Thursday, December 13, 2018

Lunchtime Listen: FDA Roadmap on Patient Reported Outcome Measures

key terms:  for program managers, developing research study designs, designing patient-centered metrics for your clinical practice

Who this Lunchtime Listen recommendation may benefit:

  • any of you working in metrics for your clinic, as a clinician or as a program manager
  • clinicians who want to understand more about patient-reported outcomes and patient-centered metrics
  • if you are interested in health policy and how metrics and health policy collide

Recommended Lunchtime Listen this week:  the National Health Council's webinar series on the "FDA Roadmap" as it relates to growing and developing patient-centered metrics for your clinic or program.  NHC is recommending clinical settings get ahead in creating these before federal mandates require this metrics to be in place.  Depending on your program, your mission, your patient demographic and needs, and your resources, these metrics may take years to develop and implement.

National Health Council Webinar Series Patient-reported Outcome Measures
November 2018 – January 2019


Clinical Outcome Assessments Webinar Series with National Health Council (NHC)
National health policy is adopting more aspects of patient-centered paradigm.  Part of this paradigm is using patient-reported outcome measures. In fact, the Food and Drug Administration (FDA) released guidance documents on clinical outcome assessment for 2019.  
This webinar series by the NHC is intended to help clinicians and clinical programs and researchers better understand these ideas and this paradigm and discuss a little about what implementation looks like.  The overall take-away I had from this was to start now because implementation of clinic-wide or system-wide metrics appropriately can take years, not weeks nor months...years.

November 2018 webinar:  Patient-Reported Outcomes and Patient-Centered Outcomes 
"Nov. 7, 2018.  In patient-centered research and care, we focus on the outcomes most important to patients.  Often, patients tell us that what is most important to them is how they feel and how well they function in their everyday lives.  These outcomes are referred to in research as patient-reported outcomes or PROs.  So, what is the difference between a patient-centered outcome and a patient-reported outcome?  Are they the same?  The answer is:  No, they are not the same!  In this webinar, presented by Dr. Eleanor Perfetto, you will learn about the difference between patient-centered outcomes and patient-reported outcomes, and whey we need patient-centered PROs in research and care."  Learn more at website listed above.

Video of the presentation:

December 2018 webinar
"FDA's Roadmap to Patient-Focused Outcome Measurement in Clinical Trials"
Dec. 7th, 2018 webinar
summary:  "in patient-centered research and care we focus on the outcomes most import to patients.  Often, patients tell us that what is most important to them is how they feel and how well they function in their everyday lives.  To capture data on these outcomes in clinical trials, measures must first be developed.  This webinar introduces participants to a document, the Roadmap, developed by the Clinical Outcome Assessment (COA) team at the Food and Drug Administration.  The Roadmap helps researchers develop tools that measure outcomes that matter most to patients."

Video of the presentation:

The next webinar in the series will be January 17th at 1300 Eastern
"Clinical Outcome Assessment Webinar Series:  Untangling the Terms..." 
The presenter will be defining and providing examples of the following terms used in the past 2 webinars which are important to understand to be able to comprehend the FDA Roadmap about the new clinical outcome guidelines.  Terms to include:  endpoints, items, outcomes, PRO, PROM, and PRO-PM
For this webinar, sign up at this National Health Council webpage

Monday, December 10, 2018

Acupuncturists Working in the Emergency Department at the Aurora Health System of Wisconsin: A Success Story

key phrases:  interview, acupuncture programs, acupuncture for acute pain, acupuncture in the ER, examples of incorporating acupuncture into healthcare systems and hospitals

Who:  John Burns, DPT, MSOM, Manager of Acupuncture at Aurora Health Care, Milwaukee, Wisconsin

Organization:  Advocate Aurora Health Care
Location:  Milwaukee, Wisconsin and surrounding suburbs
What:  Providing services in 11 oncology clinics, 7 OP clinics, 1 ED, 2 IP

Dr. Burns with his poster at the AIHM conference. #AIHM18
photo credit Megan Gale

Quick Outline

  1. Introduction
  2. The Study
  3. The Program
  4. References

Wouldn’t it be great, as a patient, to have access in your local emergency room (ER) to non-pharm therapy option for relief of your strong pain, nausea, or GI symptoms, especially if you have adverse reactions to some medications?  Wouldn’t it be useful, as a provider in the Emergency Department (ED), if you had the ability to refer to a non-pharm therapy within your ED to help ease common ED presenting symptoms of pain, anxiety, stress, and nausea?

I met John Burns, DPT, MSOM, at the Academy of Integrative Health and Medicine (AIHM) conference #AIHM18 in San Diego in September where he was presenting his ED work at Advocate Aurora Health Care of Milwaukee, Wisconsin, in a poster session.  His study looked at the practicality of offering acupuncture services in the ED of a Wisconsin hospital. And, with enthusiasm, I watched him receive first place in the poster session for his team’s work!

Dr. Burns has a doctorate degree in physical therapy and a master of science degree in oriental medicine from Midwest College of Oriental Medicine, Racine, Wisconsin.  For the past 4 years Dr. Burns has been the manager of the acupuncture services program at Aurora Health Care, Sinai Hospital.  During a lunch break at the AIHM conference, I interviewed Dr. Burns about his ED study from the poster, and about the Aurora Acupuncture program.

Part 2:  The Study
More about the AIHM Research Poster Submission
Site of the study presented in the poster:  Emergency Department, Aurora West Allis Medical Center, West Allis, WI. 

What was Dr. Burns’ inspiration for the project? 
With a smile, Dr. Burns notes it was the research study on acupuncture into the ED setting of the Allina Health system of Minnesota by Adam Reinstein and Jeff Dusek that inspired him. The Allina ED study was published in 2017 in the peer-reviewed scientific journal, Pain Medicine[1].

Poster Title
“Utilization of Acupuncture Services in the Emergency Department Setting:  A Quality Improvement Study” by John Burns, DPT, MSOM, Jessica J.F. Kram, MPH, Vashir Xiong, MSOM, Jeanne Stark Casadont, MSOM, Tiffany Mullen DO, Nancy Conway, MS, Dennis Baumgardner, MD
Dr. John Burns awarded first place of the
 AIHM 2018 posters.
photo credit Megan Gale
Background and Reason for this ED Pilot
Patients often present to the emergency department (ED) for pain.  Acupuncture may decrease acute pain experienced by patients seeking ED services.  Acupuncture is an evidence-based, non-pharmacologic option for pain relief and pain management[2].

Goal of the Pilot
Dr. Burns notes: “the major purpose was to determine acceptability of acupuncture in the ED as either adjunctive or optional care for patients.”  The study was the first to assess the impact of acupuncture in the ED for pain management in the Aurora Health system.  The researchers wanted to determine acceptability of the acupuncture program by the patients and the ED staff.  This was a quality improvement study.

This was a retrospective observational study of patients in the Emergency Department. 

Patients admitted to the ED were offered acupuncture treatment for their acute pain condition based on their:
·         Emergency severity index (ESI)[3]
·         Reason for visit
·         Their physician’s approval

What Electronic Health Record (EHR) program do you use?
Aurora uses EPIC for documentation.  Dr. Burns worked with IT staff to create a specific data field in the EHR to track outcomes from the acupuncturists’ progress notes. 

Measurements/Metrics Used in ED study
In the ED study, they tracked patient-reported outcomes.  The top 3 measures were:  pain, stress, and anxiety.  The symptoms were measured on the numeric rating scale (NRS), of 0-10 for each.

Striking aspects to note about the study
The demographics of the patients treated represented the demographics of the local ED.
When patients were treated by the ED acupuncturist, they received only acupuncture.  For example, some patients had less than 8 needles per acupuncturist’s discretion, and some did not retain the needles past 20 minutes due to other services needed (such as x-rays).

What are important points/take-aways from this study?
  • Acupuncture reduced acute pain.  In the study, patients who received acupuncture reported 50% pain relief (average)
  • Acupuncture reduced symptoms of nausea by about 60%
  • Acupuncture in the ED setting is feasible

Where is the Emergency Department (ED) research published?
Dr. Burns’ paper is not yet published. 

Review of Clinical Program Implications for this Study
Availability of acupuncture services in the ER increases ease of access to non-pharm pain relief. And, for someone admitted to the hospital, having acupuncture as an option in the ER and the inpatient unit may decrease the complexity of their medication panel.  It may reduce the medication panel complexity because it reduces the common symptoms of nausea, stress, anxiety, and pain without medication (non-pharm therapy).

Considerations for future studies
Dr. Burns noted: “This [study] was only a pilot program to determine if acupuncture would be accepted by ED patients and staff.  This was not a controlled study or a study that followed patients over a period to determine changes in their behavior.” 
He says, “Next plan is to repeat the study with a different demographic and provide free follow-up care.”
  • Reproduce the ED project in Milwaukee, WI, in next year with different patient demographics
  • Track whether availability of acupuncture in the ED reduces opioid prescriptions
  • Follow up with patients who receive acupuncture in the ED at an outpatient clinic.  No follow up with the patients was performed for this pilot program due to study limitations.  They found that "following discharge from the ED, less than 2% received acupuncture services within 30 days."  Assumptions about why this may be:  patient choice, lack of reimbursement, even though outpatient services were available at the West Allis site.

Part 3: Acupuncture in the Aurora System
The acupuncture program at Advocate Aurora began in 2002 with one acupuncturist.  The program now employees 11 acupuncturists, full-time and part-time, who provide care in 11 oncology clinics, 7 outpatient clinics, 2 inpatient units, and one emergency department. Acupuncturists in the program are employees of Aurora.

The acupuncture program is part of Aurora’s Department of Integrative Medicine (IM).  The IM department employs practitioners who provide the following services:  massage therapy, chiropractic care, acupuncture, aromatherapy, and mind-body exercise.  The mind-body exercise therapy program is at Aurora’s psychiatric hospital.

Program Funding and Sustainability
How do they sustain the program?
Program is sustained through philanthropic funding and cash-based service.
Outpatient acupuncture services are cash-based except for the ED study program.  The ED program is sponsored by Aurora at no charge to the patients.  The oncology clinic acupuncture program is supported through both philanthropic funding and cash-based services.

How is program success or failure measured?
The Aurora IM programs are measured with the new model of care: value-based metrics, particularly outcome-based measures.  Program success is not measured solely by RVUs or patient load.

More about what Dr. John Burns does and where he works
Dr. Burns teaches Tai Chi and Qi Gong to patients in the mental health clinic and psychiatric hospital.  This clinical care has been well-received by patients and by staff who have seen patients’ positive response to it.  Dr. Burns also does in-service presentations to the following provider types: acupuncturists, physical therapists, nurses, occupational therapists, and physicians.

Dr. Burns’ Vision for the Aurora Acupuncture program:
Dr. Burns believes acupuncture, as an integrative health paradigm, has a “patient empowering philosophy”.  His hopes to see acupuncture available in all services lines, but especially incorporated into the following services:  neurology, palliative care, and the back and spine group.  He feels the integrative medicine program will benefit when acupuncture services are covered by the following insurances:  Medicare, Medicaid, and the Aurora employee health benefits system.  He would like to bring acupuncture into the mental health clinic as part of the substance abuse treatment program. 

On being a manager of an integrative health program:
Dr. Burns has been in a management position for 4 years.  He wants his LAcs maintain work-life balance.  He understands that clinician resilience and program sustainability are inter-related.  So, he makes this a priority in his role as program manager.

What learning opportunities are available to integrative health students and practitioners interested in hospital-based practice?
Shadowing opportunities are available in his program.  The integrative health courses that teach self-care may be soon be open to the public.

Part 4: References
Contact information for Dr. Burns and the Aurora Acupuncture Program

Links to related publications on the Aurora ED Study


Related Blogposts

Tags:  #AIHM #AIHM18 #EDacupuncture

If you found this information useful, please sponsor this work via our website, whether it is a cup of coffee or a sustaining contribution.  Thank you.

[1] Adam S. Reinstein, Lauren O. Erickson, Kristen H. Griffin, Rachael L. Rivard, Christopher E. Kapsner, Michael D. Finch, Jeffery A. Dusek; Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study, Pain Medicine, Volume 18, Issue 1, 1 January 2017, Pages 169–178,

[2] The Consortium’s Pain Task Force White Paper. 
Tick H, Nielsen A, Pelletier KR, et al.  Evidence-Based Nonpharmacological Strategies for Comprehensive Pain Care.  The Consortium Pain Task Force White Paper.  2018.

[3] Emergency Severity Index (ESI) is a triage algorithm that measures urgency of case on a scale of 1 to 5. “1” indicates the highest degree of urgency and “5” is the lowest degree, developed by Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS).

Friday, November 23, 2018

November Leadership and Workplace Monday Roundup

keywords:  leadership, workplace, workplace culture, being an employee, mentorship and mentor relationships, mindfulness and leadership

November's roundup of favorites from the Facebook Page, theme day, "Leadership and Workplace Mondays"

The Key to a Mindful Work Life from

Have you cultivated all 5 types of mentor relationships?
mentor #1:  the master of craft
mentor #2:  the champion of your cause
mentor #3:  the copilot
mentor #4:  the anchor
mentor #5: the reverse mentor
source: TED article, The 5 Types of Mentors You Need in Your Life

Compassion in Leadership, How Compassion Builds Better Companies by Jeff Weiner, CEO of LinkedIn:
"Create the right culture, and you create a competitive advantage." 
"The flip side is developing a culture with a compassionate those....create a culture where people take the time to understand the other person's perspective, and not assume nefarious intention; build trust; and align around a shared mission. After nearly 10 years, I still celebrate the fact we can make important decisions in minutes or hours that some companies debate for months.  Create the right culture and you create a competitive advantage."
YouTube video of the talk

Workplace Resource: was bought by LinkedIn in 2016 and is available as part of their LinkedIn Learning subscription service.  However, if LinkedIn Learning is not in your budget nor available at your worksite and you want access to, go in to your public library.  Many systems already have a library subscription that is available to patrons (if you have a card, you have access).  If you are not sure if your local library system has it, ask your librarian or your library's designated reference librarian.

The Mind of a Leader 
When leaders are (1) mindful, (2) selfless, and (3) compassionate, this creates trust and social cohesion.  So, when hard times arise, the organization will be ready and resilient.” A 2018 Lunchtime Listen recommendation.

If you enjoyed this, check out our public Facebook Page and subscribe to our email list.

Leadership and Workplace Monday: A Leader who practices Mindfulness and Self-awareness is a Positive Force

keywords: leadership, mindfulness practice, self-awareness, change-agent skills

From, a long interview article, "The Key to a Mindful Work-Life", written by Sharon Saltzberg, 09.20.2018.  Read the full article on the website.

There were several good take-aways from this interview.  Here are my notes.

"Leadership is never about your title or the size of your budget or how many people you manage.  Leadership is always about influence.  Whether you're a sole practitioner, or you're leading a family, or you're leading a clinic, or leading a multi-billion dollar company, it's about influence.....Do you influence more often for better or more often for worse?"
"What we're aspiring to is every day to feel as though we have more often influenced for better and less often influenced for worse.  And to do that we have to learn a lot about ourselves and what's going on in our bodies and minds and what hooks us emotionally, and how we can connect more fully to the big picture and the people around us."

Mindfulness does not make a feeling disappear.  When you mindfully work through self-reflection, you use your principles to guide you toward how you act in the moment.

"We can't change everything around us, but we can change how we meet it."
Wisdom is..."a complete experience that sees more clearly how things actually are.  We can come to feel in our bones the frustration of trying to control something we will never be able to control or having extreme standards of perfection.  It's wisdom that tells us not to be indifferent to the needs and challenges surrounding us but to be balanced."
Wisdom helps us "recognize that the results we seek and the influence we have may not be so apparent right away."

Planting ideas for the Change-Agent:
"it may be that all we're able to do is plant a seed.  It's going to take some more time for something to unfold, a new change in policy or a process that's going to take some time.  We can dissolve a lot of that frustration if we have some insight into not being in control:  I can't just say poof and have everything accord with my view."

It is too common in the U.S. that the workplace has too much busyness causing unhealthy behavior--> you need time to drink water and go to the bathroom, at a minimum.  There is no substitute for good quality (and quantity) sleep.
"One of the most shocking things I ever heard from a medical director was that they were overrun by prescriptions for two things:  sleeping pills and bladder infection medication, because people don't go to the bathroom as often as they should.  People don't take time for a good lunch."
"If you're running on four, five hours of sleep and you're not eating well and you're not taking care of yourself, you can't be at your best and as a society we can't afford that.  We really need leaders who can be role models of self-care and who can find the win-win-win solutions we need today:  good for the organization, good for the employee, good for society."

Mindfulness and Self-Reflection for the Leader
"Mindfulness gives us a glimpse of certain basic truths about life, such as that everything is changing all the time.  It's one thing to know that intellectually, which we all do, and it's another thing to have an increasingly embodied understanding of that."
"You may have carried the smaller perspective that a strong leader is somebody who takes strong command, but you may begin to see that this smaller picture of leadership doesn't include listening, inclusion, or accommodation of other points of view.  It's me-centered.  When you've seen for yourself that this picture is not true--that the strength we associate with an overbearing leader is a seeming strength that is too harsh, too brittle, too isolating--you gain perspective again.  Then you can go forward."  

Read the full article at here.

If you enjoyed these notes, check out our public Facebook Page and subscribe to our email list.

November Self-Care Saturdays Inspiration List

key words:  self-care, practitioner resilience, wellness, mindfulness practices, nutrition for health, recipes, TCM at-home care for mild cough in children

The November Self-Care Roundup

Some inspiration from the Self-Care Saturdays theme over at our public Facebook Page

"In Chinese medicine, we view each season of the year as important in the balance of the others.  Winter balances summer, spring balances fall, yin balances yang.  And just like yin and yang have characteristics and influences that are important to each, so do the seasons have varying impacts on our health and well-being.  Autumn is the metal season in Chinese medicine.  Metal in balance presents as optimism, fresh ideas and new perspectives.  Balanced metal also gives us a sense of our self-worth.  We are equally able to let go of the old unnecessary thoughts or items in our life, and be open to new ideas and thoughts, people, places and things.  When we are out of balance in the metal element, we might view everything pessimistically.  The imbalance might also express itself as an inability to let go of things or people, living always in the past, refusing to move on with or from a project (occasionally presenting as irrational striving for perfection!), or possibly just stubbornness or a weepy depression.
"Consider these helpful tips and recipes for harmonizing with the season..."  Read more here

"It's important to understand that treating your child's cough naturally is not a one-and-done.  Instead, it's about combining the right remedies that will work for your child according to their age and the type of cough they have.....For best results, it's important to combine remedies, use them consistently, and have patience with the process."  

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Friday, October 19, 2018

Call for Papers from JACM: are you teaching classes in tai chi, qi gong, acupressure, or other self-care integrative health therapy?

key words:  research, peer-reviewed scientific journals, focus on integrative health

The Journal of Alternative and Complementary Medicine has a call out to submit your work and/or papers if you have been teaching classes in tai chi, qi gong, acupressure, foam-rolling, mindfulness, or other self-care therapies to patients.

Please read the journal's guidelines for submission and submit your qualifying work before February 28th, 2019, for their special focus issue, Innovation in Group-Delivered Services, due to publish about July 2019.

you can submit:

  • original research
  • commentary
  • reviews
  • particular interest in:
  • cost outcomes
  • payment strategies
  • sustainable program models

also interested in commentaries:

  • about related health policy
  • reimbursement changes based on clinical research
  • translational issues
  • implementation research
  • comparative cost analysis

Read more about submission options and guidelines at their website
Here are some excerpts from the guidelines page:
"An emerging mosaic of clinical evidence supports vastly expanded use of group services to deliver optimal care--especially in integrative health and medicine models."

"We see access to services among economically-challenged, multiethnic populations who cannot otherwise access integrative care.  We see emerging evidence of cost-savings and of increased satisfaction among practitioners who have a clinical component of group work." 

"Strategies for behavioral change show a facilitative leadership style with opportunities for interactivity and experiential learning are more effective methods of learning, of engagement and of empowerment.  For the values of integrative health, we see tremendous alignment."

"In July 2019, JACM will publish a Special Focus Issue on Innovation in Group-Delivered Services.  We are pleased to engage this work in partnership with Integrative Medicine for the Underserved (IM4US) and Centering Healthcare Institute." 

"We are encouraging  submission of original research, commentary, and/or reviews.  We are interested in effectiveness data from innovative models.  We seek reports on cost outcomes, payment strategies, and sustainable programs.  We are interested in group models focused on single methodologies tailored to group-based acupuncture and in multimodality approaches.  We are interested in methodologies tailored to group-based research and applied clinical education strategies on group clinical methods.  We seek commentaries that explore health policy and reimbursement changes based on clinical research." 

"In alignment with JACM''s ongoing editorial focus, we seek explorations of translational issues, implementation research, comparative cost analyses, and improvement research."

"We invite your submissions! We are interested in group-delivered services with intended clinical endpoints.  We anticipate that group services will be increasingly offered as medicine moves to become a system for enabling people toward health.  Our goal is to create a volume that will serve as guidance for increasing appropriate uptake of innovated group services in health-oriented payment and delivery of the future."
"When submitting your paper, please select the Innovation in Group-Delivered Services 2019 Special Issue manuscript category to ensure it is considered for this special issue.  Original manuscripts should be no longer than 3000 words and Systematic Reviews should be no longer than 4500 words.  Title, abstract, acknowledgments, disclosures, references, and figure/table legends do not count toward the word limit.
"Additional feature:  as an additional feature in this JACM Special Focus Issue, we urge your submission of a 500-word commentary to reflect on next steps for group-delivered services:  controversies, unusual experiences (not case reports), models of care, educational models, etc.  We will select from those submitted a set that will be published together to capture the challenges and opportunities for this moment for the field."

Monday, October 8, 2018

Leadership and Workplace Monday: Making Space for Innovation; seeing failure as constructive toward growth

wall chart to measure growth
key words:  leadership and workplace, change-makers, nonprofit leadership innovation
key concepts:  leading innovation, tools and ideas to help lead change in your organization, how to embrace failure on the path to change as opportunities to learn from your mistakes instead of fearing mistakes, moving forward and embracing change is uncomfortable--how do you help your team be more comfortable with transparency with mistakes and learning from failure as a way to improve the workplace

When you are changing the traditional medical system toward embracing more "care", "patient-centered-ness", and "health" paradigm, you will need to make time and room for innovation, change, and embracing failure.

This interview from Driving Participation podcast with Jesse Lane of Pure Charity shares practical tools to make space and time for the growth mindset and space for innovation every organization needs to grow and thrive.

Source:  The Driving Participation podcast with Beth Brodovsky.
Interviewed Jesse Lane of Pure Charity on 9.26.2018
"Creating a Culture Where Ideas Come to Life" or on iTunes.

“Trying new things can be scary—but often, the payoff is worth it. Jesse Lane of Pure Charity joins this session to explore ways nonprofits can be more innovative and how to create an environment that fosters creativity. He shares how at an organization he was a part of, they would set aside four hours every week just to brainstorm new ideas or work on implementing ones already in the pipeline. It created an environment for innovative ideas to be brought to the table in a new way and people were excited to share their suggestions. He and Beth explore why failure isn't always bad, how to get your donors involved in organizational changes, and much more.”

Megan's notes from listening

Core Values, a check-in minute 0-16
Hospitals, healthcare systems, nonprofit organizations have a published mission, vision, and core values.  After you publish your core values, are you checking in to see how your operations and products reinforcing those values?

When you know a core value isn't a core value:
If the core value does not show up in the work you are doing, it is not a core value.
As an organization, if you are not actively doing things that support, reinforce, and nurture that core value, it will not show up in your organization's products/outcomes or culture. [paraphrase]

Innovation vs. fear of failure and fear of risk-taking
growth and innovation mindset vs. scarcity mindset

When moving toward innovation, make failure a positive learning experience and keep moving forward.

Moving Forward:  Creating a Culture of Innovation

What are the needed basics?  minute 16

  • dedicated time
  • dedicated space
  • dedicated supplies

What are practical ways to initiate a culture of innovation, a growth mindset? minutes 18-19
These are the ideas Jesse mentioned:

  • quarterly shark tank experience
  • weekly meetings 
  • invest in a "sandbox lab"

What does this look like? (example) minute 21-23 and 24-26

  • 10% time innovation
  • 4 hours on Fridays.  4 hours/40-hour work week = 10% time investment
  • 4 hrs Friday afternoon "innovation lab"

What changes must leaders make to encourage this kind of innovation?  minute 26-28

  • model it themselves
  • dedicated time
  • dedicated space
  • system for accountability
    • i.e. dedicated task force (people) "innovation champions"
  • budget for it

How do organizations best address failure as a positive?  minute 28
  • celebrate the risk that was taken, even when it was not successful
  • What did we learn from this (failure)? minute 31 Where do we go from here?
  • See failure as a first step toward a success story
  • check in with your end user on your work and get feed back.
    • Must be doing regular check in with your end user on your work and getting feedback because this helps you avoid getting too far from your work/mission/end user
    • example:  "We designed this for you; what is your feedback?"
What are some first steps toward adding innovation to your organization's culture? minute 38
  1. set realistic goals, definition, and structure
    • example:  budget, time, space.  4 hours/week I go to the coffee shop with Person B to keep you accountable to your new idea
  2. start small 
  3. set goals 
  4. create an accountability system
  5. check in regularly with your end user
Quote from the TED Talk:
"...enthusiastic skepticism is not the enemy of boundless optimism.  It is optimism's perfect partner.  It unlocks the potential in every idea." --Astro Teller, "Moonshot Factory", X Project, Google.

Related Blogposts on Leadership and Work-place
resources related to changing workplace culture and moving the Integrative Health paradigm forward