S7 EP 9: Richard Macliver, Summer Series

Richard is a problem solver and healthcare innovation specialist who utilises his skills in human-centered design within the health sector with impressive results. 

If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the AHDC podcast series Health Design on the Go.

[00:00:21] I'm your host, David Cummins, and today we're speaking to Richard Macliver, who is a healthcare innovation specialist at his core, Richard is a problem solver. 

[00:00:29] He utilises his skills in human-centered design, communication, and health technology to understand complex problems and digital solutions that improve the experience and outcomes of clinicians and patients.

[00:00:42] Richard is currently the lead of the Australian Clinical Entrepreneur Program and is the product and strategy lead for Curve Tomorrow. We look forward to speaking to Richard as part of our innovation and technology series. 

[00:00:53] Welcome, Richard. Thank you for your time to be here. 

[00:00:55] Richard Macliver: Thanks David. Thanks for having me.

[00:00:56] That's a pretty good title and pretty good introduction. What is Curve Tomorrow? 

[00:01:00] Curve Tomorrow is a web development house that really specialises in digital health technology. So we service a lot of different healthcare clients ranging from government to the startup companies, to large companies, helping them build digital health applications, from idea all the way through to commercialisation. 

[00:01:20] David Cummins: That's pretty good. So that obviously helps with your innovation. Where did you get this love and passion and ideas for problem solving in the world of innovation for healthcare? Because it's such a complex beast and innovation and design thinking makes for so much sense. I just answered my own question, but would that be about right. You saw a niche and the benefits of design innovation tools? 

[00:01:41] Richard Macliver: Yeah, absolutely. When I actually first started out my career, I actually started out in a startup just purely by accident, which was based between London and also Perth in Western Australia, tackling the type two diabetes problem, which is obviously a rather large challenge to solve. And, through that I had a very narrow lens at the time around direct to consumer changes within healthcare.

[00:02:06] But as I got more and more and more involved in the healthcare landscape, I started to see the real complexities that was around primary care, tertiary care, the importance of why some of those systems aren't talking to each other. 

[00:02:20] And I got very curious as why that was happening. But then when I really started to get the Innovation Bug, well more innovation in terms of actually understood what innovation actually kind of was and all those types of things.

[00:02:33] A lot of buzzwords and a lot of different definitions for it was bio design. So Biodesign Australia, I started to really understand. Bit more structured thinking around that, so I did that. Really started to understand and delved really deep into that space and really started to go with the corporate side, the startup side, government side.

[00:02:54] I had a bit of experience across that, but that fundamental understanding of design thinking and thinking about the problem that needs to be solved was always at the core of what I've been doing today. 

[00:03:05] David Cummins: For those out there who don't understand what design thinking is and the power of design thinking, do you mind just explaining in a nutshell what design thinking is?

[00:03:13] Richard Macliver: Yeah, of course. So design thinking, probably a very common term you hear that gets thrown around a lot, started really getting very popularised. IDEO is a design firm in the US in California, and it really is a process where you put the problem that needs to be solved right at the heart of it and to try to take as much bias in terms of the solution away from how you need to solve it.

[00:03:38] So for example, empathising is how it starts, so really getting into the weeds and immersing yourself into the problem and talking to users, those types of things. And you get a lot of different problems that'll arise from that or potential causes of that problem.

[00:03:54] Then you start to define what that problem is. So really starting to hone in to which of those causes you want to solve. Then you start to, what we call 'Ideate'. So really flexing your creative muscle, think about all the potential ways that you could really solve that problem and taking away any limitation at all on how you can actually solve that problem. 

[00:04:17] And then you start to apply filters to make it more realistic, budgets and human capability, technology capability, et cetera. And then we go through this iterative process of prototyping. So start with really basic things that are very cheap to make. Things like paper and chalk, cardboard, et cetera, et cetera.

[00:04:37] And continuously test that. With an end user and see what their responses are and continuously go through that cycle until you end up with a finished product is basically the rough definition of it. 

[00:04:50] David Cummins: Yeah. The way I was taught is 90% planning, 10% execution and predominantly basing it around what is the problem we're trying to solve.

[00:04:58] And certainly in healthcare there is a lot of problems. So at what stage do you come into the construction and design process of new or existing buildings. At what stage do you come in and what do you actually do to help? 

[00:05:12] Richard Macliver: Yes, so through various roles I've been involved in helping with more service redesign or they believe that they need to build something to solve a problem.

[00:05:23] So sometimes it can be hard to come in at that point to actually go, "can we take a few steps back"? And depending on the leader that's a part of that project or whatever it is, they might be a bit more receptive to take a couple of steps back. But then others might not want to hear about it.

[00:05:39] But those that are really open to it or they know that they just have a problem that they need to solve and very open to how they solve it. When it comes to the construction, and you know how you are building physical healthcare structures. When you look at it from the emphasis stage and when I've been involved right at the very start, it has been just trying to emphasise with who the end users really are.

[00:06:06] So, for example, if we were building a new mental health service, like the physical layout of what that would need to look like and really understanding who your target customer is. So I've done some quite a bit of work with the children's hospitals and trying to talk to the pediatricians, the social workers, those types of people around, what are their current problems that they're having with the current space that they're in.

[00:06:36] And then doing the same with the children and really starting to define and listing those types of things out and trying to ideate and see what all the potential solutions could be. Now there's a bit of, I believe, a bit of misconception, especially in physical creation of space.

[00:06:53] And of actual healthcare infrastructure is that you can't prototype these such things. These are very much set and forget, but there's a lot of really interesting things that you can do to actually test really what I call 'low fidelity'. So things that aren't expensive, things are very cheap, like cardboard, those types of things with with end users.

[00:07:16] There's an awesome video on YouTube that, from the McDonald's movie where they've just literally gotten chalk and put it onto a basketball court and recreated what the the cooking rooms looked like at McDonald's and just ran simulation after simulation to see how people interacted with space and where people started bumping into each other.

[00:07:40] Those types of things because McDonald's, was really around how quickly they could get burgers and food and all those types of things out to the customer. It was really important, and we can do the same for that in healthcare, when it permits us obviously, but just in the design of space, you could actually do a lot of those types of things.

[00:07:58] Utilising cardboard, utilising iPads and the like for the technology pieces, you actually start to identify from the prototyping phase, what some of those problems are before you make concrete plans to invest large sums of money into things you can't change. 

[00:08:18] If a medical gas point was in the wrong spot, it's a lot more expensive to rip it out of the wall and redo the whole room versus.

[00:08:28] You've got a chalk and there's the medical gas point there and the surgeon goes to turn to his or her right and go, oh, there should be this machine here, otherwise gotta walk all the way across the room and that's going to add to our time. So those are the types of examples where I've worked in that space and utilising design think to help iron out some of those kinks a lot earlier, and it's a lot easier to do so. 

[00:08:55] David Cummins: You obviously work in conjunction with the architect and the users, so are you part of that user group briefing or are you separate to the user groups? Where do you actually fit in as part of that stakeholder engagement?

[00:09:07] Richard Macliver: Yeah, so when I've been involved in the past, it's more around the setup of the project and how they can actually deliver the project. So I would just be a sub user of the whole thing. I wouldn't be the project manager or anything like that. I'd just be another voice in the larger collective.

[00:09:28] David Cummins: Yeah, that makes sense. So as you've just correctly identified, the more problems you identify and solve in the design phase, the cheaper it is versus the problems you find at the end of the project. 

[00:09:38] What are some of the resistance that you face to try and get you on a project? because it totally makes sense, but I must admit, in 12 years of doing this, I haven't actually engaged anyone for design thinking.

[00:09:48] What are those, some of those barriers and how do we overcome them to try and bring you on the journey? 

[00:09:52] Richard Macliver: There's two things. One's an education bit, it's just seen as this additional fluffy thing that not a lot of people see any value in, especially when it comes to physical layout and design of pretty much a well-established industry, like in construction of hospitals and those types of things. That's number one. 

[00:10:14] And I'll get into how we could potentially solve that in a second, but number two it's just the way that healthcare funding kind of works. And this is the same with software development. You've gotta develop a budget, right? And the budget is done right at the start.

[00:10:29] And you kind of have to define everything right at the start, where everything needs to go, what materials you need et cetera, et cetera. And that's come the way it works in government world and most other places as well. And the development of agile delivery or utilising design thinking principles doesn't fit into that construct.

[00:10:55] It's very much a waterfall. This is what we need, this is how we're going to do it, and then it gets built. And this is the timeline to do so. And there's no leniency on that because it's scary for either a CFO or for anyone managing the project to have timelines that aren't concrete.

[00:11:14] So how do we solve some of those problems? The first one around education is actually targeting people like architects, like decision makers in the infrastructure teams and educating them on the importance of design thinking and how that can actually be used and use cases of how it's happened within their industry and within their type of organisation.

[00:11:37] So for a government organisation building a new service or a new wing, how that has actually worked for them practically. Then when it comes to either procurement or budgeting. That is a really challenging issue that exists within, and I don't believe that it really has been solved. It takes really strong leadership to be able to set, "okay, this is the amount of funds that we believe are needed (based on previous projects) that are needed to solve this problem". 

[00:12:10] And you draw from that amount of money as you are going through the design thinking process. And it might end up being cheaper, a lot cheaper than what you initially thought it would be. Or it could be more expensive as well. 

[00:12:26] And that is probably the area of in design thinking, especially in the government world, that needs to be thought through a lot more and more pathways to actually develop them..

[00:12:38] David Cummins: Yeah, it's interesting because banks and big corporates and Google and Apple have been using design thinking for years, but health is certainly behind the times in reference to design thinking, I would say when you look at Apple with their iPhone. 

[00:12:52] They did design thinking for years and the same thing with McDonald's. So it is something that, people have been using for years but I do think, and I do see it happening a lot more in health in the future. 

[00:13:03] So what would you like to see happen for us as an industry? There's a lot of designers listening construction developers government officials so what would you like to see help us in the us in the future in reference to design thinking, what would you like to see change? 

[00:13:16] Richard Macliver: The changes that I'd love to see, which is more interaction earlier on with the end users. That would be a really great first start and actually involving them in every single step of the process and consistently seeking their voice and testing things.

[00:13:36] To identify whether it would work for them or not, and not just going to the same types of people every single time. Typically, the loudest voice in a healthcare organisation is consulted to appease them. 

[00:13:49] And what would be fantastic to see is those that do still need to use the space that are very important, active users of having a voice, testing it and then having people that know how to disseminate the knowledge that they've gathered from those experiments that they're running and actually allow for the flexibility to change plans. 

[00:14:13] Not so much that you're going to change once things have been set in terms of a budget, but around helping shape the budget of things.

[00:14:21] So trying to collect as much information as before making any concrete changes to that because one I believe you're going to get a lot of healthcare savings by doing that process because you're actually going to identify what is actually the best way of doing things and reducing waste and making things more efficient.

[00:14:42] But also you're going to get a much better patient experience, I believe when you involve them and allow them to test things, get feedback, make adjustments to that, but then also far better clinician experience. 

[00:14:55] They're being heard, they're being listened to, they don't want to walk up and down five flights of stairs to grab x then to come back up. All these things add up to time wastage within the system when you are actually building it. 

[00:15:10] And the construction companies, the designers, the architects, the exec team, although anyone involved in that project, if they where to use those processes and those principles from the start to the finish, that would be fantastic. And that those are things I'd love to be able to see. 

[00:15:28] David Cummins: Yeah, it's really interesting, especially when you see what's happening in the future where there's going to be more patients than ever in the next 10 years, there's going to be minimal beds to deal with the supplier but also less staff.

[00:15:40] So for people to incorporate design thinking principles, to have a human centered design benefit for staff, patients and community, it completely makes sense. 

[00:15:49] Just before we go, what would be the take home message for you knowing that there's so many designers out there who are listening should everyone be doing a design- thinking course or should we engage a design thinking specialist? What can we do to try and help improve clinical outcomes for patients and also staff? 

[00:16:06] Richard Macliver: There might be a bit of backlash on this one potentially, but in terms of, for design thinking, it really isn't super hard to be honest in terms of if you can do a little bit of reading, you go onto the IDEO website and there's some very basic bits of information there. 

[00:16:21] You can do a course, those types of things. But really the take home message is be able to take a step back from what you're doing in the day-to-day in terms of the typical approach. If you are any part of that project team, to think about, okay, are we designing, how do we know and what evidence do we have that we are building the right thing that is going to deliver the optimal outcomes for the people that we are serving or building this structure for. 

[00:16:52] And how do we have that evidence? What have we tested it with? How can we test things as cheaply and quickly as possible to confirm our hypotheses about where things need to go and have that rigor throughout? And it doesn't have to be a really arduous process. 

[00:17:12] So my take home would. Just apply that lens to your next project. You don't have to bring in a specialist to do that. You can just do that yourself. 

[00:17:22] For the leaders that are here that are listening, my ask would be... it does take strong leadership to be able to say, "Hey, let's step back and think about the end user and what they need, patient and clinician". 

[00:17:38] David Cummins: Yeah, it's a really good point, especially knowing that it can save money. It definitely saves time. It definitely improves human-centered experiences.

[00:17:47] There's all these huge, huge benefits just for taking that little bit of extra time to think and not go into solution mode. So I, think your design-thinking is phenomenal. I actually haven't seen it much in healthcare, so I do think you're a pioneer and an innovator in the world of healthcare, especially in Australia.

[00:18:01] So I do want to thank you for your innovation and your time today. It's people like you that certainly help improve patient outcomes and staff outcomes in the healthcare setting, which it would be great to see more of that. 

[00:18:10] So thank you very much for your time. 

[00:18:12] Oh, well, thank you very much for having me. It's been an absolute pleasure. 

[00:18:16] You have been listening to the Australian Health Design Council podcast series, health Design on the Go. 

[00:18:21] If you'd like to learn more about the AHDC, please connect with us on our website or LinkedIn. Thank you for