Matiu Bush On How Human Centred Design Can Positively Impact The Health & Aged Care Industries

Matiu Bush is currently doing an innovation residency at Bolton Clarke based on the principles of anthropologist Clifford Geertz called "deep hanging out".

Matiu has a Master's degree in Public Health and broad clinical and managerial nursing experience, including working in Tijuana, Mexico with Nobel Prize Laureate Agnes Bojaxhiu in international boarder aid, and as a emergency, oncology, intensive care nurse and is a sexual health Nurse Practitioner.

He has experience in elective surgery waitlists and management of Specialist Clinics. In his role at the Victorian Comprehensive Cancer Centre, Matiu focused on designing "Michelin Star" waiting rooms to improve the patient experience including pioneering virtual reality for distraction therapy in dental oncology, serology and minor surgery clinics.

Matiu contributes to health system innovation through involvement with Better Care Victoria as a board member and the Emerging Leaders Clinical Advisory Committee. Matiu is a member of the Health Informatics Society of Australia (HISA) and the UX Community of Practice for healthcare and mentors the next generation of undergraduate and postgraduate science students through the University of Melbourne Science Industry Mentoring Program.

Matiu founded “One Good Street” which champions neighbour initiated care for older residents in local communities. One Good Street explores the latent capacity of neighbourhoods to provide care in collaboration with hospital and primary care.

Matiu shares strong insights on life and death, discussing areas of opportunity to deliver positive outcomes which create real change.

Highlights from the interview (listen to the podcast for full details)

[Mikaela Stephens] - To start off, Matiu, could you please share a bit about your background and what led you into design-thinking, healthcare and social impact within local communities? [3:10]

[Matiu Bush] - I was studying fashion design when I was 19 and at the time the Somalian famine was happening. So I would go from working on runways to watching dying kids on TV in the evening. I happened to be in a book store, and saw a book on Mother Teresa. So I wrote her a letter and said, essentially, I want to come and work with you. And she wrote back and said, come on over and start. So that was my first foray into essentially doing things in a very simple way with a great impact, with a huge impact. So I really learned from Mother Theresa for four and a half years on how to get shit done. I came back to Australia, and I studied public health, I'm a nurse practitioner in sexual reproductive health. So I feel that I've always worked at the edges. Funnily, I was looking at some design work that I did and I typed in 'patient journey, empathy journey', and it took me back to 2009. So it’s something I've been doing almost innate for that long and I really think it is about putting myself in the shoes of others, especially when they're experiencing the healthcare system. With a real focus of, how I can make it better just for one person, because if I can do it for one, I can do it for ten. And if I've done it for ten people I’ve got a system, I’ve got themes, I’ve got things that I can polish up so that I can do it and deliver it for 100.

I understand you have been collaborating with your local community on a great initiative called ‘One Good Street’, which has been shortlisted for the QUT Seniors Living Innovation Challenge. Would you be able to tell our audience more about the topic and its social impact? [4:43]

NOTE: After this podcast was recorded, Matiu was the awarded the winner of the challenge - we congratulate him on his achievements and look forward to seeing the program rolled out.

One Good Street is looking at the capability that exists around older people. Often when people talk about innovation and senior care, there's a technology component and they're often expecting the older person to learn or to use some form of technology. One Good Street is a better platform that encourages a participatory culture within the street itself. So street by street we look at supporting their neighbours in giving great care to the older person that lives on their street. So this is done by a platform, we currently use Facebook because it's a thick market of activity on Facebook. Facebook is where a lot of communities come together and share advice, tips, give stuff away for free. So it's a brilliant way to gain access to a really thick market of social connectedness. One Good Street will, accredit streets as being caring streets. We hope to give to the council a heat map of the best streets to live in if you're older.

You recently collaborated with RMIT on a project called ‘One Good Death’, stemming from a project within your organisation. The waves it has created on Social Media has been enormous, with a discussion surround DX, or Death Experience Design. Could you please tell us more about it, and its aims to shift the discussion around death and dying? [5:56]

Death and dying is a real passion for our CEO here at Bolton Clarke, and he came to me asking if I would begin to explain a framework to produce the best end-of-life experience. So, in true design fashion, I went to the design community. And our first workshop was not filled with clinicians or palliative care physicians. It was filled with 60 design students and together we mapped out what one good death would look like. The students came out with amazing insights from, vets that do better bereavement care than aged care facilities, about the importance of curating a digital identity to pass on to family members once the person had died, to compressing MP3 sound files of discussions around end of life care so that family conflict can be avoided. We've got tangible, practical insights, so the students came up with some amazing design recommendations. We took that back to industry, funeral directors, vets, nurses, doctors, and it resonated with them. So, expanding the type of people we bring in to solve problems in healthcare created a great solution. We are the problem custodians in healthcare, and people who are naturally good at design, are solution custodians. So putting everyone in the same room really made a big difference.

Do you believe using a design-thinking process is one of the best ways to respond to global challenges and if so, why? Additionally, how do you utilise this tool differently within large organisations, and community practice? [7:45]

That's a really good question. The methodology of human centred design needs to be flexible and the more you do it, the more you discern what aspects of it need to be at the forefront. The artefacts that human centred design produces for me are secondary to the outcome of delivering change in clinician behaviour. So, for me the end game is changing the experience for a patient, a client and the clinician or carer that they interfacing with. That's the end game. Everything should lead up to that point and be mutually reinforcing to that point. One thing with death and dying, because it's a heavy subject, the normal methodology of post-it notes just was not working, of clustering and framing. It needed something different. So we use laser cut shapes that are quite heavy and where participants in mapping of the journey would gather around a table and use these objects, write on these objects, and stack these objects. It was a really different way to tangibly grapple with all of the stuff that gets in the way of dying a good death.

In the community what was really important was developing clear personas. So; Vera is a hundred years old, she has three months to live. How can you develop, or design, a good death for her? So in the community, it had to be really structured, which is different from when you do it within an organisation where people have the corporate knowledge, they know the systems. So for them, it's a different type of mapping. Within organisations often it's the first chance where people get to really explore and flesh out their frustrations with the organisation.

It naturally comes up during process mapping and good facilitators are comfortable with that and know that's part of the journey of loosening the soil to get some creativity happening.

Your current role gives you the ability to apply design-thinking solutions and innovation into the Australian aged care industry. How do you believe the industry could utilise new technologies and design practice to keep up with the increasing aging population? [9:49]

It's absolutely critical that we expand our thinking, we expand the horizons of what we think is possible. Our current thinking has only got us to a certain point and currently with the range of new technology, we need a discernment on what's going to work and an understanding about what is the best technology to help people live in their homes for as long as possible, and hopefully die in place. We have to be the guide for older people and help them discern what are the products that are going to best suit them. Currently, We don't have enough evidence with all of the technology that's coming through in regards to the long-term outcomes. If you use this technology; sensors, artificial intelligence, machine learning, what is the benefit? It's all so new. It's a really exciting time to be in aged and community care. We’re working with artificial intelligence, with sensors, with monitoring, but we haven't yet discerned or done the research to work out what gives us the most magnitude for the minimal dollar, so there's a real growing time for all of us in the sector.

Design thinking helps us rapidly prototype and that's not normally what we see in aged and community care.

It's a conservative area, so to rapidly prototype something in an aged care facility, in a retirement village, or around the community is very, very new, but it is absolutely the way they engage in a workforce that really hasn't had a whole lot of love.

There is an incredible amount of ideas and solutions out there from our staff that we are yet to uncover and human centred design just helps with that flow and loosening up our staff to letting us know what they think is going to help the lives of older people.

Additionally, what advice can you provide for emerging designers to consider when thinking about moving into the aged care industry? [11:42]

What we like to say is, when we're designing for the aged care industry, we're designing for our future. I would encourage anyone to jump at the chance of working in aged and community care, especially as a service designer, as a human centred designer, as a UX designer. And what I would encourage you to do is work at the very edges and push your organisations to places that they're not comfortable with. And I think that's essential because you come with such a skill set and a vision. Don't sacrifice that at the altar of quality and risk or what is traditional for our organisation.

We need people in aged and community care here that stretch us to the very edge, and that's the only way we can continue to grow and deliver really radical new ways and new models of care that keep people in their homes for as long as possible.

That reduce social isolation, that starts to value the contribution of an eighty year old, of a hundred year old person and that's really important.

And designers have that vision, because they have empathy.

What local or global initiatives have you come across that you believe are successfully tackling wicked problems whilst creating opportunities that provide social and environmental benefits? [12:51]

A couple of things come to mind straight away and one of them is the Kidney matching exchange in the US. So that was set up by economists who work in market design, and market design is really, really cool. So it looks at all of the forces that make up a marketplace and especially where we're not talking about money, we're talking about other goods. So in this particular example, the good that was being traded was kidneys. So the economists in the US devised an amazing way of making sure that people get matched with potential donors. And they have the Nobel prize for economics because they devised a solution and their algorithm that helped match so many people with kidneys and save thousands of lives. Design can save lives. So that's a really exciting one, and we were looking at how we can use the same type of thinking to reduce social isolation.

Another one is called the No-Lose lottery, and that is where we all put in for savings accounts, and what banks do is offer the interest of all of our savings accounts in a lottery. So once a month somebody is randomly pulled out of all the people that are involved in this scheme and given the money as a lottery. So it's actually the odds are far better than ever winning a lottery. I've heard about linking that with health goals in regards to private health insurance or whether you want to lose weight or head to the gym. So when you hit your milestones in regards to your health goals, managing your diabetes, doing extra exercise, you then enter into a category of people that are more likely to win the lottery. So it really combines savings, obesity, increased exercise with something that human’s love - and that's gambling. So I love that sort of hybrid model.

For me, new models of care happen when two unrelated areas start coming together. I actually think models of care is limited, it's really a marketplace of care, because healthcare is so sophisticated, and when we're looking at behaviour change, we have to look at the complexity of what motivates people to change.

So that's why I really liked that.

In your vast experience, from working with Mother Theresa, clinical nursing career, to tackling waiting rooms in Oncology departments, and now solving community based problems, thinking back on the projects you’ve worked on, what are some of the challenges you typically experience and how do you work around them? [15:26]

It is really natural for people who have been working in the area to want to protect their place of righteousness. So when I come in with virtual reality and tell nurses that they need to use this when they're doing painful wounds dressings, they’re naturally going to protect the way they work because they’re defending what they feel is important to them.

So one thing I have learned is trying to engage in their place of righteousness; why they are defending their territory, and equally asking them to engage with me in my place of righteousness.

I want to improve the client experience. I want to improve the patient experience. This makes a difference. And if I empathise with them and look at the resistance, and categorise their resistance to change as part of the change process, that we're actually on the journey now of change, because the resistance is part of that and engage in their place of righteousness to understand why they're defending that. Start to tease that out. Tell me about why this is important to you. Why are you defending there? And then you get the root causes around why there is resistance to something new. It's about reframing that dynamic. So it's not us and them with being resistant. We've got something new and amazing, but constantly driving empathy in everything we do as designers.

What do you believe are the best ways to measure the social impact of a project? [17:06]

That’s a really tough one, but there were major metrics around hospital presentations. There are happiness scores, there are resilience measures, they are all part-and-parcel. But for me it is if somebody thinks of themselves differently.

The latest thinking around behaviour change is that we often don't do what we want to do, such as give up smoking, eat better, do a whole lot of exercise; because we don't see ourselves as different.

And this is one of the things when we work with personas, is that when we want people to behave differently, they actually have to change personas. Because when you see yourself as a different person, it opens up the opportunity of behaving differently every single day. So that's why it's so important for me to look at how people see themselves in their roles, especially in the workplace. How someone who is unwell sees themselves, and if they change their identity then we've got behaviour change that'll last.

What advice would you give to the budding social innovators or even those who are currently within large organisations listening, who have an idea but need to take action to expand and create greater impact? [18:06]

I would say you have the power to create the game. So when you're new in a large organisation, it can be overwhelming if you've got an idea trying to protect it, wrap it in cotton wool, and let it survive the first round of meetings. It's hard, but realise you have the capacity to create the game. Using social media, profiling your idea, canvassing, back channelling, working on a coalition of people that are invested in doing things differently. You can change culture. There's a great line that says, 'culture eats strategy for breakfast', but there are three meals in a day and you have to eat resistance for lunch. You've got to learn to find nourishment in it.

So get in the game. Don't be frightened off and realise that you too have the power to create a certain dynamic within large structures. I think that's the glory of large structures is that they are not aware of everything that's going on. You can create pockets of goodness, be micro ambitious. Stay micro.

Which countries do you believe are leading the charge when it comes to the support and implementation of social innovation programs that transform communities and what can we learn from them? [19:24]

This question probably gets answered with a lot of people talking about the Scandinavian countries, Japan, so I'm going to take a different tact. For me, it's New Zealand and the island nations, including East Timor. Where you have a focus on community because of the indigenous populations, that is really strong. So you see the client is the tribe or the client is the extended family, so the notion of client engagement is far more inclusive. If you think of East Timor or Papua New Guinea, they have a lot less resources, so they have to be incredibly creative. So using the trucks that drop off Coca-Cola all through PNG highlands to also deliver antiretroviral for HIV, so that's the exciting stuff. The diabetes management, the weight loss, obesity management in children in New Zealand shows how schools can be the primary drivers for healthcare of the future. So I think New Zealand and especially the island nations and definitely East Timor and Papua New Guinea have tremendous things to show us and also locally, outback. How in an area where the geography is so great, how we are incredibly creative about delivering healthcare in those areas. So I would work locally and I think that's important because what happens in Japan as a mono culture in Denmark and Sweden are very different cultures, and it worries me when we take a robot that somebody developed with dementia patients in Japan and then we start purchasing them for our aged care facilities here in Australia. When we've got dogs in pounds for $350 who will meet the end if somebody doesn't adopt them. So I think that's really important; how we translate that stuff in and also that we're aware that geographically isolated innovation can sometimes just be a media campaign and it's not necessarily the future of healthcare.

To finish off, could you please recommend a few great books that you think would inspire our listeners?

[Matiu discusses the books listed below in detail.]