‘Mayo is a place where people never give up. Nothing is really impossible’

Dubliner Lorna Ross uses her design background to help develop patient services

Lorna Ross is director of design at the Mayo Clinic’s Center for Innovation. Photograph: Brenda Fitzsimons

Lorna Ross is director of design at the Mayo Clinic’s Center for Innovation. Photograph: Brenda Fitzsimons

 

I grew up in Dublin and went to NCAD back in the 1980s, and after my degree I stayed on to set up a fashion company, Francobolli. It seems a long way now from my career at the Mayo Clinic, but each step has been a crucial part of what got me where I am today.

The first transition for me was when we got to a certain size and had to expand. I went to the bank to try to get a loan, and had the peculiar experience of them saying, “Yes, but you’re not really business people,” even though we’d been running the business for two years. I realised we’d never had a business aspect to our education, and it was a vital skill.

I got on to the design management course at the Royal College in London, but it cancelled it that year because there wasn’t enough uptake. The college offered me a place on its new experimental interaction design course instead. Initially I turned it down as I knew nothing about computers, and I thought it sounded terrifying, but the offer of a full scholarship helped to persuade me.

I hated it in the first year. I’d come from fashion, using my hands, building things. A lot of the other students had come from graphic design, and I felt like an idiot. It was really intimidating.

Then, in my second year, I had a breakthrough. A visiting professor gave us the creative brief to redesign the telephone. I struggled, I had no clue, and we got right down to the deadline, so I thought: what do I know? And so I went back to clothing. I designed a telephone as a wearable glove.

When we came to the critique session, I was secretly hoping we’d run out of time before they got to me. When I presented, everyone was really quiet, but afterwards in the discussion, I realised that space – the intersection between what I knew, which was designing for the body, and what I was learning – was really exciting.

I did my thesis on wearable technology, and was hired by Interval Research Corporation, a research facility in Palo Alto, connected to Media Lab at Massachusetts Institute of Technology (MIT), before I’d even graduated.

It was an incredible time. All these brilliant, fascinating people were inventing there, real geniuses, and there was a conspicuous commitment to radical education. Suddenly I was on this extraordinary team with people who knew so much about what I didn’t know, yet it was collaboration, not one person being right or better.

I was the first designer they’d had, and we were all about pushing what was possible, but still thinking of the end user: about how to help people live well. I learned a lot from working that way.

Soldier equipment

After presenting at a conference, I was hired by the US Department of Defense. It was before September 11th, and we were thinking about the future, adapting soldier equipment to potential situations, developing wearable technologies for communications and enhanced situation awareness.

I thought, I couldn’t know about the end user unless I really got to know them, so I spent six months with a Navy Seal unit on manoeuvres in San Diego. It’s a very intimidating environment, and the most terrifying experience I’ve ever had.

About three years into that job, my boss was leaving, and he thought I should leave too. He said he’d been protecting me, and I said, “This is the most frightening job I’ve ever had, and you say you’ve been protecting me?” I’d been so determined to be successful in this environment, where no one cared about design, but that stubbornness made me effective.

The experience has also given me confidence to persevere despite barriers. That, and being Irish, and so having a certain irreverence, have proved invaluable and helped me to be successful. I know how to persist in things.

I believe design should be part of the conversations, people’s experience should be considered, and design is frequently just not at the table. That’s why I’m now at the Mayo Clinic, as strategic leader in directing the discovery and implementation of transformative, user-centric care models; which is a bit of a mouthful, but it’s essentially about developing patient-first services, transforming the systems in which diagnosis and care take place.

It’s a particular environment, as the basic model of doctor-patient consultation hasn’t changed in almost 200 years, and coming in as a non-scientist means your role is frequently framed as a “servant” to the science. The system is very institutionalised, which is why it’s so useful for people from a non-medical background to be part of the process. The scientific emphasis on evidence and proof also means that change is won through compelling evidence not passionate argument.

My day starts early; my nine-year-old isn’t a great morning person, and I can’t blame him. I find the whole being-a-kid thing challenging when I look at it as an adult. You have to turn up and do what everyone wants you to do every day. It’s a big deal, because it doesn’t always make sense to them: it’s kind of like working, you have to turn up and follow certain institutional cultural or social rituals.

We’ve been watching The Walking Dead on TV – it’s brilliant. It’s set after a zombie apocalypse, and in one episode there’s this kid who keeps writing JSS in blood. When we discovered it was her mother’s last words to her – “Just Survive Somehow” – we both really loved that. So, as a secret joke we have, when I drop him off to school, I say “JSS” as he’s getting out of the car. He thinks it’s hilarious.

There is a real difference between being a kid in the US and in Ireland. I look at my sister’s kids in Dublin, and in the States, everything is analysed and labelled, so in some ways they’re trying to dodge all that attention. When he gets home, I’ll say, “How did you survive today?” It keeps things from getting too serious at nine.

My working day is pretty much 100 per cent meetings. We have access to all the clinical and administrative groups at the Mayo, so it could be doctors, nurses, patients, research scientists or the financial teams. I think what’s really important every day is not to think about the big, overwhelming things. You have to turn up with an attitude that’s pretty optimistic.

I’ve just started on a huge project leading the UX design for the electronic-health-record conversion: essentially switching the clinic’s record-keeping to an entirely new system.

We often use the analogy of flying a 747 plane full of passengers and deciding to change the engine midflight. It’s the biggest and most complex challenge I have ever faced but I’m working with an amazing team whom I have such respect for.

Working at Mayo, I understand that 99 per cent of what makes it work is the people who show up every day to make sure the system does not break. I am in awe of the people across Mayo and their capacity for insane levels of chaos and uncertainty.

No one walks into the clinic or the hospitals in the morning knowing what their day is going to be like. They just know that whatever happens, they have to make sure they keep people safe and help them heal.

Adaptations

Design is all about trade-offs and adaptations. It’s the process of making magic happen within a set of constraints. For example, we had a group working for two years on how to reduce costs without impacting on patient care; or we might be mapping the patient journey through the process from different perspectives, including an anthropological analysis, to try to see where change is beneficial.

The things you see, every day, across Mayo can paralyse you with sadness. How you get unstuck from that is to focus on all the remarkable people doing impossible things with compassion and gratitude. It’s hard to describe how inspiring that kind of environment is for design.

It’s taught me a lot about how to bring optimism, humour, humility and resilience to my own work. Mayo is a place where people never give up. Nothing is really impossible or unsolvable: we just haven’t figured it out yet. I think this is what I love about the spirit of medicine, too: it is relentless in its determination to understand things.

Obama Care

At the moment there are huge changes in healthcare in the US. The industry is being challenged to evolve itself to deliver more meaningful health outcomes at lower cost for individuals and communities. Obama Care has been the single most disruptive thing in healthcare in 30-plus years.

No one is quite sure about the long-term impact, but the degree to which it has challenged many of the established industry norms is significant alone. In essence, it was intended to protect the individual and offer more equitable access to universal healthcare; in reality it risks being used by employers and insurers to make access even harder and more expensive by shifting the cost to the consumer.

Having our industry experience this level of disruption has been uncomfortable for Mayo. The uncertainty of how things will play out naturally causes a lot of anxiety.

Our job in the Center for Innovation is to help Mayo navigate the transitions it needs to go through to remain vibrant in the market and accessible to patients everywhere.

My focus is to try to nudge at the intersections, between the patient and the system, to look at what’s feasible. Attitudes matter so much, so you can’t be judgmental. It sounds kind of odd, but we actually have to take a kind of light-hearted approach. We often talk about feeling like cheerleaders, in that we approach really confounding problems as huge opportunities. We never change something unless we make it better. That is one of our unwritten rules.

So each day I’ll focus on what I can get done that day. And then pick up again tomorrow. It’s like building a scaffold: you’ve got the chasm between the current model and the future model, and you slowly build a scaffold to bridge it. The specialisation in medicine has led to amazing things, but the patient and their experience of the system has to be brought back to the centre of it.

A lot of innovation groups fall into two categories. You can have the centre of innovation, which was my previous experience, where you work as an isolated group to come up with something brand new. But in this case, we’re a centre for innovation: we’re embedded, part of the culture. It may be just trace elements, but they do matter. Then, when it’s done, we walk away and pretend we were never there: like ninjas. The success is when others own the ideas.

Out of hours We live about 20 minutes from downtown Rochester. That’s the balance here: you can live in the centre and have the amenities, but if you move further out you get the acreage; we have about 10 acres of woodland. I may go for a drink with the team after work, or else I’ll go for a walk in the evenings. That’s a huge part of living in the midwest. I love it. People wonder why the Mayo Clinic, this world-class medical institution, is essentially in the middle of a prairie, but it was set up by the sisters at the local convent after a devastating tornado. Dr Mayo, and then his sons, established the clinic, and the rest is history. Long term, I would love to get back to Ireland and to be able to do the work I am so passionate about there.

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