Episode Transcript:
Dr. Bon Ku
What if doctors could think like designers? Can that change the way that we create services? Can that change the way that we interact with patients?
Robert Traynham
So, I’ve got to ask you the question. Tell us about surfboarding and your love of this.
Ku
People have said surfing is one of the most challenging and also one of the most addictive sports. So, it fits my personality well.
Traynham
I am told, I have a good friend of mine that surfboards with a foil or something like that.
Ku
Yeah, yeah
Traynham
That it takes a lot of your abdominal muscles, a lot of mental energy. There's a lot going on there. Is that fair?
Ku
100%. And also, you have to be so focused on the task because usually a big wave coming in, there's a risk of drowning and there's split second decision-making. But I love being in the ocean, so it really exposed me to nature and it's been a passion that I've done for decades.
Traynham
You're on the East Coast or West Coast?
Ku
I'm on the East coast. I surf all year round on the East Coast and even in January. But I travel a lot to surf all over the world.
Traynham
Wow. Good for you. Very good for you.
What's the mission of ARPA-H and what is the PARADIGM project?
Ku
ARPA-H is a new agency in the federal government. So, we are looking to go after moonshots in health care that probably no other agency or company or university can do. And I came to ARPA-H to work on the challenge of rural health care. It's a crisis in our country. One hundred hospitals in rural America have closed in the past decade. About a third of them are at risk of closing at any moment. When a rural community loses their hospitals, they lose their local health care infrastructure. So, I came to ARPA-H to work on this challenge.
Traynham
And the PARADIGM project?
Ku
PARADIGM specifically addresses that. So, what we want to do in the PARADIGM program is to be able to deliver advanced hospital-level care to every rural county in the U.S. And the way we're going to do that is to fundamentally change the model of how you get hospital-level care. So instead of having to travel to a hospital, which is a traditional brick and mortar facility, what if we could take those services and be able to distribute them directly to the communities where rural Americans live? And we want to do this through advanced mobile health unit vehicles, which I think they could do about 80% what a hospital can actually do in that form factor of advanced mobile health units.
Traynham
So, let's unpack this a little bit more because we recognize, and you alluded to it, that rural health is a challenge and I believe its access to care and quality care and the distance between the two. And so, talk to us about what insurance companies are doing, what private industry is doing to help bridge that gap from a collaborative standpoint. And also, the federal government.
Ku
Rural health is so difficult because of the patient volumes. Health care is based upon volume, and that's how hospitals survive. So, what we need to do to tackle this problem — and I really think this is one of the top priorities for our country of how to get the care that rural Americans have lost or are at risk of losing — is that it needs to be a multidisciplinary approach where we have payers, where we have government, local hospitals all get involved and work together.
We can't work in silos. It's not going to happen. And there have been some recent announcements of that. Even some of the largest companies in the world have had difficulty trying to get rural Americans the health care that they need.
Traynham
You mentioned mobile health care, and you said 80% of those health care mobile things can do almost everything that a hospital can do. What are the things that they can't do?
Ku
The most extreme cases that require an operating room, for example, or level one trauma services. So, I'm a practicing emergency room doctor. So some of the things that we do at a level one trauma center probably can't be done in a mobile health unit vehicle. But services like dialysis, services like minor procedures or imaging like CT scans, MRIs and ultrasound can be done in a mobile health unit vehicle.
Traynham
I see. Would love to do a deeper dive on collaboration. How can health insurance companies collaborate deeper around technology, around communication, around provider access? You go on down the list.
Ku
Yeah. One way is we can redesign the payment system so that providers can get paid not for just delivering care in a brick-and-mortar facility. That's how our whole infrastructure has been set up. What if we could create the technology so that a patient can get the same care outside of the walls of a hospital? If we do that though, would a provider get paid for being able to deliver that care outside the walls of a hospital? So, we need to work together to think creatively about ways that we can finance the care to be distributed across communities and not just by patient going to a traditional brick and mortar facility to get that care.
Traynham
The analogy that I would use is that there was a time when you had to go to a bank to withdraw your money. You had to. That's just what the reality was. But today with so many cash apps, with so many different things out there, you and I can exchange tens of thousands of dollars with a device and it's accurate and it's regulated in a way where you and I both have trust into that system, whatever that looks like. So, I think what I'm hearing is that we can reimagine the payment structure around health care outside of a bricks and mortar type of facility.
Ku
100%. The technology part is the easiest part. The paying for those services that are delivered in a non-traditional setting, I think, is a challenge.
Traynham
My understanding is you are a leading expert in health care design. What does that mean exactly?
Ku
So, if you think about everything in health care from the products, the services, the crowded waiting rooms, even the payment models, someone or some agency or organization has designed that product, service or space. So, it's taking the principles of design and applying it to the health care sector. And I started a program before I joined the agency at my medical school around design thinking. And it's first of its kind program for a medical school around this challenge of what if doctors could think like designers. Can that change the way that we create services? Can that change the way that we interact with patients? And so, it's been this process of blending in a creative and scientific mindset.
Traynham
Absolutely. Right. You take a look at health equity and just rethinking how one has the relationship with health care. One can make the argument that good health care design that's efficient, but also most importantly, the patient is getting the services that they need where they are, meeting them where they are in many ways. I'd love to talk to you a little bit about “design fails.” What does that mean?
Ku
So as a patient, as a physician, as a caregiver, in all these different roles and hats I've put on, I've had a bad experience of health care. So, I think of the user experience, that's a common aspect of design. What does that end user feel about the product, service or space that they are interacting with and whether it's. . . I'll tell you about a recent experience I had. My daughter had her ACL torn and she had to have surgery for it.
And it was complicated even for me. I had to go. . . I am in Pennsylvania, I had to go to another state, Delaware, for her to see a specialist because she has a bleeding disorder, von Willebrand disease. So, she had to get cleared by the specialist, but then she had to have the actual operation to repair her ACL in Pennsylvania. So, we had to navigate literally going through different states, different health systems in order to get the care that she needed. That experience was not a desirable one, because it is not centered on the patients, it's not centered on the caregivers, but it required us going to and interacting with multiple systems. And that took a lot of time. It was a little bit stressful for her as well.
Traynham
Yeah, yeah. Interesting. You have said that creativity helps us solve complex problems. And so my question is, look, I'm a creative guy, but there has to be some type of rigor, academic research, the whole nine yards. How do you blend the two? In other words, can they coexist in health care?
Ku
1000% they could coexist.
Traynham
Really?
Ku
Yes.
Traynham
Tell us more. Tell us more.
Ku
So I'm a doctor, but most people don't associate doctors as being creative
Traynham
No.
Ku
We're nerdy scientists, maybe.
Traynham
Well, I'm about to say in. . . I don't know, maybe I'm reading into a stereotype. Do you want your doctor to be creative? I don't know.
Ku
Well, let's take artists for example. Do you want artists to be creative?
Traynham
Sure. Yes. Yeah.
Ku
And part of what artists do is they think about the future of their. . . they're speculative and think about these different paths, or they envision a better future state. And wouldn't you want your doctor to envision a better future state for health care? But in order to come up with a path of how to get there, that's going to require some scientific rigor for that. So, it's not abandoning the scientific mindset, but taking that and coupling that with creativity.
Traynham
So, they both can exist. I see your point. And you clearly got very animated around this, so this is a passion of yours.
Ku
100%
Traynham
Can you walk us through some examples, real life examples of your work in terms of your impact?
Ku
Yeah. So, we're talking about the equity example earlier. And part of what designers do is they apply this principle of co-design. So not designing for someone, not designing for a certain population, but instead of how can we co-design, how can we build empathy for the population that we're trying to design for? And instead, what if we designed with that community? So, we implemented that principle during the pandemic in Philadelphia, where we co-designed COVID vaccine distribution in our city, especially working with groups that were underrepresented or under-resourced. So, one of my favorite examples is we got to work with one of my favorite, actually, taco shops in Philly: South Philly Barbacoa.
Traynham
I know it well.
Ku
We did a pop-up with the owners, and the owners understood that their community, mainly restaurant workers, did not have time to make an appointment on a Monday through Friday schedule. So, we held a pop-up on Sunday when they knew their community had time off and we held it right in front of their taco shop. And so, you got a COVID vaccine, and also a free taco. And we were able to vaccinate hundreds of people coming in who otherwise would not have gotten vaccinated.
Traynham
Yeah, I love that example because I hear this, I say this over and over and over again, is meeting people where they are. I think that's so important in health care. You've mentioned on more than one occasion that you are an emergency doc. And I would love. . . And I get the sense that you are highly creative. I would love to know a little bit more around how you're able to have one foot in one world and the other foot in the other world. In other words, how do you balance that?
Ku
So, I'm trying to solve problems in health care. In order to solve those problems, you need to have a deep understanding of those problems. So being in emergency room, I see these problems come in through the door of an emergency room. I get to experience these problems —
Traynham
In real time.
Ku
In real time. A patient telling me their story gives me empathy for them and what they're experiencing. And if we don't understand the problem, there's no way we could solve it. So, it's easy for me as a practicing physician to understand what patients and what their communities are going through by hearing their stories.
Traynham
Yeah, I think what I'm hearing is deep, deep empathy from you. It's listening to that person's story and then whatever, maybe it's surfing, I don't know when, but then you applying those lessons learned and then using health care design to go right back and make the system better. Is that fair?
Ku
Yeah.
Traynham
These are your words. I want to make sure-
Ku
You sound like a designer to me.
Traynham
Well. But thank you for that because — not for the confirmation, but thank you for thinking about it that way because I would love to know how many more practitioners actually think that way in the 21st
century.
Last question, I'd love to know, in your own words, what is the next big thing in health, according to you?
Ku
I believe the next big thing in health is bringing health care outside the walls of a hospital.
Traynham
Tell us more.
Ku
So, health care is designed for the last century, that as a patient we have to travel to get to a brick-and-mortar facility to receive advanced care. I believe in the future that we can distribute that care directly to where patients live in their communities. So instead of having to travel to get care, what if we can have a decentralized health care delivery system that puts the patient at the center so we're bringing care to them?
Traynham
Meeting people where they are. Yeah. Thank you so very much. Thanks for coming on. I appreciate it.
Ku
Yeah, great. Thanks for having me.
