Dr. Claire Phillips is an ER Nurse turned Healthcare Change Specialist who uses her love of sociology, systems thinking, and design to turn nurses into change makers. Claire has a Bachelor’s in Sociology + Anthropology, a Master’s in Nursing, and a Doctor of Nursing Practice degree in Health Innovation + Leadership. Through her organization Nursing the System, Claire is on a mission to train 10,000 nurses to lead systems change by 2030. She does this work through accessible online higher ed programs, personal coaching, and organizational consulting. Claire believes 1) systems change IS possible, 2) we each have a critical role to play in healing our world, and 3) we can have fun while doing it.

In this episode, we interview Claire Phillips, systems-thinker extraordinaire and founder of Nursing the System. We talk about “good leadership,” principles of service design, and how to incorporate service design into your practice/leadership role. We end with communication tips for leaders and front-line workers and how leaders and front-line workers can build working relationships.

1. Let’s start out by unpacking leadership. What does good leadership mean to you?
2. And for our listeners who have not checked out episode 44 about systems thinking, can you briefly describe what systems thinking is?
3. Why is systems thinking critical to leadership in healthcare?
4. During our phone conversation, you mentioned a concept that is new to us, which is service design. Can you share the principles of service design with us? Can you describe the difference between service design versus product design?
5. So you have done a large project using service design, can you share with our listeners what you did and how you went about it?
6. What recommendations do you have for leaders to infuse service design thinking into their professional roles?
7. As we know, frontline workers are critical to making change, what communication tips do you have for frontline workers when communicate as a leader?
8. On the flip side, what communication tips do you have for communicating to leaders?
9. What is the one thing you would want all listeners to know about leadership?
10. Where can folks go to learn more about design thinking and the work you are doing?

IDEO U

Nursing the System 

University of Pennsylvania’s online Design Thinking for Health Course 

Nursing the System: Change Makers Essential Course 

Service Design

Nicole: [00:00:00] Hi everybody, and welcome to the Woman-Centered Health Podcast. Today we are speaking with Dr. Claire Phillips, founder of Nursing the system and Healthcare Change Specialist about leveraging service design to lead change in healthcare.

Nicole: Claire’s name may sound familiar. She’s been on our podcast to talk about systems thinking in episode 44, and then relating her systems thinking expertise to D E I in episode 48. But before we start our interview, we wanna thank all of you for listening and let you know that you can earn ES and get key takeaways, resources, and transcripts by visiting our website, woman-centered health.com.

Nicole: Also, Stephanie and I put this. Podcast together in our free time and often use our personal funds. So please consider supporting us. You can do this by subscribing and giving us a five star ratings on iTunes or wherever you are listening to us. And if you are able to offer a financial donation, visit our website and click the support us tab.

Nicole: All right, let’s meet our guest.

Stephanie: Hi again, Claire. So [00:01:00] thankful that you are our guest on our podcast again. So for our listeners who haven’t heard you before, and because it’s been a couple years, could you provide a little bit of details about your background?

Claire Phillips: Yes. Hello Nicole and Stephanie, it’s so great to be back on your podcast. Had so much fun the last time. And, , for those who yeah, have not heard that previous episode, and for those who have but want to know what I’ve been up to the last couple years, I’ll give you a rundown on my kind of professional story.

Claire Phillips: So I am a sociology student, turned er, nurse turned, healthcare change specialist, and I first became attracted to, nursing and, healthcare as this great human systems challenge. In my bachelor’s program when I was getting my degree in sociology. And it was through. A lot of coursework about health and illness and the healthcare system that I really started to [00:02:00] identify with nursing and nursing’s position in the healthcare system as, sort of this natural change agent and patient advocate.

Claire Phillips: And so I decided to go and get my master’s in nursing after my bachelor’s degree, which I did, and then started working in the emergency department. And for anyone who’s been in the ER waiting room or has had the pleasure of serving in the er, you know that you basically see Every type of person suffering from every type of ailment.

Claire Phillips: It’s basically the intersection of every broken social system in our country shows up in the er. And so that was, very eye-opening to me as a new nurse. And I started blogging about my experience, just as a way to kind of process what I was seeing and blogging specifically from a sociology systems thinking perspective.

Claire Phillips: And as I shared more and more of my experiences and my thoughts with, , the internet, I started to get some feedback [00:03:00] from other nurses and nurse leaders that, this like systems framework for thinking about nursing and our role as changemakers in the healthcare system was really, really helpful.

Claire Phillips: And so that. Kind of was a light bulb moment for me. I thought, well that’s interesting because I’m a nurse and I have this sociology background. I wonder how I can leverage those things into a career where I’m doing some of both. So I decided, after being a nurse for a couple years in the ER to go and get my doctorate at the University of Minnesota, in nursing practice.

Claire Phillips: And the specialty focus that I had was in health innovation and leadership. So I’m not a nurse practitioner. I am. A healthcare change specialist now. And, so the work that I do is about, educating nurses and nurse leaders to think in systems to lead change. And it’s a lot of fun. So I’ve graduated now with my doctorate, last year.

Claire Phillips: I was also an er nurse leader during covid, which was a [00:04:00] whole, a whole lifetime in the year that I was doing that, let me tell you. Really a fantastic hard experience. And now I’m, I’m, I work full-time in my organization, nursing the system. And I love that work as well. So basically that’s me and I’m excited to be here.

Stephanie: And I’ll just put a shout out for your Instagram. love your Instagram of nursing the system. So if our listeners don’t follow that, I highly recommend it. Okay, so you kind of hit on some of this question, but I will ask in case you have a little bit more, but we always ask our guests what informs your perspective.

Stephanie: So in other words, why do you do what you do and what is most valuable to.

Claire Phillips: Great question. I think why do what I do, which is turning nurses into changemakers is rooted in this deep belief and reality. I have that, everything in our world touches people’s health, and so therefore we need nurses in every corner [00:05:00] of the world making change, making systems change. So that I’d say is my, like, fundamental belief that kind of drives everything that I do.

Claire Phillips: And then in terms of what’s valuable to me, I’d say, My three like core values and the what ended up being the core pillars of, , nursing the system, my organization are meaningful work, lifelong learning, and joyful engagement. I believe that systems change as a work of generations and though it’s hard, I believe that we can have a great time doing it.

Claire Phillips: And so that’s kind of the, the energy I try to bring to my work and, to my students and clients lives as well.

Nicole: I love those pillars. Those are fabulous.

Claire Phillips: Thanks. I.

Nicole: Okay, so like we said, today we’re gonna talk about leveraging service design to lead change in healthcare. So let’s jump right in. So you’re kind of sitting at the intersection of a few big concepts. So we’re gonna start out by unpacking some of those concepts and [00:06:00] then we’ll kind of get into the nitty gritty.

Nicole: So listeners, bear with us. So first let’s start out by unpacking leadership. What does good leadership mean to you?

Claire Phillips: Okay, so this is a huge question. And I’ve developed framework for leadership that I use with my, my personal coaching clients. And it’s called Spectrum and Spectrum. Think of it as an acrostic poem. So each letter Ties into a key concept that I believe that, really makes leaders exceptional, especially when it comes to leading change. So the first one is systems thinking, which I know we’re gonna talk about in a little bit. , but systems thinking, seeing the big picture, looking beneath the surface, , understanding that your perspective is very valuable, but also so as a perspective of other people.

Claire Phillips: , those are my core elements of how I teach systems thinking. The second element is partnership. So, , we will not accomplish anything of meaning that lasts alone. I firmly believe that. And [00:07:00] so partnership is all about looking for co-collaborators in, unique spaces, looking beyond the traditional, partners that we imagine.

Claire Phillips: to think about who might we be leaving out that we should partner with to do this work. Third is execution. So basically, can we do what we say we’re gonna do? And so a lot of this is about just self-management. Knowing yourself and knowing what your capabilities are, and also where your weaknesses are, and where you can strengthen those communication.

Claire Phillips: I believe that leaders need to be able to communicate. I mean, that’s pretty straightforward. And my the way I teach and, and address communication is be direct and respectful at all times. And that’s really most of what you need to know. If you can do those things that’s gonna make you a fabulous communicator, but it’s easier said than done.

Claire Phillips: And then next is transformation. So I’ve been in my doctorate, we were trained in transformational leadership [00:08:00] which is all about Casting a vision, inspiring your team, going beyond the typical day-to-day manager role. And so I do a lot of educating around what transformational leadership can look like for nurse leaders.

Claire Phillips: And a lot of that is reimagining how we think about leading and change. So that’s like a whole other podcast episode, but I just wanna throw that out there. And the next step is resilience. I think this more than ever is so critical for leaders and resilience is being able to manage a workload while taking care of yourself.

Claire Phillips: And again, easier said than done. And we can actually use kind of a systems thinking lens to look at resilience as a system property. Like why are systems resilient? How can we take that systems thinking lens and apply it to our own life and work? And then utilization, we’re almost done.

Claire Phillips: Utilization’s a second to last one. And that’s about looking at what resources we have and figuring out how to actually use them creatively. [00:09:00] Every leader faces constraints, whether that’s budgetary what, whether that’s geographic, just look at what we have and get creative about the agency that we have to do something cool with what’s available to us.

Claire Phillips: And then finally, is mapping and design. I really like the word spectrum. There’s no d in that word, so I don’t know if mapping, but mapping really encompasses this element that we’re talking about today, which is design. And so mapping refers to, we can take a lot from design thinking and systems thinking when it comes to how we think about our organization, how we think about our teams and then how we can work creatively with our teams to come to solutions.

Claire Phillips: So that’s the spectrum framework, eight core competencies of being a leader. And that’s. That’s it.

Stephanie: I love that. I’m sorry I missed some of the letters, but I will, I will listen back.

Claire Phillips: worries. I’ll email you.

Stephanie: You’re fine. [00:10:00] Okay. So for our listeners who have not checked out episode 44 yet, which we highly recommend that they do which you talk about systems thinking, can you briefly describe what systems thinking is?

Claire Phillips: Yeah, so I’ll start with the like traditional definition that I’ve definitely pulled from multiple systems thinking thought leaders and sort of made into my own mumbo jumbo. And then I’ll, I’ll give you the like clear definition. That’s much, much shorter. So if I were writing a research paper or an article, I would say systems thinking is a conceptual framework, a set of tools and a language that helps us see the interconnected patterns of the world around us and address the complex challenges that we face within that world.

Claire Phillips: Okay, so three things. Conceptual framework, set of tools, and a language. And the way I teach it is it’s a way to see problems, describe problems, and solve problems.

Nicole: Perfect. Okay. So then the third [00:11:00] concept before we dive into the, to to the meat and potatoes here is during our phone conversation, you had mentioned a concept that is those new to Stephanie and I, which is service design.

Nicole: Can you share the principles of service design with us? And then maybe within that, can you describe the difference between service design versus product design? Maybe that’ll also help firm that up for.

Claire Phillips: Sure. So let me just start by saying that service design is an approach that’s based in the principles of design thinking. So if you’re familiar with this idea of design thinking, you will be able to hop right into this conversation. If you’re not familiar with the principles of design thinking, they take us through five main.

Claire Phillips: Steps to approaching solutions or idea generation. And those five steps are as follows. First, we empathize with the user. We work to understand who is a person that we are designing this service or [00:12:00] product for. What are their pain points? What do they need from this service? And that’s always where we start with that user in mind.

Claire Phillips: The second step is to define the problem. So what are we actually trying to do? And we wanna make sure that what we’re actually trying to do relates to that user’s need. The third step is to ideate. So we’re not going to immediately jump to a solution. We’re actually going to spend a lot of time Exploring what could a potential solution look like. The next step is to then prototype. So this is how can we bring potential solutions, more than one typically potential solutions back to that user and other stakeholders. Gather feedback before we move forward with ultimately selecting which solution we want to move forward with.

Claire Phillips: And then move into that final stage, which is testing. Now I just said final stage, but really you can think about this as an infinity sign, so, or a double diamond, it’s also referred to. So we’re constantly moving through these steps. It is not a [00:13:00] strictly linear process. So design thinking is ultimately about trying things.

Claire Phillips: You know, I kind of think of, I’m not sure which tech company it is, but it’s. Move fast, break things. It’s sort of that mindset where you’re not following this like strict project management system to get to an ultimate outcome. You are exploring, you are trying things, you are adjusting, you are adapting, you are being flexible with how you solve problems.

Claire Phillips: So it’s, I think it’s really, really, really cool. And it’s something that I think we should see more of in healthcare and especially in leadership. And so that’s design thinking in a nutshell. Service design specifically focuses on how can we design services that we provide to people. And so the difference from service design and product design is we’re designing products with product design.

Claire Phillips: So if like we’re trying to build a new hospital bed, if Stryker is like, how do we make our beds faster, safer? Easier to drive, et [00:14:00] cetera, that they’re gonna follow a design process to ultimately come up with this new and improved hospital bed, but with services like say, which we’re gonna talk about, this is a project that I worked on, but if we’re looking at how can we make the ER triage experience safer, more, enjoyable faster for patients in the er how can we use design thinking to design this service?

Claire Phillips: And an important thing to know with service design is that it tends to focus on not just the patient, but rather focusing on the staff’s experience of the service. Understanding that if we. The staff’s workflow, if we make it easier for them to do their job and do it well the patients are also gonna benefit from that as well.

Claire Phillips: And this isn’t just in healthcare, this is also in other industries where we would refer to patients as clients or customers. But it’s, yeah, it’s this focus on how can we make the staff’s experience better to ultimately also make the [00:15:00] patient’s experience better. It’s a win win.

Stephanie: So we haven’t prepared you for this question, but I wanted to ask it anyway because I have this conversation a lot on my, career of what is the difference between research quality improvement and a v p. So, how is service design different or similar to quality improvement

Claire Phillips: yeah, it’s a good question. Well, so we know research is the generation of new knowledge and we know that quality improvement is the application of that knowledge that’s been generated by research in a practice space. And then if we look at service design, we can look at it as either quality improvement or this Because I think with quality improvement, I struggle with the term improvement because that means that there’s something that already exists that we’re working to improve.

Claire Phillips: And so that is like, if we talk about change versus transformation, where change is something that we’re doing to make things better or faster or more [00:16:00] efficient transformation is where we’re turning something into something completely different, caterpillar to a butterfly. And so I think service design has the opportunity to fit into quality improvement or organizational transformation, just depending on how you wanna leverage it.

Claire Phillips: But I think it gives us, i, I, I kind of like to think of it more about the transformation angle rather than the improvement angle. Because with design, you’re really starting from not the bottom, but, but from. From the center, which is the user. And so you’re, you’re building out this new thing that if you were working to improve an existing process using service design, that might be a little bit tricky cause you’re constrained by what already exists.

Claire Phillips: I hope that was understandable. Um,

Stephanie: It It was to me.

Claire Phillips: okay, great. Well, listeners write in and let us know.

Stephanie: But I also spent all my days nerding out about this stuff, so, and as do you, I’m sure.[00:17:00]

Claire Phillips: Yes.

Stephanie: Alright, so you have done a large project using service design. Can you share with our listeners what you did and how you went about.

Claire Phillips: Yeah. So I’ll actually talk through two projects because they connect to one another and I’ll start. Explaining In my doctorate, I did a lot of design coursework as well, so I have a certificate in, I don’t even remember what it’s called, I think like healthcare design, something like that. And so yeah, I, I ended up taking a lot of design classes and I adored them and I took this one human Factors class, which we learned about service design and we had to do a project. And so I partnered with one of my fellow students named Erin to develop a service design committee in my emergency department, made up of frontline staff. And this was very helpful for me as a leader.

Claire Phillips: So kind of fed two birds with one scone, if [00:18:00] you will. Because I was able to do this project, but also I was able to train this awesome team of engaged frontline staff to help me solve the problems that our unit was facing. And so Erin and I, Erin came in as an intern in my department and we started this, this committee of frontline staff.

Claire Phillips: What we did with this committee is we met, I think every other week and we did some strategic priority identification with design brainstorming tools. So it was really fun. We did a lot of like post-it mapping, things like that. And ultimately the goal was to figure out what are the, the main projects we wanna take on in this next year as a department to transform the customer and staff experience.

Claire Phillips: And one of the top priorities that we identified, and when I say we, I really mean the staff. I was just taking a lot of notes. They had fantastic ideas. Was [00:19:00] redesigning our triage process in the er. And to give you some context, This was 2021 in a fairly busy emergency department. So we were dealing with the delta variant.

Claire Phillips: We were then dealing with the omicron variant. We were seeing just skyrocketing acuity and patient census and having a lot of trouble with boarding because we could not move patients from the emergency department into inpatient beds because we just had so many patients and that the throughput in the hospital system was a disaster, to put it mildly.

Claire Phillips: So we were having really hard time in triage because that was just kind of where all the problems of the department were pushed as people were waiting longer and longer for rooms as. Staff experienced a lot of hostile patient interactions, unfortunately. And it just did not feel safe out there.

Claire Phillips: It did not feel efficient. It did not feel like we were giving people a positive [00:20:00] experience, even though our staff were running their butts off trying to do the very best that they could. And as you can imagine, this was really painful for staff as. Couldn’t help people in the way that they wanted to.

Claire Phillips: So anyway, all of that to say triage was a high priority space for us to, to to redesign. And so I ended up turning that project into my D N P project. I had another project that I was doing, but I saw how much time and effort was gonna go into this one. So I ended up switching my focus. But this project was yeah, a lot of work.

Claire Phillips: And so with the services design angle, what we did was we asked this frontline staff group to come up with what would make their experience as a triage nurse or as a triage emt or as a triage physician or nurse practitioner what would make their experience better.

Claire Phillips: So once we had [00:21:00] some initial ideas of where we wanted this to go we did a lot of work as a group to start mapping out both the patient journey and the staff journey, like the ideal journeys that we wanted to create throughout the triage process. And so this was just a really creative exercise in figuring out what could this look like?

Claire Phillips: Cause we really were doing things completely differently than ever before. And this part of the process was heavily informed by literature reviews that I and my my partner in this work, Erin did together to figure out what were other, ERs doing, what had worked, what didn’t.

Claire Phillips: We did a lot of data analysis to see like where were there, where were the pinch points in our process what were the most common chief complaints that we were seeing coming into the emergency department. At what times were more people coming in? When did we need more staff? When did we need additional seating, [00:22:00] things like that.

Claire Phillips: So a lot of lit review and then data analysis to kind of give us some, something to start with. Cause creative brainstorming is so important, but we also want it to be grounded in the reality of what we’re working with. And so with those things in mind, we ended up developing this hybrid model of multiple different strategies that ERs around the country and around the world, frankly, cuz we looked at Australia, I think we looked at the UK as well, maybe a couple other countries.

Claire Phillips: So this hybrid model between these other triage models that other hospitals were doing because I, I guess it’s important to say that every organization has a different set of challenges, constraints, context, populations, and so there’s no cookie cutter, 100% right way to do anything in healthcare, in my opinion.

Claire Phillips: When it comes to the actual like, implementation of these important ideas. so we just basically took what we thought was helpful from all these different places and made something new.

Nicole: So what would you [00:23:00] say were your biggest barriers and how did you overcome them when you were implementing this service design project?

Claire Phillips: Yeah, that’s a great question. And barriers? There were many as with any change project, right? And so it’s all about just navigating those as best you can. I think the first one would be just managing our staff’s exhaustion level. Leading change in times of crisis is X times harder.

Claire Phillips: And particularly when you are asking. The team to do something that’s never been done before. You’re asking them to trust in this unproven process. Especially when that process requires them to put in more energy upfront in order to change their deeply ingrained habits. When you’re out in triage and you’ve been a triage nurse for five to 10 years, you have a flow.

Claire Phillips: You have a rhythm, you know exactly what you’re doing. Even on the hardest days, you at least know, like you have muscle memory, you [00:24:00] know where you need to go to grab things. And yeah, you understand the process at the very least, even if it’s not like the best process in the world. And so when you ask someone in a high stress environment to behave differently when they’re already exhausted, potentially burning out that is that they’re asking a lot of them.

Claire Phillips: And so I think that was probably the biggest barrier was just navigating that. And, you know, there’s not an easy way. To do that particularly when change slash transformation is what could potentially save us from this really terrible thing that we’re dealing with. Not to say that like this project would’ve been a silver bullet solution to like our failing healthcare system, but it could have relieved some of the pressure.

Claire Phillips: So yeah, I think, I think just dealing with, and, and I don’t mean dealing with like it was this annoyance, but just like navigating the like very real emotional turmoil that comes up when you’re asking people to do [00:25:00] work differently. And then I think another barrier is just logistically like having enough staff and having enough staff hours to train people into a new process.

Claire Phillips: You know, 2021, at least in my area, we were. Hemorrhaging staff. I mean, and it was like people were just swapping hospitals looking for something different and really what they’re finding is a lot of the same stuff everywhere. But so we had a ton of turnover. We had a ton of new staff coming in.

Claire Phillips: We had staff, we were training into the to be like part of the pilot team. So we had like a core group of staff who knew the process inside and out to pilot it so that we could get a feel for how the process is working before we rolled it out to the whole staff. But then we experienced a ton of turnover within that core pilot team as well.

Claire Phillips: So it’s like the best laid plans, just nothing went as expected. Which to be clear, it never does, but I feel like we’ve faced a lot more logistical challenges in this project period than in other times [00:26:00] I’ve led projects or participated in projects. So. Yeah, I think just the staffing logistics was really challenging as well.

Claire Phillips: And then finally triage, ER triage is not just related to the er. We’re touching radiology, we’re touching transport, we’re touching lab. I mean, All of these different stakeholders, cost centers, departments intersecting to perform the process of triage for our ER patients. And that means that you have to communicate, communicate, communicate, get buy-in, talk to these folks.

Claire Phillips: And you know, pie in the sky, ideal situation would be to have a member of each of these committees heavily involved in the design process itself on the service design committee. And you can make that request of a department, but they may not show up. They may not have time or staff hours to send people to participate.

Claire Phillips: And so that was certainly a challenge as well. It’s just making [00:27:00] sure that we had those voices represented and we didn’t forget anyone and for sure we did. I. I’ve never, I’ve never done a project where we perfectly included everyone to the degree that I or they would’ve liked be included. So yeah, I think those are the top three.

Claire Phillips: Staff exhaustion, staff, logistics, and then interdepartmental communication.

Stephanie: So could you talk about things that you did to sort of overcome those barriers?

Claire Phillips: Yes, yes, I can. I think overcome is maybe overselling what was accomplished. I think again, navigate paddling through the storm, I did a lot of that. So with staff exhaustion, I think a main strategy was to do our best. Again, I don’t think we perfectly achieve this, but to do our best to. Insulate the pilot [00:28:00] experience to a core group of staff members who either volunteered or we had like motivationally interviewed to participate in this experience who could really learn it well and then be the teachers to the rest of the team.

Claire Phillips: And so I think having a designated pilot group was, was a good idea and was ultimately helpful. The other thing with managing staff exhaustion with changes, I, I was there every shift, every day, 12 hour days as a leader present with the project, myself and Erin, the intern who was helping us to. I, I just wanted to be available to answer questions to model that like, leadership is also here, working their butts off alongside you during our best to make this work.

Claire Phillips: And yeah, and then I, I worked really, really hard. I say I, myself and the service design [00:29:00] committee worked really, really hard to have clear education and curriculum built out. I mean, I have never. Spent so much time making presentations and the team and I filmed a walkthrough video with staff actors to show all the different pathways that patients could take through triage with this new process.

Claire Phillips: so that was on YouTube for them to watch, and we had all kinds of color coded charts and process maps that I designed on the wall that they could reference throughout their shift. So many resource materials and really tried to make it like engaging and fun colorful, not like this really long block of texts they had to read, but like easy user friendly.

Claire Phillips: So we were using these services, design the principles when designing the tools that were teaching the staff how to do the thing that we designed using service design. So really, yeah, just infusing design elements through everything, every part of process, including that staff education experience. So I think that, did [00:30:00] help.

Claire Phillips: I think people did feel supported and like they had things that they needed to succeed. Of course. There’s always more that you can do. It’s just kind of knowing where you wanna spend your time, like your very limited time that you do have. And then, the staffing shortage thing, I, I navigated that the best I could as any nurse leader in that context.

Claire Phillips: I mean, you’re picking up shifts, you’re working late hours, you’re trying to fill the holes, but ultimately, like the problem is bigger than you and your ability to hire people or interview people. So that one I think I didn’t have much control over and that, that, so the very, very painful obstacle that persisted after the project was piloted.

Claire Phillips: Oh, and then interdepartmental communication. I think just owning your mistakes, like when you forget to tell radiology that there’s this new, like, nuanced thing that we’re gonna do differently that you didn’t think would matter to them, but it ultimately does.

Claire Phillips: You just own up to it. I think I did a ton of [00:31:00] just like genuine apologizing and not to say like, oh, I’m the worst person ever. How could I forget to do that? But just like people are gonna get mad at you and instead of letting it be political or fight back, I mean just saying, you’re right. I’m so sorry I dropped the ball.

Claire Phillips: How can I make this right? What does your team need from me? And just kind of trying to jumpstart that relationship with this like authentic desire to.

Stephanie: Yeah, I love that.

Stephanie: I was just gonna say with that, yes, I mean, because I do a lot of the similar work, not, you know, so much service design, but change making and yeah, the staffing crisis is, is real and huge and so I’m always trying. Not necessarily sell it, but prioritize. This would hopefully make our jobs or your jobs easier or more efficient in the long run, even though we might have to pack some time in [00:32:00] upfront.

Stephanie: And really like not taking on projects that are gonna add. I think as a nurse I see that all the time in healthcare where some service line, like medicine or pharmacy or physical therapy or any of them, if they don’t have the capacity to do something, for some reason it gets put onto the nurse.

Stephanie: or, you know, it’s like the nurse’s job to Pick up the slack, so to speak. And so I constantly try to, not take those projects on or like, Hey, if this is a problem in internal medicine, then the internists need to, manage that without , giving that responsibility to a nurse.

Stephanie: Because I see that all the time, and as nurses we are like, really like, okay, we’ll do it. Like, and, and we just can’t. We can’t anymore. It’s not possible. And it’s at the detriment of our patients and ourselves, [00:33:00] our self care.

Claire Phillips: Yeah, absolutely.

Nicole: So Claire, what recommendations do you have for leaders to infuse service design into their professional roles?

Claire Phillips: Yeah, so I think the first thing that I will say is you do not need to infusing service design into your leadership style does not mean that you need to start some huge, big, transformational project. It can be in the really simple day-to-day stuff, the way that you solve these smaller, less complex problems.

Claire Phillips: And it can be, yeah, just something that you’re doing as a habit all the time. So the first, the first recommendation that I’ve had is to make your team’s success, your priority. I really believe that the greatest investment that you can make in your organization is making your employees work easier and more enjoyable.

Claire Phillips: So if you can filter your decision making through that staff first lens, I think that will make your job as a leader a lot easier. And obviously your team’s job easier as well. So [00:34:00] that’s just like, First one is filter your decision making, wanting your team to succeed. Second, engage your team in problem solving early and often.

Claire Phillips: And this can look like a lot of different things. And I, I do wanna caveat this with saying I am not a fan of presenting problems to your team and then saying, what do you think we should do about it? I find that to be taking it a step too far, I think that you should come to your team with some options of your own and then also, and, and then let that be a jumping off point for your team to give you genuine feedback.

Claire Phillips: So this is not to say like, Hey guys, we’ve got a culture problem. What do you wanna do about it? That’s my greatest pet peeve when leaders do that. But instead it’s bringing prototypes to the I don’t wanna say break room cuz like, maybe not to the break room, let them have their break, but bringing them out onto the floor and say like, Hey, I made this poster for people in the [00:35:00] waiting room.

Claire Phillips: Or I’ve made this resource list for you. Is this helpful? What would you change? And asking open-ended questions, not like, do you like this? In fact, is this helpful? No, I say, what would you change? What, what works about this? What other ideas do you have for me? What am I missing here? What have I not considered?

Claire Phillips: I think asking questions like that can be really helpful. So yeah, bringing them into the, into the problem solving process earlier rather than later. But also, bringing them something to get their ideas started with rather than just like, Hey, what do you think? Solve the problem yourself.

Claire Phillips: And then the third recommendation is to train your team in design thinking. This is what I did with our service design committee and it yielded fantastic results. If you can get your staff engaged and thinking like a designer you’re gonna get 10 x the amount [00:36:00] of good ideas that you could have generated on your own, probably more than that.

Claire Phillips: And so really leverage the brilliant minds that you have in your department and empower them to come up with these really, really innovative, cool solutions. So yeah, I, I think those are my top three. Make your team success, your priority, engage your team in problem solving early and often, and then train your team in design thinking.

Nicole: Yeah, obviously we love communication, so I really appreciate you giving the tangible. Here’s a great way to reframe that question, so thank you for that.

Stephanie: Yeah. So from the other perspective we know that frontline workers are critical to making change. So what communication tips do you have for frontline workers when they communicate with leaders?

Claire Phillips: Okay. I love this question. I get asked this a lot on Instagram and my number one recommendation for frontline workers is to [00:37:00] develop a relationship with your leader. And some of them say, well, they’re not approachable, or they don’t listen to me, make a demonstrated. To build a relationship with your leader, stop by their office, check in on them.

Claire Phillips: When you see them in the hallway, say hello, how’s your day? And obviously I expect leaders to do the same thing to their frontline staff. So I’m not in any way saying like, frontline staff, it’s on you. I’m just saying like, you can meet the leader halfway. And the value of trying to develop a relationship with your leader is that you are demonstrating to them that you are open to having this two-way relationship.

Claire Phillips: So when you mark yourself as someone open, then the leader is more likely to approach you and ask you for feedback. I think having been a nurse leader, I think sometimes you feel like you don’t wanna bother people when they’re at work. And when there was someone who identified themselves, who was an open source of creativity, who was interested in talking to me, who I knew like [00:38:00] genuinely liked me, I was naturally more likely to approach them.

Claire Phillips: Now, I certainly was aware that that was like a bias that I had and I tried to make sure to spread the love. But you’re creating this like natural pathway for your leader when you are opened and friendly towards them. So I just recommend doing those like basic things to first develop that relationship with the leader.

Claire Phillips: And then I want you to view that as an actual relationship, that two-way street. understand that because it’s a relationship. Your leader has things to teach you and share with you, and you have things to teach your leader and to share with your leader. And so don’t. I try to get out of this hierarchical view of they’re my boss, and the information can only flow one way to really think of like, this is a partnership and how can, how can I help and how can you help me and let it be this more organic, like natural, legitimate relationship rather than just like boss [00:39:00] employee.

Claire Phillips: And yeah. So, and all this is doing is just normalizing that they can come to you, that you yeah. Are that open source of creativity who can help generate ideas and give them feedback.

Nicole: Okay, so say you’ve created, you’ve laid this groundwork and we now have this relationship. Is there a certain way to like frame. Ideas you have or suggestions you have.

Claire Phillips: Yeah. I think There, there’s one framework that I teach that I like, and I don’t think this is the only way to talk about problems or present ideas, but I do think it’s really helpful, particularly if you’re working with someone who is maybe like less open and you feel like you have to, like, prepare and really make a case rather than just like sit down and have a chat.

Claire Phillips: And in that case, I, it’s helpful to think about presenting the gap and the gap is the gap, the literal gap between what we’re doing now versus where we wanna be and what we wanna be [00:40:00] doing there. And so if you can say, here’s the current situation here is either my experience or the experience of other people as well.

Claire Phillips: Or the like literal data taken. The unit spreadsheet, whatever it is, here’s a situation. Here’s current state and here’s where we wanna go. You know, cast the vision for your leader. You know, your leader should be able to do this as well. But when you’re presenting an idea, present the gap, current reality, where you wanna be, ideal future.

Claire Phillips: And then the natural question that comes from, here’s where we are versus here we wanna be, is how will we get to this ideal future? And then that is the impetus for starting to have a conversation about solutions, creative brainstorming. And the key here is to not present a definitive solution. You just want to initiate the conversation because with design thinking, like we talked about at the top of that episode, we don’t wanna jump too quickly to a solution and [00:41:00] discount the possibilities for something even better.

Claire Phillips: We wanna spend time in that exploratory stage. So it’s like, for example, let’s say we’re talking about the triage project and Nicole’s, my boss and I come to her and I say, Nicole, the nurses and EMTs are absolutely exhausted in triage. We don’t feel safe. You know, if I have data, here’s the data to support this.

Claire Phillips: Wait, times are getting longer and longer. What we imagine is a triage experience where the staff feel supported, where they feel safe, where patients are getting the care they need and it’s efficient. And where, the business is doing well because we’re actually generating revenue from the patients that we’re actually able to help rather than them leaving.

Claire Phillips: This is, the current reality of what I see. This is where I want us to go. I’m curious, have you noticed this? I’m curious, what have you thought about this problem? And just start the questionnaire and they might say, well, I have no idea. What do you think? And then you can give some some of your own perspective there as well.

Nicole: Okay. I wondered if maybe. A [00:42:00] couple solutions or, and I use, I guess, solutions loosely, ideas, you know, if that is helpful to have in that conversation or what your thoughts were.

Claire Phillips: Yeah, I think, I think if you have, like, if you’ve done, I think informed solutions are helpful. I think if you just told me like, well, I just think that we need five more triage nurses, and I’m like, okay, tell me more about why you think that. Well, I don’t know. That’s, that’s not super valuable. But if you’re like, yeah, I’ve been, I did a alert review.

Claire Phillips: I read a few articles. This model seemed to work really well. I’m curious, has this department ever tried anything like this before? Have you read anything about models? I think. absolutely present an informed solution. If you think it, it would be a good idea, but leave room for a conversation, leave room for other ideas.

Claire Phillips: Yeah. But what we wanna avoid is like shutting them down or making them feel like you’re making a demand of them No one is in a position in an organization to be making [00:43:00] a demand of anyone else, regardless of your position, because you do not have the full perspective and context that you need in order to do that in a meaningful way.

Stephanie: So we talk a lot about, you know, all nurses as leaders. So even if you are a frontline worker and you don’t maybe think of yourself as a quote unquote nurse leader in your organization, often we, you know, as nur, as frontline workers can be leaders like informal leaders.

Stephanie: So do you have any tips on, for frontline workers to kind of communicate with other frontline workers, like in this kind of informal leadership role, like a change agent?

Claire Phillips: Yeah, I think honestly, it’s a lot of the same stuff. Develop relationships establish a culture of open creativity and curiosity. I think one thing you have as in a peer-to-peer conversation about making change is [00:44:00] that your peer is gonna be able to be a little bit. They’re probably more comfortable being honest with you about what they really think.

Claire Phillips: And so you as a frontline change agent can leverage that. You don’t have to do the work of a leader, which is like reading between the lines and like filtering everything anyone says through you too. Like, are you just saying this to me because you’re my direct report and you’re scared? Or like you, you know, there’s just a whole other layer of meaning that you kind of have to peel away when you’re a leader.

Claire Phillips: Having a conversation with a frontline staff member, even if that’s not like what you desire from that conversation, like that just kind of naturally is something you have to consider. But peer to peer, like you have potentially more transparency, more just natural trust established between you.

Claire Phillips: So I think you can apply that to the suggestions that I’ve already given, but. Frontline workers. Like, it’s the same thing if you’re, if you wanna engage people in solving problems, present the gap. Ask exploratory [00:45:00] questions bring them prototypes, seek their feedback. Genuinely like engage with their ideas.

Claire Phillips: Don’t shut people down. I mean, it’s really a lot of the same stuff. Yeah. Thank you.

Nicole: Yeah, and you make a good point. There’s definitely maybe a little bit more of like trust equity or, or you have more trust equity when it is frontline to frontline. So that can be very helpful in making change.

Nicole: So thank you for that. Well, we. Talked about a lot of things. What is the one thing sometimes this gets fudged to, like one to three things that you would want all listeners to know about leveraging service design to lead change in healthcare.

Claire Phillips: I think the one thing that I’d want people to know is, is that it works. I think I would want them to know the definition of service design and understand why it works. And when I say that, I mean this idea that when we invest in our people in an organization, when we invest in our staff’s [00:46:00] experience, They are going to create and craft and deliver a more meaningful experience for the people they are providing a service to.

Claire Phillips: I just like so deeply believe in this approach, and I think if we look at healthcare today, unfortunately we’re completely missing that. and so I think, yeah, if there’s one thing I want people to know, just do it. It’s invest in your people. It is leverage your people’s expertise in the work that they do because they know their work best better than you.

Claire Phillips: Even if you did their job five years ago or five minutes ago, you’re not doing their job right now. and you need to understand that, respect that, and as a leader you have responsibility to leverage that knowledge. So, yeah, my, I guess, I guess my, the one thing is do it, do service design, understand why it’s important, and then share that understanding with other people.

Claire Phillips: There are fantastic [00:47:00] books and articles about service design and why it works. There are consultants, hi me, who can come into your organization and give presentations about service design to your C-Suite to help them understand how to leverage it, how it’s so useful, why their team should be trained in it.

Claire Phillips: Yeah, spread. Spread the word is my advice

Nicole: Well, and Claire, I almost forgot to ask cuz you know, we’ve probably, a lot of our listeners are still probably wondering, and perhaps you answered your own question is, did your change, your project that you did with the er, did it work? Is it transformed into this new, beautiful, thanks cuz I bet they wanna know.

Claire Phillips: in. A short answer. Did it work? Yes. The intervention itself, we had a very positive data. Outcomes wait times went down. Medications were given much faster to sicker patients. We had lower wait [00:48:00] times in the er. In terms of was it transformed? I would say no, because ultimately when, where we left the project, when I transitioned out of my role we were in a major staffing crisis.

Claire Phillips: We could not staff the model that we had built. We had buy-in from our physician group. We had buy-in from our a p p group. We had buy-in from radiology. We had buy-in from everyone we needed to. My nursing director was incredibly supportive. Our c o was supportive. We were actively hiring for the roles that we had developed.

Claire Phillips: But we did not get enough nurses in the door to staff those roles. Additionally well, I, I think Omicron kind of Through a wrench in some things because we were anticipating this massive omicron surge. So we ended up adapting the model further to support having a ton of hallway [00:49:00] beds for omicron patients.

Claire Phillips: And then the surge did not arrive as anticipated, which is fantastic news that we did not have an overwhelmed, a further overwhelmed healthcare system. But we didn’t end up using that secondary model either. So I think it was an, I think it was a success in that we built a model that had the capacity to be successful if logistically we were able to staff it in the future.

Claire Phillips: So that is what I am proud of. I am proud of the, the concept that we developed and then the fact that when we had the staff to run it, it was successful. But I and my team can’t take responsibility for like the greater systemic factors going on that could make, that could make or break that projects.

Claire Phillips: Experience. So yeah, it’s a mixed bag. I think a lot of change projects are. But I think that it was a really important step in the right direction for that department, for that team. And [00:50:00] just for well definitely for me, in terms of how I think about leading change and er triage. I mean, we developed a new model.

Claire Phillips: It’s really quite cool what we did. Yeah, so I’d say was it a success? In some ways yes. In some ways, no.

Nicole: Yeah, I mean that certainly deserves accolades and it’s a lot of work to create an. New model and I would say that if you are able to reduce wait times and get medications admitted cert faster, those, those are wins. Those are big wins, so congratulations.

Claire Phillips: Thank you. Yeah, it was, it was, it was awesome when it was rapping and rolling. It really was. And I think everybody was a little dis it maybe everybody is a, a strong statement, but I think the people who were really engaged in the work were excited about it and disappointed that we couldn’t ultimately deliver on it as a sustained intervention.

Claire Phillips: But it’s there if they need it. And I’m hoping that the leadership that followed [00:51:00] me will continue to try to transform triage.

Stephanie: Huh. All right. So, and I, you know, I always think it’s, it’s awesome to even just demonstrate that you can. Makes even incremental changes or temporary changes cuz it shows that, if you can do that, you can do that with in other areas. And I think that’s so impactful for a team.

Stephanie: Okay. So let’s talk about where folks can go to learn more about service design, design thinking, and the work that you’re doing.

Claire Phillips: Sure. So I think if you’re interested in design thinking and you are a healthcare clinician provider listening to this I really recommend University of Pennsylvania’s online course for design thinking for healthcare professionals. I believe it’s free. I know they have at least a free mini course on their website.

Claire Phillips: So definitely check that out. Other organizations that I really like [00:52:00] to learn about design skills from are I D O. And I feel like I had another one in my head but is now gone. So I will say U Pens course and then I also talk about design thinking, some in my content as it relates to nurses and nurse leaders.

Claire Phillips: So if you are a nurse or a nurse leader or really any kind of healthcare worker, you might find value in, in what I share on Instagram. So you can go to my Instagram, which is at nursing dot the system. And my website, nursing the system.com has a lot of free resources and blog posts around leading and change in the healthcare sector.

Claire Phillips: So I would recommend going there as well. And then in terms of the work that I’m doing, you can find everything you need to know on my website, but I will give you just like a couple things that might appeal to this particular listener. If you’ve made it this far in the episode, you might like these things.

Claire Phillips: The first is I have a 10 week online program. [00:53:00] That is for healthcare professionals and it is called Changemaker Essentials. And it is to learn all the little known fundamentals of systems thinking, change, leadership and professional development. It is available for individual healthcare providers and also for teams and organizations.

Claire Phillips: And RNs who take the course can earn a 12 continuing education contact hours. This is my like signature course. All of my one-on-one coaching is available to graduates of the course. So this is like the prerequisite to a lot of what I do because this information is truly so foundational to being a change maker.

Claire Phillips: And I wanna make sure everybody has this information so we’re all operat. On the same page. And then if you are a nurse leader looking to infuse system syncing and design thinking into your practice, I do offer a personal nurse leader coaching as well, and I am currently accepting new clients. I’m not sure when this will air, but feel free [00:54:00] to email me or DM me to inquire about that and we can have a conversation about what that would look like.

Stephanie: Claire, I would personally like to thank you so much for your time and commitment to advancing sexual and reproductive health through communication. And thank you for being on again. Do you have any last thoughts that you would like to add before we end?

Claire Phillips: No, I don’t. Thank you so much for having me. It was a blast as always.

Stephanie: Yes, it was.

Nicole: Thank you so much, Claire.