A year-long co-design program with the Ford Foundation, 3 corporate partners, and IDEO to better center the voices of frontline workers in key company decisions, particularly related to technology. Back in 2020, during the height of the pandemic, the contrast between the public narrative around frontline workers as “essential” and the realities of harmful/undignified working conditions for many.

The Ford Foundation approached IDEO with the question of how far companies would voluntarily go to embrace the idea that what’s good for worker wellbeing is also good for business outcomes.

To explore that question, we formed a cohort with three partners: a health system, a port authority and an airline company, to go on a 12-month learning journey. This journey involved forming worker councils both across and within the three companies, where workers led the design of digital and org prototypes that addressed real operational challenges. Unsurprisingly, it was clear that when workers solve workplace issues, both workers and customers benefit.Throughout the year, we regularly convened the companies to reflect on their experiences and learnings together :pill::station::airplane:. And at the end, we synthesized the year’s learnings, tools, and stories into a public storytelling website intended to invite other corporate leaders to go on their own worker voice journey: workervoicedesignlab

In healthcare systems, a priority is to provide high-value and cost-effective medical care, including an infrastructure to ensure seamless and cohesive care coordination for patients.

The patient volume at San Francisco Health Network (SFHN), especially in the ED, has steadily increasing.

This may be due to poor access to care, patients going to an inappropriate level of care compared to their low-acuity medical needs, and under-utilizing of other available care such as the nurse advice line and urgent care.  Some of this may be attributed to disjointed care coordination, especially for our most vulnerable populations, including non-English speaking, marginalized and jail populations. Frequently, our patients will state that they came to the ED because they did not know if they have insurance or who is their assigned primary care doctor.  Other times, patients will present to the ED after missing their follow-up due to confusion about how to contact their clinic or they did know that for minor complaints, they can call our nurse advice line or go to our urgent care. Furthermore, while the ED is responsible for acute care management, providers frequently find themselves spending a bulk of their clinical time facilitating the next steps for patients once they are discharged. Many of our providers lack the tools and knowledge about how SFHN operates, as well as other SF social services available that would aid in better transitions to the ambulatory setting.

Given the complexity of SFHN system with multiple independent care centers, we having several projects building a comprehensive care coordination system that gets ED patients to their follow-up, improve rate of no-show appointments and reduce costly and redundant ED bounce-backs . The primary goals include using low and high fidelity tools and health implementation science methodologies to  1)Improve education and health system literacy, and 2)Create coordinated patient flow and provider communication systems. By building systems that are cohesive, we can minimize fragmented care and improve the patient’s experience navigating our health system.. We have many cross-functional collaborations and partnerships with different stakeholders and departments throughout the entire SFHN network and San Francisco Department of Health.

The Waiting Room Project (WRP)  is an opportunity to harness technology to not just educate, but actively engage patients during a time that commonly is just spent waiting many hours for ED care at Zuckerberg San Francisco General Hospital. Patients are no longer just passive listeners, but collaborative participants in improving their health. This project fuses implementation science and innovation to improve care coordination across multiple departments, by engaging all users from the acute ED setting to the ambulatory setting. Our goal is to integrate into the ED workflow, a patient-driven tool that increases access to care, enhances patient experience and improves health system literacy. 

An initial prototype can be seen here:

www.sfwaitingroom.com

I came up with this idea because as a medical provider, I was having difficult time understanding the complexity of our health system. If I didn't know how to help my patients get to the next step of their care, I couldn't expect from my patients to figure out how to navigate it on their own. 

Currently, the WRP is only a one-way tool where patients drive what they want to learn, but eventually we want to incorporate holistic engagement.  We can engage our patients by addressing not just their medical needs, but also their social, insurance and health literacy needs through responsive and interactive tools such as the WRP. Recognizing our diverse population needs at a county, safety-net hospital, we will employ interactive, advanced two-way features to notify providers which additional post-ED visit services are needed and equip providers to assist. If patient is looking for alcohol cessation, the tool can notify the social worker to begin those discussions. If a patient comes for low-acuity complaint, we can show them how to get a primary care appointment in the future. We can provide discharge instructions in different languages or show videos that explains how to self-care (eg. wound care, hypertension reduction). We want to provide a virtual child life specialist and build an informed consent section for commonly done procedures. 

 Patients come to the ED for all different types of needs. We should embrace these opportunities to help direct patients to the right place and right care.  The WRP is building our health system’s capacity to help patient drive their discharge care experience, connect the dots and navigate our complex health system, and unify a holistic team to help solve what patients need most and get them to the next step of their care.

I am the Innovation and Design Lead at UCSF's Acute Care Innovation Center. Through the emergency department and the hub of acute care,  we are creating private-public partnerships with design and engineering groups, to bring innovative ideas to test and iterate them in our robust, integrated and unique Acute Care Test Bed and among our diverse high-volume patient population. We are a robust clinical, research and policy team that includes expert advisors in various fields including Health Systems Design, Global Health, Pediatrics,  Emergency Medical Services (EMS) , Trauma Care, and Medical Education, that will collaborate other sectors to create creative and evidence-based solutions that target the gaps in San Francisco,  national and global healthcare systems. 

If you like to learn more, check out acutecare.ucsf.edu.

During residency, I approached Dr. Michelle Lin (my mentor and creator of the blog, Academic Life of Emergency Medicine  (ALiEM)), about creating a series of articles focusing on the practice of pediatric-specific emergency medicine. In partnership with pediatric emergency medicine specialists Drs. blah blah, we’ve created a simple and easy-to-use resource for emergency medicine providers (eg. physicians, nurses, and paramedics)  around the world. As the Editor-in-Chief of PEM Pearls, I have built a team of editors and collaborators to peer-review and curate the material.  I’ve also am using the opportunity to experiment with different educational media including video, illustrations and animation. I also help other physicians be more creative with the type of media they use to get across their information.  Below are a few examples I worked on as the editor-in-chief and as a contributor.

As a medical provider, my main focus is about providing the best medical care for patient. At the same time, understanding the greater context in which patient decisions interplay with history, race,  socioeconomic determinants and structural inequalities,  helps me realize the complexity of providing good and equal healthcare and empathy at an individual and population level. 

In my residency, I wanted to create a health policy curriculum. At UCSF, I am afforded the opportunity to meet some of the top policy and health system movers and shakers. I have started a resident-led lecture series on a variety of different topics that affect emergency medicine and our patient population.  Some of the topics that we have talked about include the Affordable Care Act and health reform, Cost and Waste in Medicine, Gun Violence and Homelessness in San Francisco. 

We hope to continue integrating more health policy talks into our curriculum and create discussion for how we can be better doctors and nudge change for better healthcare for all.