Nicole Chen and Vinitha Watson: On Empathy and the Medical Student Resident Experience

Medical students fulfilling their residency requirement -- a formative but grueling experience that involves at least three years of treating patients in a hospital -- need to have intense stamina.

"It's common for a resident to finish a 12-hour shift and realize they never stopped to eat, or even go to the bathroom!" says Vinitha Watson, an innovation consultant, CCA trustee, and 2010 alumna of the MBA in Design Strategy program.

Watson knows this from research she did with Nicole Chen (also MBA in Design Strategy 2010) looking into conditions that affect the health and wellness of residents at the prestigious Johns Hopkins University School of Medicine.

The culture of this intense learning environment is geared toward the residents becoming the best doctors they can be . . . and putting their heads down and plowing through by whatever means necessary.

The impetus for Watson and Chen's research project came from a deeply personal and moving event. "In March 2008," Watson relates, "Dr. Priya Palagummi Makadia, my best friend, was in her final months of residency at Johns Hopkins and passed away from a sudden illness at the age of 29. Although the cause was unknown, Priya often sacrificed her own health for the health of her patients. I am proud of the noble cause she championed, but I wish she'd been able to slow down occasionally to take care of herself."

The Power of Design Thinking

Design thinking is a process that employs "creativity grounded in user insight, empathy, visual storytelling, prototyping, and innovation," as Chen describes it. "It is powerful because it's a specific, actionable approach that can help solve complex, ambiguous problems in creative ways." Watson adds: "It's grounded in observation and ethnography, and centered on human needs."

The process of working with Johns Hopkins began with empathy, inspired by Watson's personal experience. "The School of Medicine had originally approached me about designing a humanitarian and ethics-based program to more deeply educate their doctors about patient care.

I simply responded with the following question: Tremendous effort goes into how physicians approach their patients' health, but how are doctors trained to approach their own health and well being?"

Holistic Approaches to Health

Johns Hopkins responded by making the question a priority. Other institutions and companies, Chen points out, including Stanford, Google, and Facebook, are doing the same: going beyond thinking about how to retain quality employees and starting to think about how to make sure employees have more quality in their lives.

This New York Times article discusses the phenomenon in some depth, and quotes a Google executive as observing that the benefits the company offers have been evolving away from free food and toward more holistic approaches to individuals and their health. This allows the employees, in turn, to continue to do better work.

For anyone who's ever been a medical patient (and that includes just about all of us, including doctors) the benefit of your doctor being well enough to do better work is quite clear.

Doctors, Meet Daylight

Watson and Chen met in 2008 as students in the first-ever cohort of the newly created MBA in Design Strategy program. So, in 2012, when Watson became the founder of the Johns Hopkins Resident Wellness Program and needed partners with whom to collaborate, she turned to Chen and the San Francisco design and innovation firm she had since joined, Daylight, where Chen is a design researcher and strategist.

They assembled a team of Daylight researchers and designers and started work. The first step was to empathize with the medical residents through interviews as well as direct experience. "Our week at Hopkins in September 2012 was extremely revealing," remembers Chen. "We basically lived as residents, attending 7 a.m. patient rounds, checking on patients, doing an all-night on-call rotation, coming to conference lunches, conducting in-depth conversations. Putting on doctors' coats for a week helped us feel and experience firsthand what life as a hard-working resident is all about."

They came to understand that the task of designing solutions was going to be even more complicated than they'd realized. "The doctors at Hopkins are extremely motivated and ambitious," Chen says, "and while they recognize the importance of being healthy, their learning experience on the way to being amazing doctors is more important to them. Their health isn't a priority; the health of their patients is. So, our challenge is complex: How do you help those who don't necessarily feel like they need it?"

First Solutions

Along with a larger Daylight team, the two came up with a program of solutions, several of which are currently being implemented on a small scale so results can be tested and proven. (Read more at Daylight's blog). These include making high-energy, quick-to-eat food -- for instance (tidy) bananas rather than (messy) oranges -- and rapid water-bottle refilling stations easily accessible in the "firm offices" where residents stop throughout the day.

Making healthier lunch choices available during their daily noon conferences is a related idea. Options for quick workouts on-site might induce residents to sneak a few minutes of stress-relieving jump roping or DVD-led yoga into a busy day.

And helping residents arrange help with laundry and grocery shopping would mean their rare days off could be spent on "quality" activities instead of mundane errands.

Chen acknowledges that the first interventions currently being tested focus primarily on addressing basic needs, like access to healthy food, water, and exercise. "But we know there are larger cultural challenges to address, like how to ensure emotional well-being in the high-pressure, high-stakes work environment they choose to be in. Our plan is to first address the most immediate needs, which will then free up more mindspace to tackle the larger, higher-order needs that require more thought and finesse."

Stanford Partnership Makes Things Happen

Daylight has already been in contact with WellMD, the physician wellness committee at Stanford, with the idea that its findings could eventually be applied at hospitals across the country. The work, in other words, is still in process.

Chen remarks that gaining the ability to make things happen from beginning to end is what drew her to the MBA in Design Strategy program in the first place. She had some experience in design thinking from her undergraduate studies at Stanford, "and at CCA I strengthened this experience while adding more analytical thinking to my creative approach. The program helped me understand the realities of the broader business world -- what it actually takes to bring ideas to life from the standpoints of marketing, branding, strategy, pricing, promotion, distribution, and production."

Watson sums it up: "The most valuable thing I learned in the MBA program is how to take an ambiguous idea and make it real."

Other Projects

Chen’s other projects at Daylight include everything from ending modern-day slavery (for a nonprofit foundation called Humanity United to helping integrate design thinking into K-12 classrooms at Punahou School in Hawaii, one of the largest private schools in the country and President Obama's alma mater.

Daylight has also been working with Back to the Roots, a Berkeley-based company known for its at-home mushroom growing kits that use coffee waste, on its second product launch: a sustainable, self-cleaning, home aquaponics herb garden / fish tank.

Watson is CEO and founder of The Zoo Labs, an incubator for young creative professionals. She also works as a consultant for clients such as Echoing Green, which provides fellowships for social entrepreneurs who are out to realize their visions for a better world.

These projects align perfectly with the work she does on the boards of directors of several important businesses and institutions, including CCA, that are addressing what she calls the "key arenas" of education, public health, and social impact.