Orchestrating Conversations: The Battery Story
At the time of the lab event, Ken was involved in a battery working group within the FDA. Because the FDA’s organizational structure regulates products by use, a focus on batteries was not easily achieved. Within the FDA, one group handled cardiovascular products, such as pacemakers; another worked on ventilators; another oversaw infusion pumps or external defibrillators. Though all these products require batteries, the organization had no common path for battery regulations. Although seemingly simple, batteries are actually complex. Their characteristics change depending on how they are used and maintained in different environments. Device batteries need to work reliably under adverse conditions, during power outages, and in snowstorms with very cold temperatures. Battery failures can lead to serious consequences—even death.
The FDA saw value in initiating a discussion of best practices across all groups that handled battery-powered devices. The work team, wanting broader engagement, decided to sponsor a public workshop. They thought it important to bring diverse parties together, but they approached the conversation with trepidation because the FDA was not considered an expert in the battery space.
Coincidentally, at about that same time, Ken’s neighborhood in DC, Georgetown, invited residents to think together about the future of their community. Ken attended the event and again found himself part of a human-centered approach:
Some attendees were business leaders in the community. Others were residents or people who worked in the neighborhood. There were representatives from universities. And I was just amazed at the way one idea led to another, and then to another—even though you might expect businesses, for instance, to have opposing views to universities, or residents, or whatever. But it was just the opposite—the process helped us all understand each other’s perspectives and build towards a common vision.
Ken left the community event inspired that a group with such diverse interests, in a place as traditional as Georgetown, could create the ambitious plan for the future that emerged from the process. He shared his experience with the battery working team, suggesting a similar approach to engage their constituents.
Recalling his experience with the Lab@OPM, he reached out to lab staff for advice and assistance. Initially, lab staffers were uncertain about facilitating a design conversation with a group as large as the battery working team envisioned—two hundred to three hundred people. They decided to solve the scale problem by breaking the larger group into eight smaller teams of about thirty people, and then subdividing into groups of ten. Lab staff then trained eight FDA employees to facilitate that discussion.
The event that Ken’s team planned and implemented offers us the opportunity to take a deep dive into the mechanics of orchestrating a successful design conversation among diverse stakeholders. We choose the word orchestration deliberately; the need for advance planning and forethought, the assembly of the right players in the room, and the need for a conductor’s deft hand helping them to work together make it an apt metaphor. We often find a puzzling paradox in attempts to facilitate these kinds of strategic conversations. On one hand, leaders are excruciatingly sensitive to all that can go wrong. On the other hand, they naively believe that inviting a group of people into the room and asking them to “talk to each other” is enough. Such an approach is a prescription for embarrassment and disaster. Successful design conversations—especially across difference—require a level of attention to detail rivaling that of a successful military campaign. The battery workshop gives us a chance to explore what a well-orchestrated conversation looks like.
Designing the Workshop
Successful designing begins with knowledge and planning. Knowledge, in this case, was provided by the lab’s training, utilizing a tool kit from LUMA Institute (whom we met at the lab in chapter 1). As they planned the agenda, Ken’s team incorporated design thinking into their own process, using design techniques to brainstorm ideas for organizing the two-day event. They invited each facilitator to suggest which tools to use and in which order. Using LUMA’s human-centered design planning cards as a planning tool, each facilitator placed his or her preferred tools on the wall. Then, as a group, they moved the cards around as they refined the agenda. They used the resulting roadmap to lay out the details of the facilitation in terms of time, responsibilities, room layout, and goals.
To Ken’s surprise, the most inexperienced facilitators sometimes had the most creative suggestions:
On day one, we had planned to create these posters for the different ideas. Typically, we’d take a picture of each and just save it, but someone suggested putting them on a projector and having them scrolling in the morning on day two, when attendees arrived. Then somebody else suggested putting them up around the room, instead, so that people could walk around and look—like an academic poster session. That worked well because you not only had people looking at the posters but the people who created them got engaged. That encouraged a dialogue that wouldn’t have taken place if we had put them up on a screen. If it’s on the screen, you don’t have people talking to each other. They’re not roaming the room. They’re not intermingling.
Roadmap of workshop facilitation.
The intention of the resulting plan—to identify challenges and propose and refine initial solutions—was straightforward. Making it happen with 240 people in the room was not. That required the carefully planned flow and pacing of exercises.
Team composition would also be critical. As the date for the event drew close, the battery working group collected information on attendees in advance, which allowed them to set up diverse teams representing battery manufacturers, medical device manufacturers, and health care providers. They queried attendees about their hopes for the workshop. The group was concerned that most attendees responded that they wanted to see what the FDA was going to tell them about how they intended to regulate batteries and battery-powered devices. Yet the team’s vision for the workshop was the opposite: the FDA did not have an answer; instead, the federal government hoped to engage stakeholders to learn more about the challenges and possibilities.
The two-day event was held in July 2013. In addition to the 240 people who attended in person, approximately seven hundred more participated online. The workshop design included a session in which selected attendees sat around a conference table and participated in an on-camera discussion. Online attendees were able to post questions and thoughts, with facilitators selecting thought-provoking questions for display on a screen in front of the panel for response, the first time this approach had been incorporated at the FDA.
In his introductory talk to the assembled group, Ken began by setting expectations, acknowledging that the pre-meeting survey suggested that attendees had come to hear what the FDA had to say. Instead, Ken explained, the FDA’s goal was to engage the stakeholders in the room to define how they could best work together. “That took the pressure off of us to be the experts, and we became facilitators to bring people together to have a conversation,” Ken recalled. He also shared a rough stakeholder map, a diagram showing the different constituencies in the room.
Day one of the meeting then kicked off with traditional prepared talks by experts, with the presentations kept short and to the point (ten to twelve minutes each). “We wanted to keep things aggressive so we didn’t lose people’s attention,” Ken offered. In the afternoon, they broke into smaller teams (dividing the 240 participants into eight groups of thirty as planned) and began the human-centered design sessions. This agenda focused on the identification of the challenges facing the group and the drafting of possible solutions, using a variety of design tools.
In the first activity, each participant was asked to quickly share his or her name, organization, and stakeholder group. Participants were then sorted again into smaller, diverse groups of ten, a critical design element. “Because people didn’t know each other, they were all on an equal footing,” Ken explained. “It encouraged them to speak up and engage i
n the conversation in a much more natural way than if they were able to form groups on their own.”
Identifying Challenges
Next, the group used Rose, Thorn, Bud, a design method from LUMA’s tool kit, to identify challenges. Attendees were asked individually to use pink sticky notes to identify what they believed to be done well (roses), blue for areas needing improvement (thorns), and green to identify potential (buds). Each participant was encouraged to write multiple items of each type. This exercise encouraged each participant to reflect on his or her own view of What is before sharing it with the larger group. Next, the individual participants shared their notes, and the group clustered the collective set, highlighting areas of similarity and difference. There was no debate about whose view was better or worse. Instead, the focus was on understanding and exploring how each member of the team saw the situation.
LUMA Institute card describing the Rose, Thorn, Bud tool.
Next, again individually, each participant was asked to create at least three “Statement Starters.” The statements each identified an area of opportunity that participants saw as important and focused attention on actionable challenges. They then shared the statements with their group, which together agreed on a single one to continue to work with. The time in which to select the particular challenge the team would work on was limited—extended debate was not allowed.
LUMA Institute card describing Statement Starters.
Brainstorming Solutions
After a short break, groups addressed the What if? question by brainstorming ideas to solve their identified challenges, using another LUMA Institute tool, the Creative Matrix. The goal was to create at least one solution for each box in the matrix; groups of stakeholders (each with a column) interacted with a particular technology (contained in the rows). At this point, the goal was to encourage divergent thinking about possible solutions.
The ideas from the Creative Matrix that the group found most compelling were then prioritized and placed on an Importance/Difficulty Grid that positioned each idea according to its relative importance to attendees and their assessment of the ease with which it could be implemented—this focused on convergence again. In their final activity that day, each group presented the Importance/Difficulty chart to the larger groups.
LUMA Institute’s Creative Matrix tool.
DIVERGENCE/CONVERGENCE IN DESIGN THINKING
Design thinking makes use of cycles of divergence and convergence around each of the four questions. When participants each wrote out their individual thoughts in the Rose, Thorn, Bud exercise, the process invited divergence in order to get differing perspectives on the What is conversation. Clustering these perspectives for similarity moved the group toward convergence, and the Statement Starters exercise completed that convergence and focused their transition into What if. The Creative Matrix then encouraged divergence again.
Refining Solutions
Day two focused on refining and testing the proposed solutions, using a different set of human-centered design tools. When attendees arrived, all the charts created the previous day were on display in the breakout room. The charts acted as a kind of prototype that summarized each group’s thinking in a way that members from other teams could quickly grasp. One member of each group was asked to stand by the group’s chart to receive feedback; other group members toured the gallery of charts to give feedback to other groups. Groups were then given a chance to revisit their solution plan based on feedback received. They captured the revised solutions on Concept Posters. After another set of short presentations to other teams in the breakout room, the group of thirty voted for one poster to be presented to the larger group of 240. They then rejoined the large group. Pictures of the other posters were taken for future reference.
LUMA Institute card describing Concept Posters.
In the larger group, each of the eight teams whose poster had been selected by their breakout group gave a five-minute presentation. Facilitators were not allowed to present. The ideas presented were diverse. One group, for instance, suggested compiling a comprehensive guide for clinicians and users titled “The Hitchhiker’s Guide to the Battery Universe.” Another focused on the creation of a self-managing battery system.
Concept Poster of a comprehensive battery guide.
Concept Poster of a self-managing battery system.
Testing Solutions
To get an initial sense of how well the resulting solutions appealed to the larger group, all participants were asked to vote (using electronic voting devices) on three questions:
1. Which concept will have the most significant impact?
2. Which concept can be implemented quickly and easily?
3. Which concept would you be willing to support, based on your expertise?
The session concluded with the announcement of the results of the votes: the self-managing battery system was seen as having the most significant impact and the most support, while the “Hitchhiker’s Guide” to batteries was voted as the quickest and easiest to implement.
The feedback on the workshop was overwhelmingly positive: 87 percent of attendees registered satisfaction, with the breakout sessions seen as particularly helpful. In contrast to a typical government public workshop consisting of a panel of speakers with little opportunity for the audience to share their thoughts, this approach created a new dynamic. Attendees were shocked that a government agency would be so desirous of having an open dialogue without solutions already in mind. Ken talked about what his team learned:
When we put a medical device manufacturer and a nursing health care provider and a hospital technology manager who maintained the device batteries together, they fed off each other’s ideas and perspectives and engaged in a dialogue that moved the conversation forward.
Outcomes from the workshop took different forms. The most obvious was a typical FDA output: a guidance document. The intention of the guidance document was to capture the different views and learnings. “In the absence of our meeting, we certainly wouldn’t have had those views,” Ken explained, and offered an example:
For instance, we learned about a big issue with sterilizing battery-powered medical devices. When you sterilize something, you typically heat it to a very high temperature or you use very special chemicals on it. There’s a perception from the end user that if you do that with a battery-powered device, it’s not going to work. This was something that we had never considered before. It was identifying potential issues like this that were in our blind spot that was the most valuable for us.
Attendees from outside of the FDA also moved forward with actions as a result of the conversation. AdvaMed, an industry trade association, took on the task of creating a best practices document. Bruce Adams, an executive at Cadex Electronics, a producer of battery testers and chargers, came away from the FDA conference excited about the open dialogue and the chance to connect with other producers, regulators, and users, especially from the health care field. “I think the FDA did a great job,” he said. He continued:
It was well organized, with all the right people, a broad cross section of participants, many joining remotely via web access, the breakouts and hosted interviews, and then the wrap-up with human-centered learning to gather enthusiasm to drive improvements in the market. I hadn’t participated in an FDA-hosted think tank like that before and I was impressed.
Even more impressive is that Cadex used the conference to explore new ways of thinking internally. Conversations with regulators, manufacturers, and users at the conference encouraged them to develop a web-based service to judge whether medical batteries were functioning at peak efficiency. Building on the connections made at the conference, Cadex is working with cell and battery producers to build a bench tester capable of saving three to four hours per battery in the testing process, and is also seeking a method of remote monitoring. Hospitals with 150 beds, Cadex learned, are so dependent on battery technology that they need a full-time staffer dedicated to year-round, full-time testin
g. Cadex is using the co-creation methods they learned at the conference to work with hospitals to save that time, a goal that grew directly from the FDA’s battery conference. Bruce explained:
One of our big takeaways from the conference was just how much human error impacts confidence in battery-powered devices. If a battery device is unplugged for any period of time, people just don’t know or trust its capability. If we can solve how to get real-time state of battery health communicated between the device, the hospital, and manufacturers, staff can make more intelligent decisions on when any battery needs to be replaced.
News of the success of the battery workshop spread within the FDA. Members of another program, Emergency Preparedness/Operations and Medical Countermeasures (EMCM), faced an equally vexing challenge. They approached Ken’s team about using a design approach for their upcoming workshop on respiratory protective devices (RPDs).
Design Thinking for the Greater Good Page 13