sion, I re­alised that space – the in­ter­sec­tion be­tween what I knew, which was de­sign­ing for the body, and what I was learn­ing – was really ex­cit­ing.

I did my the­sis on wear­able tech­nol­ogy, and was hired by In­ter­val Re­search Corpo- ra­tion, a re­search fa­cil­ity in Palo Alto, con­nected to Me­dia Lab at Mas­sachusetts In­sti­tute of Tech­nol­ogy (MIT), be­fore I’d even grad­u­ated.

It was an in­cred­i­ble time. All th­ese bril­liant, fas­ci­nat­ing peo­ple were in­vent­ing there, real ge­niuses, and there was a con­spic­u­ous com­mit­ment to rad­i­cal ed­u­ca­tion. Sud­denly I was on this ex­tra­or­di­nary team with peo­ple who knew so much about what I didn’t know, yet it was col­lab­o­ra­tion, not one per­son be­ing right or bet­ter.

I was the first de­signer they’d had, and we were all about push­ing what was pos­si­ble, but still think­ing of the end user: about how to help peo­ple live well. I learned a lot from work­ing that way.

Sol­dier equip­ment

Af­ter pre­sent­ing at a con­fer­ence, I was hired by the US Depart­ment of De­fense. It was be­fore Septem­ber 11th, and we were think­ing about the fu­ture, adapt­ing sol­dier equip­ment to po­ten­tial sit­u­a­tions, de­vel­op­ing wear­able tech­nolo­gies for com­mu­ni­ca­tions and en­hanced sit­u­a­tion aware­ness.

I thought, I couldn’t know about the end user un­less I really got to know them, so I spent six months with a Navy Seal unit on ma­noeu­vres in San Diego. It’s a very in­tim­i­dat­ing en­vi­ron­ment, and the most ter­ri­fy­ing ex­pe­ri­ence I’ve ever had.

About three years into that job, my boss was leav­ing, and he thought I should leave too. He said he’d been pro­tect­ing me, and I said, “This is the most fright­en­ing job I’ve ever had, and you say you’ve been pro­tect­ing me?” I’d been so de­ter­mined to be suc­cess­ful in this en­vi­ron­ment, where no one cared about de­sign, but that stub­born­ness made me ef­fec­tive.

The ex­pe­ri­ence has also given me con­fi­dence to per­se­vere de­spite bar­ri­ers. That, and be­ing Ir­ish, and so hav­ing a cer­tain ir­rev­er­ence, have proved in­valu­able and helped me to be suc­cess­ful. I know how to per­sist in things.

I be­lieve de­sign should be part of the con­ver­sa­tions, peo­ple’s ex­pe­ri­ence should be con­sid­ered, and de­sign is fre­quently just not at the ta­ble. That’s why I’m now at the Mayo Clinic, as strate­gic leader in di­rect­ing the dis­cov­ery and im­ple­men­ta­tion of trans­for­ma­tive, user-cen­tric care mod­els; which is a bit of a mouth­ful, but it’s es­sen­tially about de­vel­op­ing pa­tient-first ser­vices, trans­form­ing the sys­tems in which di­ag­no­sis and care take place.

It’s a par­tic­u­lar en­vi­ron­ment, as the ba­sic model of doc­tor-pa­tient con­sul­ta­tion hasn’t changed in al­most 200 years, and com­ing in as a non-sci­en­tist means your role is fre­quently framed as a “ser­vant” to the science. The sys­tem is very in­sti­tu­tion­alised, which is why it’s so use­ful for peo­ple from a non-med­i­cal back­ground to be part of the process. The sci­en­tific em­pha­sis on ev­i­dence and proof also means that change is won through com­pelling ev­i­dence not pas­sion­ate ar­gu­ment.

My day starts early; my nine-year-old isn’t a great morn­ing per­son, and I can’t blame him. I find the whole be­ing-a-kid thing chal­leng­ing when I look at it as an adult. You have to turn up and do what ev­ery­one wants you to do ev­ery day. It’s a big deal, be­cause it doesn’t al­ways make sense to them: it’s kind of like work­ing, you have to turn up and fol­low cer­tain in­sti­tu­tional cul­tural or so­cial rit­u­als.

We’ve been watch­ing The Walk­ing Dead on TV – it’s bril­liant. It’s set af­ter a zom­bie apoc­a­lypse, and in one episode there’s this kid who keeps writ­ing JSS in blood. When we dis­cov­ered it was her mother’s last words to her – “Just Sur­vive Some­how” – we both really loved that. So, as a se­cret joke we have, when I drop him off to school, I say “JSS” as he’s get­ting out of the car. He thinks it’s hi­lar­i­ous.

There is a real dif­fer­ence be­tween be­ing a kid in the US and in Ire­land. I look at my sis­ter’s kids in Dublin, and in the States, ev­ery­thing is an­a­lysed and la­belled, so in some ways they’re try­ing to dodge all that at­ten- tion. When he gets home, I’ll say, “How did you sur­vive to­day?” It keeps things from get­ting too se­ri­ous at nine.

My work­ing day is pretty much 100 per cent meet­ings. We have ac­cess to all the clin­i­cal and ad­min­is­tra­tive groups at the Mayo, so it could be doc­tors, nurses, pa­tients, re­search sci­en­tists or the fi­nan­cial teams. I think what’s really im­por­tant ev­ery day is not to think about the big, over­whelm­ing things. You have to turn up with an at­ti­tude that’s pretty op­ti­mistic.

I’ve just started on a huge project lead­ing the UX de­sign for the elec­tronic-health-record con­ver­sion: es­sen­tially switch­ing the clinic’s record-keep­ing to an en­tirely new sys­tem.

We of­ten use the anal­ogy of fly­ing a 747 plane full of pas­sen­gers and de­cid­ing to change the en­gine mid­flight. It’s the big­gest and most com­plex chal­lenge I have ever faced but I’m work­ing with an amaz­ing team whom I have such re­spect for.

Work­ing at Mayo, I understand that 99 per cent of what makes it work is the peo­ple who show up ev­ery day to make sure the sys­tem does not break. I am in awe of the peo­ple across Mayo and their ca­pac­ity for in­sane lev­els of chaos and un­cer­tainty.

No one walks into the clinic or the hos­pi­tals in the morn­ing know­ing what their day is go­ing to be like. They just know that what­ever hap­pens, they have to make sure they keep peo­ple safe and help them heal.

The things you see, ev­ery day, across Mayo can paral­yse you with sad­ness. How you get un­stuck from that is to fo­cus on all the re­mark­able peo­ple do­ing im­pos­si­ble things with com­pas­sion and grat­i­tude


De­sign is all about trade-offs and adap­ta­tions. It’s the process of making magic hap­pen within a set of con­straints. For ex­am­ple, we had a group work­ing for two years on how to re­duce costs with­out im­pact­ing on pa­tient care; or we might be map­ping the pa­tient jour­ney through the process from dif­fer­ent per­spec­tives, in­clud­ing an an­thro­po­log­i­cal anal­y­sis, to try to see where change is ben­e­fi­cial.

The things you see, ev­ery day, across

Mayo can paral­yse you with sad­ness. How you get un­stuck from that is to fo­cus on all the re­mark­able peo­ple do­ing im­pos­si­ble things with com­pas­sion and grat­i­tude. It’s hard to de­scribe how in­spir­ing that kind of en­vi­ron­ment is for de­sign.

It’s taught me a lot about how to bring op­ti­mism, hu­mour, hu­mil­ity and re­silience to my own work. Mayo is a place where peo­ple never give up. Noth­ing is really im­pos­si­ble or un­solv­able: we just haven’t fig­ured it out yet. I think this is what I love about the spirit of medicine, too: it is re­lent­less in its de­ter­mi­na­tion to understand things.

Obama Care

At the mo­ment there are huge changes in health­care in the US. The in­dus­try is be­ing chal­lenged to evolve it­self to de­liver more mean­ing­ful health out­comes at lower cost for in­di­vid­u­als and com­mu­ni­ties. Obama Care has been the sin­gle most dis­rup­tive thing in health­care in 30-plus years.

No one is quite sure about the long-term im­pact, but the de­gree to which it has chal­lenged many of the es­tab­lished in­dus­try norms is sig­nif­i­cant alone. In essence, it was in­tended to pro­tect the in­di­vid­ual and of­fer more eq­ui­table ac­cess to univer­sal health­care; in re­al­ity it risks be­ing used by em­ploy­ers and in­sur­ers to make ac­cess even harder and more ex­pen­sive by shift­ing the cost to the con­sumer.

Hav­ing our in­dus­try ex­pe­ri­ence this level of dis­rup­tion has been un­com­fort­able for Mayo. The un­cer­tainty of how things will play out nat­u­rally causes a lot of anx­i­ety.

Our job in the Cen­ter for In­no­va­tion is to help Mayo nav­i­gate the tran­si­tions it needs to go through to re­main vi­brant in the mar­ket and ac­ces­si­ble to pa­tients every­where.

My fo­cus is to try to nudge at the in­ter­sec­tions, be­tween the pa­tient and the sys­tem, to look at what’s fea­si­ble. At­ti­tudes mat­ter so much, so you can’t be judg­men­tal. It sounds kind of odd, but we ac­tu­ally have to take a kind of light-hearted ap­proach. We

of­ten talk about feel­ing like cheer­lead­ers, in that we ap­proach really con­found­ing prob­lems as huge op­por­tu­ni­ties. We never change some­thing un­less we make it bet­ter. That is one of our un­writ­ten rules.

So each day I’ll fo­cus on what I can get done that day. And then pick up again tomorrow. It’s like build­ing a scaf­fold: you’ve got the chasm be­tween the cur­rent model and the fu­ture model, and you slowly build a scaf­fold to bridge it. The spe­cial­i­sa­tion in medicine has led to amaz­ing things, but the pa­tient and their ex­pe­ri­ence of the sys­tem has to be brought back to the cen­tre of it.

A lot of in­no­va­tion groups fall into two cat­e­gories. You can have the cen­tre of in­no­va­tion, which was my pre­vi­ous ex­pe­ri­ence, where you work as an iso­lated group to come up with some­thing brand new. But in this case, we’re a cen­tre for in­no­va­tion: we’re em­bed­ded, part of the cul­ture. It may be just trace el­e­ments, but they do mat­ter. Then, when it’s done, we walk away and pre­tend we were never there: like nin­jas. The suc­cess is when oth­ers own the ideas.

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