This interdisciplinary course focuses on sustainable innovation, introducing entrepreneurial students to the realities of problem identification and solution design within the complex world of healthcare.
Week 2 Concluding Conversation
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Del curso dictado por Duke University
Healthcare Innovation and Entrepreneurship
84 calificaciones
De la lección
Finding What's Needed
What are the key elements of disease fundamentals? What are our treatment options? What is the most objective method to observe and document the disease process? Can treatment methods be understood through process improvement?
Conoce a los instructores
Marilyn M. Lombardi, Ph.D.Associate Clinical Professor
School of Nursing
Bob Barnes, PhDInstructor
Biomedical Engineering
Ladies and gentlemen, we started out with a lot of you last week.
I hope that there are a lot of you still here.
We'll see. This is Bob Barnes on behalf of myself
and Marilyn Lombardi and we're here talking about healthcare innovation
entrepreneurship in week two. And looking at my notes here it says that
we've been covering. Finding what's needed this past week.
And one of things that Dr Lombardi covered had to do with ethnography and
immersion. So I want to turn to her and ask her, you
know, out of all the things we talk about in terms of ethnography and immersion,
what's the most important thing that one can do?
To ensure you actually see what maybe no one has seen before.
And, through similar si-, situations.
>> Well, we, we emphasized when, when I was talking about it, I emphasized the fact
that you have to, as far as possible, be able to see from the point of a very,
very wide range of participants. So it's your job, now I don't believe
neutrality is possible, but it, it's your job to be aware of the assumptions that
you bring into the room. And to calculate with those in mind,
while placing yourself in the position of the patient the, the, the various.
professional health care workers who were involved in that care, and the way the
episode you're watching right now relates to the full continuum of care that that
patient experiences throughout the, the day, whatever the clinical environment.
So that's an interesting one. Because a lot of people tend to watch a
particular intervention.
>> Now, let me interrupt you there.
>> Yeah.
>> You said a lot of people and when we look at, the, the last time I looked 25,000
plus people that were originally signed up for this.
>> huh.
>> I don't think all of them are engineers
or entrepreneurs or English majors.
>> But they're interested.
>> But are, hopefully they're interested.
>> Yeah.
>> And they all come from different different backgrounds.
>> Mm-hm.
>> And you had some interesting things to
say about engineers and our perspective on life.
I mean, how, how is this, how does somebody come into this and leave their
career, their profession. The thing that they put their culture
behind actually observed. Is that possible?
>> To leave your disciplinary background and
your, your prejudices and assumptions and frameworks behind you.
>> I don't have prejudices.
>> None?
>> Yeah.
>> So, the, the, you can't leave that behind
you but in writing your thick descriptions, we talked about this, which
comes from the, the social science of ethnography.
In, in writing those thick descriptions, you're looking for ways of superimposing
the frameworks that you're comfortable with on to the environment, the new
environment, the unfamiliar context you are seeing.
And so long as you are foregrounding the fact that you come with presumptions into
the environment then at least you can, protect your ideas from that
contamination. Or, you know, use it, leverage that
contamination.
>> One of the things that I, I've said to my students, and it just drives them nuts
when I do this.
>> Mm-hm.
>> I say write down everything in your relation notebook.
>> Right, right.
>> I want to take that a step further.
One of my students which I'm really particularly pleased with.
>> Observe that the two doctors she was
observing took a break during the off, during the operation.
>> Mm-hm.
>> And she actually recorded the brand of
Greek yogurt they were eating, and the size of the container.
>> Mm-hm.
>> Has she actually timed the period of when
they started eating and when they finished.
And I complimented her on that amount of detail.
>> Right, mm-hm.
>> So, that's the level of detail we're
talking about.
>> For me that is. Some people would say, well, that doesn't
have any content.
>> You don't know yet.
>> I think you're right.
>> You don't know at the, at the, while being, well, you're in a very interesting
position. Think of it as Parallax.
You are both a participant and an observer.
And you have to be very aware at the same time that your presence as an observer,
and this is something endemic to anthropology, your presence as an
observer is going to shift and may shift the events themselves.
>> Right.
>> Right.
So, there's no telling what will be important and what won't be important in
the aftermath. Write down everything.
Write down lengths of time in particular because this might be a process
improvement that you're going to come up with.
And so these are the dimensions, you worry about space, time, etc.
>> One, one of the things that came from
this very one was that we can solve the problem.
>> Mm-hm.
>> But I can't imagine.
>> What was the problem?
>> What, what was the basic need?
>> Yeah.
>> because when the two surgeons stopped to
eat. It was a six hour surgery.
>> Right.
>> And what people don't realize, I think,
until they've actually been in the moment.
That is in the environment. You're bending over working with a
patient for a long period of time. You get hungry.
You get thirsty.
>> Mm-hm.
>> You have other biological functions that have to be taken care of.
>> Right.
>> You wouldn't know about that if you read
a book.
>> You have to observe it. But then we were talking just now, and
you were saying but that's an episode.
>> Mm-hm.
>> In the ongoing saga of continuous care.
>> Right.
>> And so what's the problem? I remember we talked about this.
What's the problem of having one of our students sign up to observe surgery that
day? And leave it's done.
What perspective have they followed, have they captured?
And what perspectives may they have missed?
>> and I think what we strive for.
And this is the reason we call it finding what's needed.
>> Mm-hm.
>> Not finding the solution.
>> Mm-hm.
>> Is until you watch you don't truly see
where the need is. And let's talk about different kinds of
needs or different aspects of need. And there were three you and I talked
about. Episodic, patient centered and what I
recall more population or epidemiological, in terms of the way we
think about these.
>> Right. Good.
Yeah. In terms of an episodic event or an
episodic need, we may indeed see a surgeon that we may, or for that matter a
nurse practitioner. We see that by changing certain things,
either procedures or giving them certain tools, we could reduce their time.
>> To one half.
They may see that as a success in terms of need.
>> From their perspective, it is.
>> To be able to process more people through
an environment that we otherwise went through, the operating rooms or the
primary care, so it's episodic. From the patients' perspective, they
don't get any Improve mobility, they don't get any improved mortality, their
family doesn't see anything different.
>> In this scenario.
>> In this particular scenario. But the episode is a success because we
cut the time in half. The patient in terms of their quality
doesn't change. but when we look at a patient
perspective.
>> Mm-hm.
>> The operation may take longer, the procedure may take longer, and the
physician or the care giver see that as something negative.
>> Hm.
>> But if the patient realizes higher
quality of life, more mobility.
>> So how do you prioritize the two needs?
>> And the story is, that is not necessarily our job as innovators and entrepreneurs.
Our job is to see that there's an improvement and how can we best
facilitate, facilitate that Info.
>> Okay.
>> Now, later when we talk about marketing.
>> Mm-hm. [LAUGH] Yes.
>> We will see lots of opportunities for
improvement.
>> Mm-hm.
>> But the question is, will anybody want it?
Is the market large enough to support what we want to do?
>> Absolutely.
>> And before anybody gets too excited about
thinking about profits and loss. Remember that we're talking about
improvement. And we're going to talk some more about
sustainability. And we're going to talk some more about
return. And sometimes, return may be simply
within a hospital. Not changing anything about money.
>> Mm-hm.
>> But changing how efficient we can be.
>> Mm-hm, mm-hm.
>> That may translate money at some point.
Now, when we look at epidemiologically, there's a whole population wise.
No one patient may get any better or any higher quality service than they were
before.
>> Mm-hm.
>> But rather than being able to treat 50,000 in a year, perhaps we'll be able
to treat 75,000 patients. So success is important for the
entrepreneur the innovator to be able to define that and understand how they are
going to address it from a marketing perspective, and we'll talk about that.
>> Right, and we'll talk about that later.
>> Absolutely.
>> And so to wrap up what we've accomplished
this week and needs finding, we've really laid down the importance of observation.
And of course that depends on access and so that's, that's going to vary across
the group of students that we have here in Coursera.
So what you need to do is gain some kind of access, if you go in as a patient to a
clinical environment, make sure you are conscious.
And, perhaps carrying a notebook of what your impressions are of the, the
experience. So having said that we're going to move
on next time to talk a bit more about the marketing implications of coming up with
that unmet need. And deciding whether that need should be
prioritized above all others. Thank you very much.
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