What we can learn from MichelAngelo

MichelAngelo said "The sculpture is already complete within the marble block, before I start my work. It is already there, I just have to chisel away the superfluous material.” In a recent dialog with a doctor I admire greatly, we spoke about the problem that Bob Sutton and Hayagreeva Rao wrote about in The Friction Project and that is "Addition Sickness". In my experience, using Subtraction as a design guide and mindset toward innovation is a great approach. That mindset is to think about subtraction when innovating vs adding. Some can think about this through the theory of reductionism, which is simply any theory or method that holds that a complex idea, system, etc, can be completely understood in terms of its simpler parts or components. Simplify is a powerful approach.

Maybe an example of this mindset and approach will be useful. When my team and I embarked on altering the business model of kidney health, we started with dialysis. A large focus for us was removing the workload, the not-knowing problem, the lack of flexibility, etc. We learned what needed to be removed because we practiced empathetic grounding in the circumstances of those people we are hired to serve. https://www.dhirubhai.net/pulse/beyond-rounding-health-care-leaders-need-dig-deeper-todd-dunn/

Through our immersion work we learned, on the inpatient setting, that the kidney is manually-managed today. Yes, an organ that is manually managed. We found a way with Accuryn Medical to digitize the kidney and automate urine flow. Due to our deep immersion with the clinical teams, we knew we couldn't add one net-new thing to the clinical teams' lives. If we add something, like Accuryn, what must we take away? WE TOOK AWAY:

• not knowing the outs
• the delay of insights that a serum creatinine test can't take away. Some research shows that a SR test can lag actual kidney injury by up to 24 hours, which means damage is happening before the test can show it
• having to document urine output, because when integrated Accuryn will be putting that into Epic with no effort from the nurses
• not easily knowing intra-abdominal pressure
• having to crawl under the table in an OR to know urine output
• having to milk the foley to keep urine moving
• the j-loop/retrograde stagnant urine, and by doing these things we reduced the threat of patient harm with CAUTI and the escalation of AKI
• we reduced much of the underlying lack of visibility that often causes AKI to escalate to inpatient dialysis, which leads to quality penalties.
• we reduced nurse and doctor frustration with all of the above,
• we reduced the amount of time being spent trying to manually manage the kidney
• and by taking away all of the above, we enabled the ability to take away and remove some of the the human and financial costs associated with kidney injury.

This is a picture of the device from a nurse setting.

This picture told us we had served the teams in a way they valued. Like Bezos said it isn't innovative is the user doesn't adopt it! Well, they adopted it.

We can take this subtraction approach at the process level and the business model level. One point of view that I hold is that Empathy is the Heartbeat of Healthcare! We have often encased that empathy, that our teams want to demonstrate, in poorly designed processes, tools, etc. As teams focused on transformation, lets take a subtraction approach and remove the wasted/superfluous things and let the beauty of empathy shine through!