There's an inherent tension in introducing a highly creative process into a highly complex system. When it works, that tension resolves into a harmony with a sum greater than its parts. When it's discordant the results feel like chaos.

For the last year, we've undertaken a huge challenge: create the largest rollout of human-centered innovation in any hospital, ever. Our organization charged every leader -from nurse managers to C-suite executives -with identifying, running and sharing two human-centered design based innovation projects. In addition to training and coaching those leaders, we still had several large-scale, patient-facing projects on our plate. The volume of work alone forced our innovation team to go headfirst into rethinking how to systematize a process which is normally characterized by non-linear paths, creative doubling back and a general whimsy. We've come to know these axioms as Hub Rules.

We wanted a way to give people, including our own team, guard rails; operating guidelines for the work. But we didn't want the rules to be so constraining they'd stifle the work itself. We wanted sign posts that a traveler would fine encouraging, not daunting. The rules themselves needed to feel optimistic, intuitive, and even slightly disruptive.


Rule 1:
Empower Everyone

democratize design!

Rule 1: empower everyone: let's face it, even the word innovation is loaded. To some it means iPhones and to others it's just a rebranding of strategy. If you're an incumbent player in a space, like a radiology tech who's worked their whole career in known model, innovation may sound like code for being obsoleted. We couldn't have that, not if we need people to want to come to this work. Empowering everyone is all about making the process open, easy, clear and accessible. We heeded Empower Everyone when we created our simplified process and tools: Listen, Imagine, Do.

We changed our language to make innovation feel normal, like things anyone would do every day; we just put those things in a purposeful order. It also means going to the gemba, or going to where the work is. It's more empowering for a coach and supplies to go to a nursing station than ask nurses to leave their post and come to our studio.


Rule 2



always be designing!

Rule 2: always be designing: It goes like this: "so we're ready to hire the coder/videographer/doctor/whomever, right?" Well, maybe not so fast. Do we know the script for the video? Have we tested it? Can we make a prototype film with a smart phone? Can we mock up the app in PowerPoint first and get people to test it? If we haven't exhausted our opportunities to get input and feedback from users, then let's keep designing. This might sound counter intuitive to those of us who believe in the always be shipping mantra of the startup world. If we keep designing, are we chasing perfect instead of accepting good? The key here is to recognize that the process of iterating ideas and prototypes still produces impact! If a team of mid-level managers creates a pretty good iPhone video as a prototype, they can get it deployed as a test so much faster than hiring a video company. And when they want to make a change, it's a 15 minute effort, not months of work and dollars spent. ABD also means we inculcate the notion that a good design is never finished, it's only getting better.

Rule 3:
Solve Within Arm's Reach

(or how we learned to always go smaller)

Rule 3: solve within arms reach: If there were one rule to rule them all, this would be it! We've all tried to boil the ocean -those projects where in the first meeting we've already identified 20 contingencies and resource needs. If a nurse comes and says I want to redesign discharge for our hospital, which executive wouldn't embrace that energy with open arms? So the nurse tries. Before he gets started, someone else takes them aside and suggests who else they need to include in the project. After 3 months of trying to align the schedules of 15 people, the meeting happens. Some know immediately what must be done. Others don't know why they are there. And somewhere, someone is running it up the flagpole that they weren't included. We should probably meet again, right? Maybe monthly? And so the discharge committee gets formed. People debate best practices, egos get bruised, and the courageous nurse who stared the project feels more defeated than if he'd never bothered at all.

Solve Within Arms Reach is all about short-circuiting that. To that nurse we say: "awesome! Let's get started. What part of the discharge process can you work on first? Which part can you and maybe a small team affect on your own?" Often, it turns out, that scope is pretty small. It might be constrained to reimagining the last sentences you say to someone going home. But we can work on that! We can get started today! We can make an impact on that and tell the story and get others doing it too. That's how innovation spreads. That's how we go to scale!

SWAR has another benefit. People do and make quickly. And that's something we don't get to do enough in this modern life. It feeds the soul and makes us feel productive. Who wouldn't rather go home and say: "today, I started doing discharges differently"? That's so much more rewarding than: "we had our monthly discharge project meeting today..."


Rule 4
Run Towards

The Challenge

because it CAN be solved!

Rule 4: Run Towards the Challenge: One of my dad's favorite lines is action conquers fear. What happens we we see a challenge and run headlong towards it, believing it can be solved? Too often, in corporate settings, we start by failing to start. We have meetings, we study the problem, we debate who has the right to work on it, who can work on it and what the solution must be. Some of the best innovators I know flip that it's head. The early pioneers in the United States Digital Service and early Presidential Innovation Fellows speak about this often. These were some of the brightest folks culled from Silicone Valley. They came with the mindset it's easier to start tackling a problem when you run towards it head on. We've borrow that energy and encourage our colleagues to do the same.

Running towards is all about optimism. Think about every action movie where the heroine is outrunning imminent danger. She gets to a chasom, the metal airlock door slowly sealing itself on the other side. What to they do? They taking a running start, leap across and know the rebells will have cracked the code, opening the door on the other side by the time they've gotten there. Whew!

Rule 5
Design With,

Not For

together is always better

Rule 5: Design With, Not For: perhaps no other industry is as plagued by paternalism as healthcare. We have a culture of doing for, not with. But for innovations to take hold, they have to be things we all feel good about and see value in. There's nothjng more empowering than involving people. When we have a team of patients, innovators, doctors and administrators, all on equal footing, all participating in creating the solution, it's unlike anything else. It completely obliterates the need to sell ideas and concepts back to someone. No groups feel left out. No one feels like they have to paint the barn shed.

These, like all rules, should be questioned. They should be bent, and broken and reformed. And if they are as helpful to you as they have been to us, then pass them along.