CCSQ PRA Generic Clearance Successfully Renewed

Dear CCSQ Colleagues, 

We are pleased to announce the renewal of the CCSQ Paperwork Reduction Act (PRA) Generic Clearance, registered under OMB Control Number 0938-1397. This renewal significantly enhances the capacity to fast-track PRA approval for Human-Centered Design (HCD) research, reducing the approval time to just a few weeks and extending coverage through July 31, 2027. Additionally, information collection requests previously approved under the clearance now have extended coverage through July 31, 2027. 

The Generic Clearance is intended for teams collecting data on stakeholder awareness, understanding, attitudes, preferences, or experiences about existing or future products or services. This clearance enables us to gather feedback through various research methods such as surveys, interviews, usability testing, card sorting, and other essential data collection techniques without undue delay. An information collection request may be eligible if it meets all the following criteria: 

• The data collection focuses on improving existing or future services or products. 
• The collection is voluntary.  
• The collection is a low burden for respondents and low-cost for the Federal Government. 
• The collection is non-controversial and does not raise issues of concern to other federal agencies. 
• There is no dissemination of the findings to the public.            
• Information gathered will not be used to inform policy decisions substantially.

If you are interested in leveraging the Generic Clearance for your HCD research, we encourage you visit our Confluence page to learn more and to contact our team with any questions. Here's a link to the form CMS-10706 Template_CCSQ Generic Clearance.docx to complete your information collection request under the Generic Clearance. 

We look forward to your continued collaboration and innovation in improving healthcare quality standards. 

DHS (Department of Homeland Security) Usability Testing Kit — So Easy, Anyone Can Do It

Reading Time 2 mins

Usability testing is a way to learn how easy or difficult it is for people to use something by observing them actually using it. 

In this highly accessible session, you’ll learn how to use the kit’s guidelines and templates to test the usability of your services and solutions. We’ll dive into the details for four common approaches to usability testing — from quick tests with colleagues in the office, to structured, remote testing with real users. The resources provided in the DHS Usability Testing Kit can help you systematize the testing process, produce reliable findings, and expand your ability to test your websites, forms, and mobile apps with real users — before you launch them out into the world. 

Our guest presenter is Dana Chisnell, Deputy Director for Customer Experience (CX) - U.S. Department of Homeland Security.

What you will learn: 

• How to get familiar with usability testing 
• What you need for usability testing 
• How to plan for usability testing 
• How to conduct a usability testing 
• Four approaches to usability testing 
• Easy to apply templates & tools 

The presentation slides and recording are available on Confluence. 

Human-Centered AI: 5 HCD Principles for Developing AI 

Reading Time 6 mins

Introduction 

In recent years, Artificial Intelligence (AI) has transcended the realms of science fiction to become an integral part of our daily lives. From recommending the next song on your playlist to predicting global financial markets, AI's capabilities are vast, varied, and truly transformative. As with any disruptive technology, the potential of AI is unparalleled, promising solutions to some of the most pressing challenges we face today in healthcare. 

Yet, amidst this meteoric rise and potential, lies a pressing concern: For whom is this AI being developed? And more importantly, who gets to decide? This is where the significance of a human-centered approach in AI development emerges. It is not just about building intelligent systems, but about crafting solutions that resonate with, empower, and uplift people, ensuring that technology complements human capabilities rather than competing with or marginalizing them.  

Why is Human-Centered AI Critical? 

Artificial Intelligence, in all its prowess, is not immune to the complexities of human nature. In fact, when not crafted with a human-centric vision, its impact can be starkly detrimental. Ignoring human factors in AI's development can lead to systems that are not only unhelpful but potentially harmful. Here's why: 

1. Bias and Discrimination: Without careful consideration, AI can perpetuate, and sometimes amplify, societal biases. These biases, present in data or algorithms, can lead to unfair or discriminatory outcomes, further marginalizing vulnerable populations.
2. Loss of Trust: AI systems that act in unpredictable or unsatisfactory ways can quickly lose user trust, making them less likely to be adopted or effectively utilized.
3. Safety Concerns: In a critical sector like healthcare, a non-human-centric AI can directly endanger lives due to ill-informed decisions or actions. 

Case Study: Oversight in Healthcare AI 

IBM's Watson for Oncology was acclaimed as a groundbreaking AI that could help doctors diagnose and treat cancer by providing tailored treatment recommendations based on the analysis of vast medical datasets. However, it faced criticism and challenges upon actual implementation. 

In 2018, reports surfaced indicating that Watson had occasionally made unsafe or incorrect treatment recommendations for cancer patients. For instance, there were instances when Watson suggested treatment plans that weren't in line with best practices and clinical guidelines. 

A critical issue was how Watson had been trained. Rather than being purely data-driven, it relied heavily on the input from human experts at the Memorial Sloan Kettering Cancer Center. If these experts had a particular bias or if there was a gap in the knowledge provided, Watson might not make a fully informed recommendation. 

This situation underscores the importance of the data used to train AI, the potential pitfalls of over-reliance on AI recommendations without human validation, and the challenges of deploying AI in complex, real-world medical scenarios. 

5 HCD Principles for Developing AI 

As AI becomes increasingly integral to our daily routines, it's vital to create systems that align with human values and needs. Beyond advanced algorithms, the real challenge is ensuring AI resonates and serves its users. Here are five essential HCD principles for genuine human-centered AI development. 

1. Empathetic Problem Definition: At the heart of effective AI solutions lies a deep understanding of users' genuine needs and emotions. By embracing an empathetic approach, we ensure that AI not only aligns with but also addresses the real challenges faced by users. To truly achieve this, ongoing collaboration with end-users should be woven into every phase of AI strategic planning.
2. Fairness and Bias Consideration: Achieving fairness in AI is crucial to avoid amplifying existing societal biases. AI system designers and developers must engage in continual introspection and assessment to prevent inadvertent propagation of these biases. While technical solutions, such as adversarial testing and fairness toolkits, play a pivotal role, a deeper approach demands an appreciation of the broader historical and societal contexts in which these technologies are deployed. As a recommendation, AI development teams should integrate interdisciplinary experts, including sociologists and ethicists, to provide comprehensive insights into the potential socio-cultural implications of AI systems. 
3. Transparency and Explainability: Imagine boarding a self-driving car that doesn’t tell you how it decides its routes. An unnerving experience, right? This highlights the necessity for AI decisions to be transparent and explainable. Especially in critical domains like healthcare, understanding AI’s reasoning instills trust and facilitates better decision-making. Tools like LIME (Local Interpretable Model-agnostic Explanations) are being developed to demystify the often complex inner workings of AI, enabling users to have a clear view of the decision-making process.
4. Privacy and Data Protection: In an age where data breaches make headlines, the importance of user data privacy in AI cannot be overstressed. Every piece of personal information processed by AI systems poses a potential risk if not handled with utmost care, especially in healthcare. There have been instances where seemingly harmless AI applications, like photo-editing apps, were found mishandling user data. Ensuring rigorous data protection protocols, incorporating techniques like differential privacy, and being transparent about data usage are critical steps towards establishing and maintaining user trust.
5. Ethical Considerations: Beyond the bits and bytes, AI has profound societal implications. Ethical AI development isn’t just about creating efficient algorithms; it's about asking the deeper questions: Who benefits from the AI? Who might be harmed? Is the AI reinforcing harmful stereotypes or contributing to societal inequalities? Consider the ethical debate around AI in surveillance. While it can enhance security, unchecked usage can lead to invasive privacy violations or state control. Developers need a holistic ethical framework, one that ensures that AI serves humanity and respects fundamental rights.

Case Study: Bridging Gaps in Healthcare AI 

Diabetic retinopathy (DR) is the fastest-growing cause of blindness, with nearly 415 million diabetic patients at risk worldwide. Early detection and treatment can significantly reduce the risk, but many patients, especially in low-resource settings, lack access to screening. Recognizing this challenge, Google Health developed a deep learning system to assist eye doctors in identifying DR. 

A truly human-centric approach was employed in the design and deployment of this AI solution. It was trained on a dataset of retinal images that were extensively labeled by ophthalmologists, ensuring its foundation was rooted in expert human knowledge. Recognizing the potential diversity of patients, efforts were made to ensure that the training data was representative of various ethnicities and backgrounds. 

But what made it particularly human-centered was its usability for the intended end-users: the doctors and medical staff. The AI system provided not just a binary result, but also highlighted the areas of concern on the retinal image, thereby giving physicians a transparent and interpretable result, allowing them to make the final diagnosis. 

The result? In field deployments, this AI showed performance on par with U.S. board-certified ophthalmologists. It has been heralded as a potential game-changer for regions where there’s a shortage of ophthalmologists, emphasizing how a human-centric approach to AI can bridge gaps in healthcare and improve patient outcomes. 

Conclusion 

In the ever-evolving landscape of AI, it's paramount to ensure that our technological advances remain rooted in human needs and values. A human-centric AI not only enhances user trust and satisfaction but also ensures ethical and effective solutions. As we delve deeper into the AI realm, let's prioritize this human-centered approach, making technology an enabler rather than a barrier. 

Reference 

Gulshan, V., Peng, L., Coram, M., Stumpe, M. C., Wu, D., Narayanaswamy, A., ... & Kim, R. (2016). Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. JAMA, 316(22), 2402-2410. 

Ross, C., & Swetlitz, I. (2018). IBM’s Watson supercomputer recommended ‘unsafe and incorrect’ cancer treatments, internal documents show. STAT News. 

Continued Learning 

Team Essentials for AI: Apply Design Thinking to AI (Free 3-hour training) 

https://www.ibm.com/design/thinking/page/courses/AI_Essentials 

AI in Healthcare, Standford School of Medicine (5-course specialization via Coursera subscription) 

https://www.coursera.org/specializations/ai-healthcare  

How Collaboration Improves U.S. Health Care

Reading Time 6 mins

In the face of escalating healthcare costs and inconsistent quality, the call for increased competition in the United States healthcare system has been prominent. Proponents argue that competition could incentivize hospitals to deliver superior care at reduced costs. However, it's crucial to acknowledge that competition isn't a universal remedy; the quality of care remains highly variable both within and between health systems, and some research indicates that competition may even diminish quality and worsen disparities, particularly among less profitable patient groups. An alternative and potentially more effective approach involves fostering collaboration among hospitals, an idea that entails sharing internal data, financial transparency, and cooperative efforts with neighboring institutions. Although this notion may appear ambitious, it's already in practice, yielding positive outcomes. 

Why Collaborate? 

Collaboration holds immense significance, not only within a company but also between different organizations. It fosters enhanced problem-solving, peer-to-peer learning, a shared sense of purpose, and the emergence of innovative ideas. Rosabeth Moss Kanter emphasized the vital role of collaborative relationships between companies in achieving individual success. Successful collaborations among organizations are characterized by their capacity to unveil unanticipated opportunities, generate fresh value rather than engage in zero-sum transactions, and operate as collective endeavors with equal contributions from all stakeholders. This concept has been coined as the "collaborative advantage." 

Collaborative Success Stories 

In 1997, Blue Cross Blue Shield of Michigan initiated the BMC2 Cardiovascular Consortium, a program with a simple yet ambitious goal: bring hospitals together to enhance cardiovascular disease care, a leading cause of death in the United States. Starting with five hospitals, it expanded to encompass over 50 hospitals across Michigan. These hospitals shared in-depth clinical data, including their approaches to treating the disease, complication rates, and technology utilization. This transparency unveiled hidden performance gaps, led to innovative solutions, and spurred practice improvements. Instead of competing, hospitals began to learn from one another. Impressive outcomes in infection control or smoking cessation, for instance, were shared and adopted collectively. Consequently, this collaboration elevated care quality, reduced cardiovascular complications, hospital readmissions, care costs, and mortality rates statewide. 

• Bariatric surgery — 56% reduction in mortality 
• Blood clot prevention — 175,000 unnecessary lab tests prevented 
• Cardiovascular care — 51% reduction in bleeding complications 
• General surgery — 23% reduction in surgical-site infections 
• Hospital medicine — Reduction in unnecessary antibiotics, leading to a change in national guidelines 
• Knee and hip replacement — 53% fewer discharges to extended care facilities after surgery 
• Urology — 50% reduction in procedure-related hospitalizations 

Moreover, collaboration in healthcare proves invaluable in crisis response. The Michigan Hospital Medicine Safety Consortium, comprising over 40 hospitals, adeptly redirected its collaborative efforts to address the Covid-19 pandemic. Within a month of the first documented Covid-19 case in Michigan, this collaborative established a statewide database for tracking Covid-19 hospitalizations and identifying critical risk factors for severe illness. The outcome was a publicly accessible risk calculator that aided clinicians in assessing patient risk on an individual basis. This model of collaboration extended nationwide, with healthcare systems across the country uniting to share information and resources, effectively combating the pandemic. 

Furthermore, the financial benefits of collaboration cannot be understated. Preventing complications, reducing hospital admissions, and minimizing unnecessary care translate into substantial cost savings. Collectively, Collaborative Quality Initiatives (CQIs) have saved an estimated $1.4 billion in healthcare expenses. A study by the RAND Corporation reveals that Michigan boasts some of the nation's lowest healthcare costs. This success has prompted other states like Illinois and Wisconsin to adopt a similar collaborative approach to enhance care quality and reduce expenses, demonstrating that collaboration may rival, if not surpass, competition in achieving the elusive goal of better care at lower costs in healthcare. These insightful examples explain the true value of collaboration across teams, organizations and functions to the benefit of patients and customers. 

How Does Collaboration in Health Care Work? 

Collaborative quality improvement has been a fixture in healthcare since the 1980s, involving multiple stakeholders, including clinicians, non-clinicians, departments, and entire hospitals, pooling resources to share information, identify performance gaps, and develop solutions. This approach departs from the traditional proprietary model, emphasizing transparency by openly sharing outcomes, processes, and expenses across the group. 

The impact of this collaboration is twofold. Firstly, it provides hospitals and physicians with insights into their performance relative to peers, enabling them to identify high and low performers, fostering competition and improvement. Secondly, it facilitates the tracking of performance over time, allowing for the assessment of effective strategies. In essence, collaboration contextualizes performance, addressing the critical need for benchmarking and revealing that leaders in one aspect of care may lag in others 
The second major advantage of hospital collaboration is that it empowers those providing care to shape the improvement agenda, highlighting the crucial importance of physician and hospital engagement. Once hospitals grasp their standing within the group, they can take ownership of localized solutions. 

For instance, when a coalition of 26 hospitals in the Michigan Spine Surgery Improvement Collaborative identified patients' post-surgery urination difficulties as a major challenge, local experts—spine surgeons, anesthesiologists, and nurses—developed tailored solutions. Remarkably, these solutions saved an estimated $20 million. This approach sharply contrasts with traditional top-down regulatory reform, where uniform regulations mandate identical problem-solving approaches across all hospitals, often without sufficient data. Regrettably, such a top-down approach can result in inefficient resource utilization and unintended patient harm. Conversely, collaboration allows hospitals to enhance their performance by leveraging their unique processes, addressing specific challenges, and capitalizing on their individual strengths. 

Scarcity and Abundance 

The concepts of "scarcity" and "abundance" mindsets, popularized by Stephen Covey, provide a valuable lens through which to examine the dynamics of competition and collaboration. The prevalent call for competition in healthcare often stems from a scarcity mindset, where resources are perceived as fixed, and the healthcare industry is viewed as a zero-sum game reliant on securing a competitive edge. This perspective can often dominate boardrooms, where hospitals may regard each other as adversaries to be surpassed or absorbed. In this framework, only a subset of hospitals that outcompete their peers is expected to see improvement. 

Conversely, an abundance mindset, which regards opportunities as additive rather than mutually exclusive, offers the possibility of simultaneous improvement for all hospitals. Unlike the scarcity mindset, which necessitates a winner for every loser, an abundance mindset recognizes the potential for "win-win" scenarios. Collaboration emerges as a potent avenue to harness these opportunities. Over more than two decades, Michigan has showcased the benefits of this collaborative approach, delivering reduced costs, enhanced quality, and heightened patient satisfaction for payers, providers, and patients alike. Collaboration underscores the idea that healthcare thrives when its most exceptional talents collaborate rather than compete, suggesting that increased collaboration might be precisely what the healthcare industry requires. 

What should CMS do? Six Actions

1. Promote Collaborative Initiatives: CMS should actively encourage and support collaborative initiatives among healthcare providers, similar to the Collaborative Quality Initiatives (CQIs) in Michigan. This can be achieved by providing incentives and resources for hospitals and healthcare organizations to collaborate on improving care quality and reducing costs. 
2. Emphasize Transparency: CMS should advocate for greater transparency in healthcare by encouraging hospitals to share data and performance metrics. Transparency enables hospitals to benchmark their performance against peers, identify areas for improvement, and adopt best practices. 
3. Localized Solutions: CMS should recognize the importance of localized solutions. Encourage healthcare providers to take ownership of solutions at a local level based on their unique challenges and strengths. This approach can lead to more effective and efficient improvements in patient care. 
4. Measure Outcomes: Develop a robust system for measuring healthcare outcomes, not just costs. CMS should focus on tracking metrics related to care quality, patient satisfaction, and health outcomes. This data can help identify successful collaborative efforts and guide future initiatives. 
5. Abundance Mindset: Promote an "abundance mindset" within the healthcare industry. Encourage healthcare organizations to view collaboration as an opportunity for mutual benefit rather than a zero-sum competition. This mindset shift can lead to more widespread improvements in healthcare. 
6. Incentivize Collaboration: Consider offering financial incentives and reimbursement models that reward healthcare providers for participating in collaborative efforts and achieving specific quality and cost-saving outcomes. 

In summary, CMS should prioritize collaboration, transparency, and localized solutions as key strategies to address the challenges of rising healthcare costs and inconsistent quality while also emphasizing the importance of an abundance mindset within the healthcare industry. These actions can contribute to better care at lower costs, benefiting patients and healthcare providers alike. 

Resources: 

Michigan Hospital Medicine Safety Consortium; https://www.mi-hms.org/quality-initiatives/mi-covid19-initiative-retired 

COVID-19 In-Hospital Mortality Risk Score Model: https://micovidriskcalc.org/ 

Blue Shield - Collaborative Quality Initiatives: https://www.valuepartnerships.com/programs/collaborative-quality-initiatives/ 

Rand Research Study: https://www.rand.org/pubs/research_reports/RR3033.html 

Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S1070324116304084 

Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S0741521421019777 

Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S1070324116304084 

Forbes: https://www.forbes.com/sites/carolinecastrillon/2020/07/12/5-ways-to-go-from-a-scarcity-to-abundance-mindset/?sh=6dfc8c2b1197 

CNS Journal: https://journals.lww.com/neurosurgery/abstract/2023/10000/minimally_invasive_transforaminal_lumbar_interbody.18.aspx?context=featuredarticles&collectionid=39 

Working with the Public to Improve Digital Forms: A GSA Case Study

Reading Time: 2 min

The American public spends approximately 11.5 billion hours per year filling out federal government forms. Form complexity can result in lack of submission or completion, and errors on forms can cause processing delays and affect whether the form is accepted — which can have far-reaching consequences.

Join the CCSQ HCD Community of Practice on Thursday, September 28, for Working with the Public to Improve Digital Forms: A GSA Case Study. We will welcome members of the General Services Administration’s (GSA) Office of Evaluation Sciences (OES) to discuss the digital forms evaluation project and share how five GSA offices and the public worked together to improve federal forms.

During the session, we’ll explore how to:
•    Build and use evidence in the federal government,
•    Utilize data analytics and user feedback, and 
•    Evaluate the impact of form changes.

Stephanie Tepper - Associate Fellow at the Office of Evaluation Sciences

Stephanie Tepper received her Ph.D. in 2023 in Social Psychology from Cornell University. Her research focuses on how people in the U.S. think about economic inequality and how economic disadvantage influences well-being. Stephanie also studies how to develop behavioral science interventions to promote economic opportunity. Prior to earning her doctorate, she worked as an applied researcher at the Center for Advanced Hindsight at Duke University, where she developed and tested interventions with nonprofit and government partners to improve the financial well-being of people in low- to moderate-income households. Stephanie holds a B.A. in Psychology from the University of North Carolina at Chapel Hill. 

Blair Read - Associate Fellow at the Office of Evaluation Sciences 

Blair Read received her Ph.D. in Political Science at MIT, where her research focused on the politics of private service delivery with an application to education policy in the Global South. Through her applied policy research, Blair uses randomized control trials, quasi-experimental design, and descriptive inference with large-scale administrative data to study how to improve citizens’ experiences with the government, and poverty alleviation. Other applied research interests include political behavior in the Global South, and survey design and measurement. Prior to the Office of Evaluation Sciences, Blair was a data scientist with Code for America, and a field research associate with MIT GOV/LAB, where she implemented lab-in-the-field experiments in Tanzania and Uganda. 

The presentation slides and recording will be available following the session on Confluence. 

***

When: Thursday, September 28, 1 PM ET

Where: Zoom; Meeting ID: 161 139 6449; Passcode: 585100 

How to Design the Best Meeting Ever

Reading Time 8 mins

I have a confession to make: I'm not a big fan of meetings. Now don't get me wrong. I understand why we have meetings. Meetings can be used to provide new information. Meetings can be used to make new decisions. Meetings can be used to align expectations. Meetings can be used to "meet" new coworkers. Meetings can be long. Meetings can be short. Meetings can include many people. Meetings can include as little as two people. But often there are few engaged people due to lack of design. Yes, I said design. To run an effective meeting, you need to intentionally design it so it achieves your objectives.

One of my favorite types of meetings are ones where teams go through an affinity diagramming activity. One variation, called the KJ Technique, offers a chance for teams to both brainstorm and prioritize possible solutions. So in as little as an hour, there's a chance to discuss potential solutions to a problem and reach decisions with the consensus of many. It's an activity that intentionally encourages active engagement and participation from everyone. Yet not all meetings can be run this way. So I offer up 7 suggestions for designing the best meeting ever.

1: Test the Technology

How many times have you shown up for a meeting and had to wait while the organizer sorts out a technical issue? I remember one job I had where it felt like I could show up 15 minutes late because there was always some issue with computer connectivity or problems using some piece of software. While it is not always possible, try to run a tech check ahead of the meeting to ensure that technology will enhance, rather than subtract, from the time you have called people together. A majority of us work remotely and use the same computer day after day. But if the meeting is in person, go to the location ahead of time to make sure that you know how to run any technology and to confirm that your tools will play nicely in a setting that closely resembles what will really happen. I've even had laptop updates impact my ability to run an app. Or sometimes something I wanted to show on my screen instead looked fuzzy or out of focus when projected to an audience. Test and practice the meeting logistics before you facilitate the meeting. And also prepare for the worst and have a backup plan ready to go.

2: Start. Stop. Break.

It's difficult to know for just how long to schedule a meeting. Sometimes that question may be answered simply by the availability of others you want to invite. Nonetheless, before you can even decide on how long to schedule a meeting, you need to determine your goals and objectives (see #3). But here's what you can decide. First, when you schedule a start time, start on time. If people learn that you are punctual and respect everyone's time, then they will respect your time. But in today's age of remote work, the reality is that some people have back to back to back meetings with no breaks in between. So what can you do to show consideration? The easiest thing you can control is to end the meeting before the top or the bottom of the hour. Consider hosting a 45 minute meeting so that people can break and prepare for their next meeting. Chances are, most meetings begin and end at the top or bottom of any hour. But what if you have a challenge with people showing late because they just came out of another meeting? Could you take what was normally a 1 hour meeting and shorten it on either end, so it starts at 5 minutes after the hour and ends 5 minutes before? Again, these little changes demonstrate that you respect everyone's time but also sets the expectation that you will start at the start time. And while many meetings only go for an hour, if you have meetings that last longer, consider scheduling breaks every 1-1.5 hours. This can help attendees re-energize so they can contribute more.

3: Win the Battle for Structure

In The Family Crucible, Carl Whitaker and Augustus Napier describe a battle that take place between counselors and clients in the counseling setting. The authors indicate that the counselor’s task is to make a therapeutic environment where the client can process experiences and make changes. This would include a counselor:

• set session expectations and structure,
• review policies and informed consent with the clients,
• discuss confidentiality and limits of confidentiality, and
• help clients stay focused on their goals.
  
  

In other words, one primary responsibility of a counselor is to structure a session to make the clients feel safe. I would argue this is no different in a business meeting setting. And without intentionally structuring a meeting and setting expectations, participants may take it over and turn it into something that does not meet your goals and objectives. So, how do you win this battle for structure?

Before the Meeting

Before the meeting even begins, you should set expectations. Clearly state the goals and objectives in any communications, including on the calendar invite itself. If you have an agenda, communicate that information as well so people gain an understanding of what you seek to accomplish during the timeframe. If some attendees do not respond, consider reaching out to them individually, asking them to respond. This sets expectations for meeting behavior. Be intentional when sending an invite if the attendee should be considered required or optional. And if they are optional, should they be invited in the first place? Persons invited as optional should receive communication ahead of time indicating why they are optional and what you role you expect of them. And be prepared to cancel or reschedule the meeting if a required attendee is unable to join the meeting.

During the Meeting

Maybe a required individual responds in the affirmative but then is a no-show. Again, be prepared to cancel or reschedule the meeting. Remember, you must win the Battle for Structure, and it may mean speaking with that person afterwards to stress how their behavior impacts the success (or lack thereof) of the planned meeting. But assuming the required people show, spend a few minutes setting expectations and creating a safe environment by:

• Goals, Objectives, Agenda: Reiterate the purpose of the meeting by stating your goals and objectives. Review the agenda and setting expectations for time breakdown.
• Participation: Tell meeting attendees what their participation and contribution will look like. When can they speak? Can people just jump in or should they raise their hand and take turns to speak?

4: Assign Roles

My wife will tell you that I have a poor short term memory. What this means is that if I attend a meeting and I fail to take notes, I may very easily forget what was accomplished in that very meeting. While we may not always have our own resources to spare, consider enlisting meeting attendees to fill some roles, including:

• Facilitator - This is often the organizer of the meeting, responsible for covering all goals of the meeting.
• Recorder - This is the note taker - the person responsible for documenting and what happened and any action items/ next steps
• Tech Check - This person manages tech functions. If there is a remote portion of the meeting, this person can monitor communications during the event
• Time Keeper - This person makes sure the facilitator is aware of the time and what other agenda items must be addressed before the meeting ends.

5: Use Ice Breakers

If meeting attendees do not know one another, consider starting with an ice breaker. Certainly we can fall back onto a simple "introduce yourself" moment, but research suggests your ice breaker should give attendees an opportunity to share an embarrassing story. The idea being that if persons are able to be vulnerable and take off their mental masks, there's a greater likelihood of opening up opportunities for genuine creativity and innovative problem-solving. It also builds trust among the group, which leads to higher productivity in subsequent team interactions.

6: Keep Detours Brief

I sometimes joke how I am like the easily distracted dog chasing the proverbial squirrel. It's easy to get sidetracked. There may be a very important person or someone with a domineering personality who takes your meeting in another direction. But again, you must win the Battle for Structure. When discussions get sidetracked,  validate the person and their idea, but consider creating a "Parking Lot" of ideas. Consider even carving out some time at the end of the meeting to circle back and address other ideas mentioned in the meeting.

7: Take Meaningful Action

Nobody wants to leave a meeting without understanding what is going to happen as a result. If a meeting does not move the needle, then I would argue that the meeting never had clear goals defined. If you have clearly stated meeting goals that is known by all, then be sure to carve out enough time to both identify and document decisions and next actions. This will increase team morale as attendees will feel they participated in meaningful activity. Further, any delegated tasks will add a sense of meaning and responsibility to the person who must take action.

--

Nobody wants to waste their time attending a meaningless meeting. By approaching any meeting as a design challenge, consider crafting each meeting with intent. Win the Battle for Structure by creating an environment that sets expectations and provides a safe place to be creative and build trust. 

Six Methods for Sustained Collaboration

Reading Time 8 mins

Wondering about the real importance of collaboration in organizations? Just ask any leader, and you'll receive an enthusiastic confirmation. Yet, when it comes to the actual outcomes of their collaboration strategies, the answers might differ. A high-ranking executive from a major pharmaceutical company recently revealed, “We've tried various changes, but nothing sticks or brings the results we anticipated.” This sentiment resonates widely—many leaders share the same frustration, investing substantial effort with disappointingly little to show. 

The challenge often stems from how collaboration is perceived—as a value to uphold, rather than a skill to cultivate. Companies have experimented with methods like open offices and official collaboration goals, yielding progress by creating opportunities or demonstrating support, but relying on superficial or forceful means. Surprisingly, these tactics rarely yield consistently effective collaboration. A psychological shift is needed. Successful collaborations in various industries share a mindset characterized by respect for colleagues' contributions, a willingness to explore diverse ideas, and a keen awareness of how actions impact both peers and the mission at large. Unfortunately, these attitudes are scarce. Most individuals lean towards skepticism and self-focused biases. The task for leaders is to transform this self-centric outlook into a genuine interest in learning from others. Refer to our blog article 7 Sneaky Cognitive Biases that Wreak Havoc on Innovation. 

Though it may seem like a daunting task, some organizations have cracked the code. Recent research has identified six interactive training techniques that empower leaders and employees to collaborate seamlessly, learn from each other, and overcome psychological barriers. These methods facilitate deeper and more consistent connections by emphasizing distinct phases—listening, expressing ideas, critiquing concepts, and selecting the best ones to pursue. By clarifying these stages and preventing overlap, these techniques lay the groundwork for genuine collaboration to thrive. Practical examples are provided to offer context and adaptable solutions.  

1) Teach People to Listen, Not Talk: In the competitive business world, the art of self-presentation takes center stage. Employees invest significant effort in making persuasive arguments, impressing bosses, and ensuring their viewpoints are heard. However, this obsession with self-presentation can hinder effective collaboration. Research indicates that instead of truly listening when others speak, people often gear up to respond. This inclination grows more pronounced as individuals ascend the corporate hierarchy. Anxiety about personal performance and the belief in one's superior ideas are among the reasons for this. This lack of attentive listening leads to conflicts that could be avoided, missed opportunities for progress, alienation of unheard colleagues, and reduced team efficiency. 

Four actionable listening examples of how to: 

• Ask expansive questions: Pixar encourages this behavior by incorporating a 90-minute lunchtime class on listening skills. The class is adorned with posters urging participants to "Stay curious" and "Build on others’ ideas." Open-ended "what" and "how" questions are emphasized over yes-or-no queries. This encourages more comprehensive information sharing and reflection. 
• Focus on the listener, not on yourself: Demonstrated through exercises, active listening involves empathetic responses rather than self-centered reactions. Coaches simulate conversations, showing how active listening involves understanding the speaker's emotions and experiences, as opposed to turning the conversation towards oneself. 
• Engage in "self-checks": Webasto's North American roofing-systems business unit implements the Listen Like a Leader course, which incorporates self-checks. Participants analyze their past listening failures and identify common patterns. This raises awareness of their own tendencies, fostering improvement. 
• Become comfortable with silence: At Webasto, they initiated another exercise involving silent participation in a conversation while maintaining positive body language. This approach promotes an atmosphere of attentiveness and respect, providing less vocal individuals with an equal opportunity to contribute.

2) Train People to Practice Empathy: Recall your last conflict with a colleague – often, we tend to perceive the other person as either uncaring or lacking intelligence in such situations. However, my research suggests that fostering receptiveness to differing viewpoints can lead to better outcomes. In successful collaborations, a key assumption is that everyone involved, regardless of background or position, is intelligent, caring, and fully engaged. This outlook fosters a desire to comprehend diverse perspectives, enabling constructive conversations to take place. Instead of judgment, curiosity takes the forefront, allowing the recognition of the value of other viewpoints. Two valuable approaches can facilitate this. 

Two examples of how to think: 

• Expand others' thinking: Pixar utilizes an exercise called "leading from the inside out," where collaborators present a challenge and teammates ask questions without pushing their own ideas. The aim is to aid the presenter in rethinking the problem from various angles. The questions delve into the presenter's and others' perspectives. This technique encourages active listening and generates creative solutions, contributing to a sense of being genuinely heard. 
• Look for the unspoken: A marketing firm employs a similar approach and trains participants to pay attention to unspoken cues. When someone presents an idea, colleagues focus not just on the words, but on the presenter's tone, body language, and underlying emotions. By addressing these subtleties, team members create a more empathetic atmosphere, enhancing satisfaction with discussions and promoting smoother collaboration. 

In addition to listening and empathizing, engaging in candid conversations and expressing views courageously is crucial in effective collaboration. The next three techniques concentrate on achieving these goals. 

3) Make People More Comfortable with Feedback: Effective collaboration hinges on giving and receiving feedback adeptly, rooted in influence rather than authority. Here's how you can cultivate this practice. Implementing these strategies can be challenging, but the transformative impact on collaboration and personal growth is well worth the effort. 

Five examples of how to attain feedback: 

• Discuss feedback aversion openly: Pixar’s new managers are trained to provide and receive feedback more effectively. By acknowledging that many of us shy away from feedback – as givers, we fear hurting others; as receivers, we juggle the desire for improvement with the desire for acceptance. This open discussion normalizes these concerns and fosters a sense of shared experience. Consider using the Design Critique method. 
• Make feedback about others’ behavior direct, specific, and applicable: Organizations like Pixar use three principles for impactful feedback: Be straightforward in your communication; specify the particular behavior you're addressing; and elucidate the impact on you and others. An exercise challenges participants to provide feedback using these principles and reflect on the experience. This addresses the tendency for vague feedback and empowers clearer communication. 
• Give feedback on feedback: Volunteers share drafted feedback, while others contribute suggestions for improvement. This practice counters the common challenge of offering vague or indirect feedback. The process, often aided by rehearsing, equips leaders with the confidence to articulate their thoughts succinctly and effectively.  
• Add a “plus” to others’ ideas: At Pixar, commenting on a colleague's idea entails offering a constructive "plus" – a suggestion for improvement. This method draws from improv comedy's principles: accept all ideas, build on them with a "Yes, and..." approach, and elevate your teammate’s contributions. Consider  
• Provide live coaching: Coaches participate in brainstorming sessions to reinforce constructive feedback methods. They intervene when comments lack a collaborative spirit, encouraging reframing. While these interventions might initially be met with resistance, they're ultimately seen as invaluable gifts for personal development. 

4) Teach People to Lead and Follow: While the qualities of effective leadership are widely studied, the importance of adeptly following hasn't received as much attention. Successful collaborators master both roles, fluidly transitioning between leading and following—a skill known as "flexing." Cultivating flexing skills ensures individuals can seamlessly switch between leadership and follower roles, enhancing collaborative dynamics. 

Three examples of collaborative leadership: 

• Flexing in Crisis: During the Thai cave rescue in 2018, diverse experts collaborated to rescue a trapped soccer team. Flexing between leading and following allowed them to combine their expertise effectively. When an inexperienced engineer suggested an unconventional plan to divert rainwater using tubes, senior engineers flexed by considering the idea, which ultimately proved successful. Flexing involves relinquishing control, a challenge for many. Boosting flexing skills can be accomplished through straightforward exercises: 

• • Increase self-awareness: By having individuals rate themselves relative to peers in areas like decision-making, interpersonal skills, and honesty, their inflated self-perceptions become evident. Recognizing this disparity helps build self-awareness, crucial for successful flexing. 
  • Learn to delegate: Effective delegation isn't solely crucial for leaders; it's equally vital for collaborative efforts. Pixar's training on delegation explores common reasons for micromanagement, emphasizing trust-building and adopting a tailored approach based on the skills and motivation of those taking control. 

5) Speak Clearly and Avoid Abstractions: In collaborations, the ability to navigate discussions effectively between sharing ideas and providing clear directions is vital. Psychological research reveals that our communication often becomes overly indirect and abstract. Precision and vivid imagery in communication are shown to increase impact and perceived truthfulness. For instance, communication exercises in organizations like Pixar and a pharmaceutical company involve role-playing to practice conveying messages with clarity and purpose, reframing abstract statements into concrete, specific directives, and enhancing collaboration dynamics. Consider using improvise role-play method to dry-run conversations.

6) Teach Win-Win Interactions: In a classic exercise, students are paired to divide an orange, each secretly assigned a unique purpose: one for juice, the other for the peel. Often, without discussing interests, they either argue or settle for equal, but less beneficial, shares. This demonstrates the importance of exploring both sides' needs for mutually beneficial outcomes. 

Effective communication often falls short due to indirectness and abstraction. Only a few excel at optimal win-win outcomes by genuinely investigating each other's needs, a key aspect of successful collaborations. In such projects, transparency about personal interests and contributions leads to more favorable results, allowing participants to explore various winning scenarios. Many organizations teach team leaders and employees to discover mutual interests through exercises simulating real-world collaborations, emphasizing techniques like questioning, attentive listening, and understanding each other's perspectives. Balancing self-expression with inquiries and comprehension fosters solutions that add value, unlocking opportunities in differences with a win-win mindset. 

Conclusion:

The six techniques work in harmony and complement each other, making it optimal for employees to incorporate them all regularly. Balancing talking and listening, empathy and self-expression, they foster a positive cycle of respect, enthusiasm, and openness. This cycle, however, hinges on leaders and teams initiating it. Encouraging collaboration involves consistently owning mistakes, actively listening, respecting diverse viewpoints, and fostering direct yet respectful communication. By training individuals in these techniques, teams and leaders can establish a culture of sustained, productive teamwork. 

Resources:

Harvard Education - Win Win Negotiation: Managing Your Counterpart’s Satisfaction: https://www.pon.harvard.edu/daily/win-win-daily/win-win-negotiations-managing-your-counterparts-satisfaction/

Forbes - Leadership From The Inside Out: Eight Pathways To Mastery: https://www.forbes.com/sites/kevincashman/2017/10/08/leadership-from-the-inside-out-eight-pathways-to-mastery/?sh=30b0492f549c

The Royal Society Publishing - The impact of the ‘open’ workspace on human collaboration; https://royalsocietypublishing.org/doi/full/10.1098/rstb.2017.0239

Research Gate - Truth From Language and Truth From Fit: The Impact of Linguistic Concreteness and Level of Construal on Subjective Truth: https://www.researchgate.net/publication/47429344_Truth_From_Language_and_Truth_From_Fit_The_Impact_of_Linguistic_Concreteness_and_Level_of_Construal_on_Subjective_Truth

NNG - Design Critiques: Encourage a Positive Culture to Improve Products: https://www.nngroup.com/articles/design-critiques/

United States Peace Institute - What is Active Listening? https://www.usip.org/public-education-new/what-active-listening

MindTools - Active Listening: https://www.mindtools.com/az4wxv7/active-listening

Harvard Business Review - Cracking the Code of Sustained Collaboration: https://hbr.org/2019/11/cracking-the-code-of-sustained-collaboration 

HCD COE - 7 Sneaky Cognitive Biases that Wreak Havoc on Innovation: 7 Sneaky Cognitive Biases that Wreak Havoc on Innovation

Improv: Building Ideas With the Yes, and Principle : Improv: "Yes, and" Marketing Brainstorm Exercise: https://www.youtube.com/watch?v=eicyG2hPoIE

5 Ways to use Role-Playing in eLearning: https://www.youtube.com/watch?v=kF4qKbVFR0s

HCD COE - Critique: Design Critique Workshop: Design Critique Workshop

Why all the Healthcare Supply Chain Shortages? 

Reading Time 6 mins 

The COVID-19 pandemic exposed vulnerabilities in the US health system supply chains, leading to persistent and elevated supply shortages, economic uncertainty, and growing inflation. Between 2021 and 2022, new medication shortages spiked by close to 30 percent, and according to the American Society of Health-System Pharmacists (ASHP), health systems now recognize the need to improve supply chain resilience to face future challenges. During the pandemic, health systems struggled with shortages of personal protective equipment (PPE) and resorted to unconventional procurement practices, sometimes resulting in overstocking or receiving subpar supplies. As the pandemic abates, health systems are focusing on creating more resilient, efficient, and economically viable procurement approaches for the long term. 

Health systems are facing severe shortages in the generic drug market, drawing attention from the White House and Congress. This has been brought to front-page attention with two glaring cases. Firstly, the recent case of Intas Pharmaceuticals, a company in India with critical chemotherapy drugs in short supply, highlights quality control issues in overseas manufacturing. The shortage of essential chemotherapy drugs, including cisplatin and carboplatin, is a significant concern for patients. These drugs are the best shot at a cure for patients with testicular, ovarian and other cancers and shrinking tumors. The limited supply due to the complexity and cost of manufacturing makes them challenging to produce for a few companies. This scarcity, along with shortages of other cancer drugs and medications, such as antibiotics and injectable fluids, poses potential risks to patient health. 

To address the disruptions, there are calls for creating an exchange to allocate drugs where needed most and increasing production of small-batch medicines. The influence of intermediary companies in contracting with generic drug makers is also under scrutiny, as they often demand rock-bottom prices without accountability for shortages. Market-level solutions and expanded government contracting with organizations like Civica Rx, a nonprofit generic drug company founded in 2018 by national philanthropies, may help stabilize the industry and mitigate shortages in the long run. Leaders in the generic drug industry and other experts cite the pressure from intermediary companies that award the lowest-price bidder with access to millions of customers. The “race to the bottom” in prices, they say, destabilizes the industry and rewards those who might cut corners or operate overseas, often in India, where labor costs are lowest. 

The other major case, the natural disaster on July 19th by a 150-mph tornado ripped apart the vast Pfizer drug warehouse in Rock Mount, North Carolina will probably lead to disrupted supplies of crucial drugs. Pfizer released a list of drugs that could go into shortage — or in some cases, a deeper state of shortage. These include common I.V. pain relievers like fentanyl and morphine used in surgery and critical care, as well as lidocaine, used in local anesthesia, and heparin, used to treat or prevent blood clots. The U.S. Pharmacopeia (USP) examined the impact of tornado damage on drug supply chains, assigning "vulnerability scores" to medications based on factors linked to shortages. Painkiller infusions and I.V. electrolytes were identified with a Vulnerability Score of 92% before the disaster. However, one positive aspect is that under federal rules, specialized pharmacies can make these drugs on an emergency basis, helping mitigate the impact of the unexpected shock to the system caused by the shortages.  

Actions at Hand 

Here are just some actions that are at hand to extend the visibility of the supply chain. The Biden administration is assembling a team to address the vulnerabilities in the pharmaceutical supply chain and improve its resilience. The scarcity of generic chemotherapy for cancer treatments is particularly concerning, with potential negative impacts on patient outcomes. Possible long-term solutions include extending supply chain visibility, exploring product-specific strategies, developing relevant protocols, and optimizing costs. The Food and Drug Administration (FDA) is seeking authority from Congress to access additional information about drug manufacturing and supply chains. However, the agency has expressed concerns about the financial strain on the generic drug industry and emphasizes the need to address the core economics of the system. Bipartisan Senate bills aim to speed up the availability of generic drugs, and addressing tactics causing delays can play a crucial role in easing shortages. This has come in the form of the bipartisan bill for Mapping America’s Pharmaceutical Supply (MAPS) Act (S. 2364) to use data analytics to identify supply chain vulnerabilities and other national security threats.  

In June of this year, the administration announced a new lower-cost prescription drug law—the Inflation Reduction Act. The Inflation Reduction Act is already lowering out-of-pocket Part B drug costs. As part of the new law, manufacturers are required to pay a rebate to Medicare if a drug’s price increase exceeds the rate of inflation. CMS intends to send the first invoices in 2025 to manufacturers for the rebates owed to Medicare in 2023 and 2024. Some people with Medicare Part B, which generally covers drugs provided in doctors’ offices and hospital outpatient departments, may pay lower coinsurance on 43 drugs, whose prices rose faster than the rate of inflation in a benchmark quarter. People who take these drugs may save between $1 and $449 per average dose between July 1 – September 30, 2023, depending on their individual coverage.  

Medicare has initiated a new proposal, the 2024 Outpatient Prospective Payment System (OPPS) rule, aimed at incentivizing hospital payments to maintain essential drug stockpiles, addressing ongoing drug shortages through price transparency, prior authorization process, rural hospital provisions and new payment options. However, some experts warn that this policy may inadvertently lead to the very shortages it seeks to prevent. Traditionally, efforts to tackle drug shortages involved empowering the FDA, granting it authority to require backup plans for manufacturing disruptions and gathering information on ingredient sources. The FDA can also prioritize reviews and inspections for drugs in short supply. 

Four Supply Strategies

Health systems have a chance to strengthen their response to future shocks beyond the COVID-19 pandemic. Health system leaders can consider four initiatives to improve supply chain resilience.

• Firstly, extending visibility into an opaque and sometimes interrupted supply chain internally and externally can help detect potential shocks earlier and track inventory accurately. Although implementing sophisticated inventory-tracking systems may be costly, developing tools like RFID bar-coding for critical supplies can increase visibility.
• Secondly, exploring product-specific strategies can identify key items requiring special attention and proactive management.
• Thirdly, developing relevant protocols, capabilities, and governance can enhance decision-making and coordination during supply chain disruptions.
• Finally, optimizing costs can involve strategic sourcing, collaboration with suppliers, and managing excess inventory. These initiatives can help health systems be better prepared for future challenges and ensure smoother operations in times of crisis. 

Resources

NY Times: How the Shortage of a $15 Cancer Drug is Upending treatment - https://www.nytimes.com/2023/06/26/health/cancer-drugs-shortage.html 

NY Times: Drug Shortages Near an All-Time High, Leading to Rationing - https://www.nytimes.com/2023/05/17/health/drug-shortages-cancer.html 

NY Times: Tornado at Pfizer Warehouse Likely to Worsen Shortage of Surgical Drugs https://www.nytimes.com/2023/07/25/health/pfizer-warehouse-tornado-drug-shortages.html 

Pfizer Announces Post-Tornado Relief Plans for Rocky Mount Community and Manufacturing Facility https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-post-tornado-relief-plans-rocky-mount?cid=em_PfizerNewsroomAlert&ttype=em 

United States Pharmacopeia:  U.S. Pharmacopeia statement on supply chain impact of tornado damage to Pfizer Inc. Rocky Mount facility https://www.usp.org/news/us-pharmacopeia-statement-on-supply-chain-impact-of-tornado-damage-to-pfizer-inc-rocky-mount-facility 

United States Pharmacopeia: Visibility to build a stronger supply chain. https://www.usp.org/supply-chain/medicine-supply-map 

Congress.Gov: A bill to map the United States pharmaceutical supply chain and use data analytics to identify supply chain vulnerabilities and other national security threats. https://www.congress.gov/bill/118th-congress/senate-bill/2364/all-info#subjects-content 

Medicare has a new plan to address drug shortages — but it could backfire https://www.statnews.com/2023/07/18/medicare-cancer-drug-shortages/ 

Drug Shortage RFI - https://www.finance.senate.gov/imo/media/doc/drug_shortage_rfi.pdf 

Creative Sprinting

Reading Time 6 mins

The dictionary definition of sprint is "to race or move at full speed, especially for a short distance, as in running, rowing, etc." Agile methodologies use this term frequently, but organizations such as Scaled Agile Inc. instead use the more generic term iteration to refer to "a standard, fixed-duration timebox during which Agile Teams and ARTs individually and collectively deliver incremental customer value while working towards the PI objectives." The term "sprint" may imply a sense of urgency that can cause anxiety or stifle divergent thinking because the goal of each timebox is not to increase understanding but to instead move the needle by delivering increasing "customer value" through working software. This same term also implies a solo, rather than collaborative, endeavor. I rather use the metaphor of the relay race because the work product (baton) is passed between team members. Not everyone is moving at full speed, only the person with the baton. So, if every iteration is more like a relay race, what are some creative ways we may utilize our time in an iteration? I offer a few ideas that I wish we had time to teach in the joint course both LACE and HCD Centers of Excellence offer, entitled UX & Agile for Software Development.

SPRINT 0

A "sprint 0" is used as a way to help teams organize themselves and set themselves up for success before a project's development begins. This takes team members out of their typical roles and gives them an opportunity to conduct one or many activities, including:

• Reframe the problem: Product Managers are charged with identifying feature level work items and prioritizing this work before the Program Increment (PI) begins. But what if they have only communicated the work to be done rather than the problem to solve or the goals of the PI? Product teams may use Jeff Gothelf's Lean Canvas and perform activities appropriate in HCD's defined Initiate Phase to really gain alignment by answering the why.
• Implement improvements: Good product teams hold iteration reviews and inspect and adapt (I&R) ceremonies as a way to continually learn and improve as a team. Other team building activities, including creating or updating working agreements can improve team culture and productivity.
• Design Sprint or Code Jam: During a sprint 0, full teams can innovate by being presented with a challenge, which may even give the team a head start on a PI's planned work. This can manifest itself either as a time to create multiple design ideas for feedback or workable software.

Since a "sprint 0" is technically not a development sprint, it may be structured in a variety of ways, including:

• At the beginning of a PI: Some teams might build a no-code iteration to focus on aligning as a team and determining the research and design needs prior to beginning development.
• At the End of a PI (see graphic): Some teams might take a 2 week I&P iteration (as seen in the above graphic), usually the last iteration of a PI, and use one week for PI planning and another week to focus on innovation. This sprint 0 can help teams hit the ground running when they begin the next PI.
• Outside of a PI: Without disturbing the normal cadence of a Program Increment, leadership may decide to host a sprint 0 at regular intervals, such as quarterly, semi-annually, or annually, as a way to align the team and refocus on priorities.

DESIGN SPRINT

The Design Sprint, attracting attention in Jake Knapp's Sprint: How to solve big problems and test new ideas in just 5 days, argues that teams can be very effective if they spend one week before development creating a highly collaborative atmosphere by solving a real-world problem broken down into the 5 day work week:

• • • • Monday - Map and choose a target
      • Tuesday - Sketch competing solutions
      • Wednesday - Decide on the best
      • Thursday - Build a realistic prototype
      • Friday - Test with target customers

LEAN UX RYTHMS IN EVERY SPRINT

The previous ideas tried to carve out one moment in a development lifecycle (i.e., Program Increment), when design thinking could be applied to better understand a product's consumers, create a workable solution, and gain user feedback, which would help the product team learn from the experience and improve their future delivery. The problem with these solutions is that while they may be good temporary moments that might help product teams improve upon the way they predict what work to tackle, collaborate on getting their work done, and learn from this one a PI activity, true prediction, collaboration and learning must be applied continuously throughout a Program Increment. Jeff Gothelf, in his book, Lean UX: Designing great products with agile teams, argues that there are other ceremonies we may add to sprints to aid and mature a team's capacity to predict, collaborate, and learn. Some examples include (also, see graphic):

• Ideation/Sketching: Before iteration planning, include an opportunity to ideate and sketch solutions, which may impact development in the current or a future iteration.
• User Testing: Include regular user testing, where all members of a team are required to observe users at least 2 hours every 6 weeks.

BUFFERED SPRINTS

In contrast to baking in these rythms within a sprint, another approach is to pull them out of a sprint by creating a gap of 1-3 days between sprints where ideation, planning, and user feedback sessions take place without impacting team members' commitment to their craft. For example, if engineers on a team have committed to coding a feature in two weeks, only to be strongly "encouraged" to collaborate with usability researchers or observe a user test, chances are they may be disincentivized. They may reason they are getting paid to code, not to participate in activities that are not part of their job description. On the other hand, if there is a formal 1-3 day gap between sprints where an engineer is instead required to participate in ideation, planning and user feedback sessions, then the incentive is there.

CONCLUSION

Whether it feels like a sprint or a marathon, product teams run a relay race, where the baton is really the incremental work products that lead to working software. Mature teams know how to accurately predict their work, efficiently collaborate by fostering a culture of shared responsibility, and learn and improve team efficiencies after each iteration. This is accomplished by respecting the roles and capabilities of each member of the team and finding creative ways to mature your team's working relationship and product outputs throughout a product's design and development lifecycle. If you want to learn more about effective ways to integrate research and design into agile cadences, check out the CCSQ Center of Excellence training offerings or reach out to us for a consult.