Blake Gregory is the medical director at Alameda Health System and an alumna of Catalyst, CCI’s human-centered design training program. She shares how the "design thinking" skills she learned now play a central role in her work. Learn about the surprising benefits of having all staff engage in hiring, how Gregory uses "affinity clustering" on a weekly basis, and why encouraging people to draw their experiences increases empathy and understanding.
Dr. Blake Gregory is the medical director at Alameda Health System and an alumna of Catalyst, CCI’s human-centered design training program. She shares how the "design thinking" skills she learned now play a central role in her work. Learn about the surprising benefits of having all staff engage in hiring, how Gregory uses "affinity clustering" on a weekly basis, and why encouraging people to draw their experiences increases empathy and understanding.
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This is an automated transcript. Please excuse any errors or hilarious mistakes.
Today we have Blake Gregory. Who's the medical director at Alameda health system.
she's been in the catalyst program, she's been a coach and regularly shares at the catalyst program. The new thing she's doing, um, applying the catalyst methods at Alameda health.
Thank you so much for doing this. We really appreciate it. Um, it's great to have you here today.
Sure. Thanks. I'm super excited to join this group.
Chris had asked me to kind of, uh, sort of give a little bit of a intro or background about how I got into, into design thinking. And so, um, you know, I, I'm a physician I've been at my organization for almost six years now. Um, and it was my first real job out of my training. So, um, I'm a medical director, um, and I'll just kind of talk about how I got started on my leadership, um, on my leadership journey and the things I've learned.
So, um, what I was telling Chris is that, you know, culturally, the sort of culture of medicine and medical training is, um, pretty hierarchical. So when I reflect back on my days as a med student, and then as a resident, um, this sort of model of success and the things that I think we were taught to look up to is this sort of top-down approach. Um, and so, you know, it's, you know, the way it usually works is like the senior, most person, the one with the most experience calls, all the shots, does all the teaching and so very top down. Um, and I think there are good reasons for that, you know, like you don't want to be in the middle of an emergency doing a code blue and turn to the nurse and be like, well, what do you think we should do?
Like somebody has to take charge. Um, but you know, w when I think about my role models for leaders coming up in my medical training, that that's sort of what it was. It was like somebody just making the decisions, you know, figuring out what the best thing to do is so, um, you know, when I was done with my training, I took my first job here at Alameda health system. And, um, I was brought on as the associate med director for this clinic. Um, and I was recruited by my friend, um, Paula [inaudible], who's also a catalyst graduate. So she was the medical director and the plan was, you know, I was going to start on July 1st as the associate medical director, Paula was pregnant. And so she was going to be due in like a month or two after I started. So the plan was, I kind of get my sea legs, learn the ropes, and then she'd have her baby and I'd run the show for a few months.
So, um, that all seemed okay. Um, and then the F like, literally the fifth day I showed up for work, Paula went into labor early. And so suddenly, you know, I didn't even know where the bathrooms were, but I was expected to lead this clinic that takes care of, you know, 8,000 patients. We've got, you know, 70 providers, like it was, you know, a lot. And, um, so I, I just sort of jumped in with like the best leadership skills that I had. And so I would show up to these division meetings, um, bringing my a game, like all prepared with a plan and I come and be like, okay, here's my problem statement. And here's what we're going to do. And, um, that didn't go over very well actually. And it was sort of like pitchforks, like, you know, these are people who have been in this organization for 30 years.
They really know the system and I had no clue. Um, and, you know, so I, I was using the best tools that I had, but, um, I was not remotely human-centered and, um, I was just trying to like, you know, be a good resident. Um, so, so I think that was a big aha moment for me was coming to these meetings and, you know, presenting something fully packaged and it just didn't work. So, um, I was really fortunate. Paula did the catalyst program and then encouraged me to apply. And then, you know, um, our team got accepted. We did a lot of work that we're really proud of, but that's sort of, my leadership journey was just learning, like the model that I came up with of like bringing your a game, always knowing the right answers really doesn't work in the real world. And what people really want is to be engaged. They want to partner with you. They often have better solutions and answers than you do. Um, even if you're in a leadership role. So it's a very humbling journey, but I'm, I'm really, um, happy to, you know, have arrived at a better place and have learned these skills through CCI is a tremendous gift. Nice.
Yeah. And so that's awesome. Love sharing. I love that you share that story, um, because it wa it is one of getting humbled, right? It's like, holy cow, this doesn't work how I thought it might work. Um, can you say a little bit about, so when you did go through catalyst and started learning a more collaborative approach, more tangible approach, how did that feel? Did you initially reject it or did it tend to make sense for you? Or what was it like learning initially?
I think for me right off the bat, I was like, this feels right. Like, this makes sense just from my learned experience and like all the mistakes that I made, it totally resonated. And, um, you know, I think it also suits my personality. I, I, I'm like a big believer in Myers Briggs. Um, I know not everybody is, but, uh, my personality type is, um, you know, pretty spontaneous, like, you know, and I, I I'm okay with sort of the, you know, the journey that's not completely linear and I'm okay. Starting a process without knowing exactly what it's, how it's going to end. So that appeals to me. And it's not, that's not to say that people who have a different personality type that this wouldn't work for them, but I actually liked the sort of like seeding of control to sort of letting go and surrender to the process and just seeing where we end up. So I think that that actually works really well for me. It fits my style.
Yeah. I definitely think, I mean, we saw it, uh, with you and catalyst and we see it all the time. Sometimes some, some people, the, the approach just resonates from the beginning and they have a, a certain knack for it or personality type for it. Um, if they've come up and been exposed to design or, um, you know, the artistic process of kind of finding the answer in the work you do versus having the answer and then doing the work, um, it, it, it, it, uh, yeah, it resonates a little bit more, it's a little bit easier to kind of, uh, be open to the change in pace from a typical corporate, uh, approach to problem solving.
Yeah. I mean, even for me, it's a little anxiety provoking to be like, oh my gosh, I have so much data. What am I going to do with this? Where is this going to go? But, you know, you just have to kind of surrender to it.
Yeah. I mean, that's it. Yeah. It doesn't mean the work is that easier or that you're not getting like a stress about, oh, we got to figure this out. We've got, gotta figure this out, but you're, you know, you're swimming in the data and swimming in the, in the problem solving a little bit more versus portraying a false confidence about what you're going to go do. Um, and that really allows the, uh, I think, a better solution to, to emerge. Yeah. Yep. Very cool. Um, can you share real quickly what your project was for catalyst?
So we, um, we're looking at workplace happiness. Okay. And then, um, you know, I think we like many healthcare organizations struggle with morale and engagement, absenteeism turnover. And so we spent our project trying to understand that, um, and really got in the weeds. So we, um, I think what we learned is that, um, people work really hard in our clinic and, um, they really care a lot. They do amazing work and we do not do a good job recognizing them. So our project was, um, we called it, no good deed goes unnoticed. And we, um, it was like, um, we had these like little monopoly bills that we sprinkled throughout clinic. And anytime somebody saw another person doing a good deed, they would just scribble on the back of the monopoly bill, what the person did and give it to them and just say, thank you. So we, and then we would collect all the bills and we had these periodic recognition ceremonies where we were, you know, just, you know, have read out like what that person did and give them a little rinky dink prize. And it was just a really nice way to bring everybody together. And it's so easy to see all the problems, but, um, in this case to just reflect on the amazing work that happens every day.
Right. Yeah. I thought one of the great things about that project was how, um, kind of qualitative or, uh, ephemeral the problem statement is, you know, workplace happiness. Um, but what you see here in, in using these methods and working with the people and then deciding, oh, well, what's, uh, what's a different way. We can kind of spread recognition, people being recognized and, um, on a more regular basis, you made the solution very tangible. Um, and I, that whole notion of figuring out a, uh, uh, an experience that people can, can engage with that, um, moves that, you know, moves that challenge forward or, or, um, takes advantage of that opportunity. You want to, you want to, uh, bring to life in the, in the organization. I still remember the pictures of people celebrating and just be, you know, appreciating being appreciated and who doesn't. Right. Um, when it's so easy to always just be problem-solving or calling out the bad parts, right. Uh, very human centered project, um, and, uh, and, uh, probably a solution that has some, some system-wide implications of a way, you know, easier, lighter ways to recognize each other and between peers instead of just top-down as well. Yeah, exactly. Cool. So, um, let's, uh, let's hear about the ways you're applying, uh, human centered methods, engaging your staff differently and how that's working.
Sure. Yeah. So I, I wanted to talk about, um, some of the tools that I use. I think the theme here is going to be, um, creating a safe and, uh, sort of creative space to, you know, for input and idea generation. Um, and so, um, there's this tenant and design thinking about the wisdom of crowds and, um, as opposed to, again, like, you know, just a few people in the ivory tower solving all the problems, how can you take that out to, out to the populace, out to the people on the ground, doing the work and guide them in solving the problems instead of doing it all yourself. Um, and then I think the other, the other attendant that I love from design thinking is, um, there's this sort of reverence for ideas. Um, and, and it's really like an w as far as ideas go, it's really, um, quantity over quality.
So just how can we get as many ideas out on the table as possible? Um, and how can we remove judgment from the process of idea generating? So I think at least in medicine, um, there's so much emphasis on quality of ideas that it can be repressive and it can, um, discourage people from speaking up because they're really worried, oh, what if my idea is really bad? You know, are people going to judge me for that? So, um, again, like the theme for today is going to be the wisdom of crowds and, you know, idea generation focusing on quantity, over quality, just getting all the ideas out there. And then, you know, the dust will settle and, you know, we'll, we'll figure out how to move forward. So, um, one thing that I, that I have done just over the past few months, we've had, um, some leadership vacancies in our clinics.
Um, so we're recruiting for a practice manager and also for a nurse supervisor in one of our clinics. And, um, these are really, really important jobs. Um, cause I think we know the middle managers, um, do so much work to set the tone of the work environment and drive joy and work drive satisfaction. So making the wrong choice is catastrophic and making the right choice can really drive us forward to make things better. So we have to get this right as we recruit. So just, I I've done a lot of reflecting on how we've recruited in the past and it's, um, really not been very human centered. Um, generally how we recruit is, you know, the, the system leader who's gonna, um, you know, directly supervise the manager will be responsible for the recruiting. They'll identify, who's going to engage in the interviews. It's usually only a few people.
And so what ends up happening is like only a small set of, you know, the 120 people in our clinic wind up actually vetting the candidate. So, um, I have been wanting to do things differently. And so what we've been doing as we're recruiting for these two vacancies is, um, we're really trying to again, use the wisdom of crowds to drive the selection. Um, so one thing that we've done are these like meet and greets where the, and we just did one yesterday, actually, where we got candidate, um, you know, come, we make sure they overlap during lunch or during everybody's break. And we have an hour where we like just bring cookies and lemonade and, um, ask everybody like all the staff, as many people who can just come by and meet the candidate. I, you know, I tell people, even if it's two minutes, just please come, I really, really want your input.
Just, you know, shake the person's hand, ask any questions that are on your mind, um, and take as much time as you want. Cause we really, really wanted that as much as possible. Um, and then we ask everybody who meets the candidate to just fill out like a little slip of paper with like a net promoter score. Like, would you support this candidate on a scale of one to 10? So, um, since we've been doing that, it's been amazing. And really there are a lot of surprising things that have come out of that for me. So I think, um, number one is that people are coming, you know, even though it's on their break, even though they're on lunch, they, they care enough to show up. They want about these people. So we have dozens of people coming and it's actually kind of overwhelming for the candidate.
Like, you know, like do these meet and greets, but you know, for me, it's like, this is what the job's going to be like. So it's important for you to get a preview. So, so number one, people are coming, number two, I send out the resumes, you know, a day or two in advance. You know, people are reading the resumes and we're talking about frontline staff, you know, like medical assistants, clerks, admin assistants, they, they read the resumes and then they come to me and they give me feedback on the resume. And so I just love that, you know, I don't even read resumes all the time, you know, I don't like, I'm not worried about my email and so, but they're doing it. And I think these are all into indicators of how much they care about this process. And then, you know, they're giving us feedback.
And so I think the, the third surprise that has struck me is that there are these candidates that I, when I interview them, they actually seem great to me. Or at least I can fantasize or imagine that it would be, must be the selection. Yeah. I know like, well, there was that thing they said, but that's probably a fluke. Like, I'm sure that it'll be fine. So there are these people that I really would have supported and made an offer to, but the staff were very lukewarm in their net promoter scores, much to my surprise. And, um, that really forces me to reflect. And when I see the net promoter score is then I go and I circulate and I just talked to the staff, like, what did you think? You know? And they give really, really insightful feedback. Um, like we had a candidate who, um, was applying for the practice manager position, but she had actually been a very high level person, like a VP from a years.
And, you know, she was pretty far away from being a middle manager. And so the staff pointed out that, you know, whenever they asked her questions, she would give examples from her experience as a VP. And so, you know, th that made them a little skeptical, like, is she, is she ready to do this? Like, you know, on the ground, in the weeds type of work, if she's been working at such a high level for a long time in that it just didn't even Dawn on me, even though they're totally right. That that is how she answered. So there are all these insights that I get, um, from people that I never, that it would have totally missed if I had just kind of kept it at this time of ivory tower or type of process where only a few people are live or inviting, um, I think a fourth surprise, or maybe the fourth, like this is more a source of angst, but, you know, we, we brought a lot of candidates and, um, it turns out the staff were very picky and, you know, um, I, there, we just hadn't really found somebody where there was clear consensus.
And then I started to get like, what, what if this is the wrong process? Like, what if, what if I'm asking the wrong question? What if, like, we're not gonna get everybody to agree. And so I was pretty stressed about that actually. And anyway, just this week we brought somebody who was really like, knocked it out of the park and everybody I talked to was like, she's the one she sees. Yeah. And so it turns out we just really needed to keep looking. Um, but I, I just feel so much more confident about our selections now that we're tapping into this wisdom of crowds because this person is going to be our staff's boss. Like they really, really need a role in it. And they have amazing insights, um, things that I never would have picked up on if I hadn't asked.
Yeah. What an amazing, uh, use of wisdom of the crowds inclusiveness. And again, what I, one thing that I take away from that, not just the four or five amazing insights you've had or, or learning from that. Um, it's, it's some time from everybody, but it's not overwhelming. You're not having 25 people do 45 minute long interviews if they touch point. And it's like a lot of little touch points, but people are taking enough time to really take a vet from their point of view, giving you that point of view, and then there's a signal and all that feedback. Uh, that's really interesting. I love that. Yeah. Cool. Do you want to share a couple more and then we'll open it up for, uh, uh, questions we want to make sure we get plenty of questions. I'm sure people are thinking.
Um, so the, another, this is another tool that, um, I think I it's just like bread and butter design thinking that I just use all the time that folks may already be familiar with, but I think it's just worth mentioning again, because it's such a powerful tool. And so I just wanted to spend a little time talking about affinity clustering. So just to review very briefly, affinity clustering is, you know, you take, uh, you know, a stack of stickies and, um, you know, ask a question, um, you know, how might we, whatever. Um, and everybody, you know, gets a few minutes, one idea per sticky, and they just write as many ideas as they can think of. And then you go kind of around the room and put all the stickies up on the wall and try to cluster them by theme. Um, so that that's affinity clustering.
And, um, again, I find that just to be an incredibly powerful tool, um, for idea generation, um, if you know, how, how can we accomplish this? How might we do that? Um, I think that the things that I love about affinity clustering are again, getting back to the wisdom of crowds and the quantity over quality. Um, it's a great way of generating quality. I mean, I'm sorry, a great of generating quantity. Um, so you wind up getting like a lot, a lot of stickies. And I think, again, you guys can see up here on my wall. Um, these are all just ideas from asking a question, so it can actually get a little overwhelming. You may be stuck with like 50 or a hundred stickies, but I think what's cool is that as you start to cluster by theme, you get to see like a lot of commonality and then usually just a smaller handful of themes that are bubbling to the surface.
So it really gives you a sense of like where people on the same page, like where are the major themes here? And then you also get outliers. Like you may get these odd little one-offs that you didn't expect. And those were important too. Like, it doesn't actually matter if it's just a single sticky and its own little category. Cause that may be the breakthrough idea that may be, you know, the sort of groundbreaking, um, moment. And so you all, you really, really have to give dignity to every single sticky. So I love affinity clustering for that reason, just because again, it's like, it's a way to get a lot of ideas out there. I also love affinity clustering because, um, it is, it's a way to get ideas out there without judgment, um, because everybody's doing it in the privacy of their own head space.
They're just writing the ideas down before anybody said a word. Um, what, you know, the opposite of affinity clustering in my mind is something called popcorning where it's like, you just, you know, ask a group, oh, what do you guys think of this? And then leave people, oh, you know, this is what I think this is what I think. Um, and so I popcorning I think is problematic for some reason, for several reasons. I think number one is because it tends to favor people who are extroverted people who have really strong opinions, people who may dominate the conversation popcorning is also problematic because, um, it can, you know, uh, lead you into group things. So, uh, your, your conversation may be biased by the first one or two ideas that somebody puts out and then you kind of go down that rabbit hole, um, before you really put all the ideas out on the table. Um, and so I, I just love affinity clustering, cause I think it helps, you know, people who are quieter, uh, are a little more hesitant people who are afraid of being judged for their ideas. And it also doesn't, um, bias the conversation because, you know, you're just, just writing them down and putting them up on the board. So, um, I use affinity clustering all the time. Um, and so that's just like a crucial tool for me. Would you say you're using it on a weekly basis?
Pretty close. Yeah. Pretty close or yeah, or some format.
I mean, I do think, I do think it's a, you know, it's a habit, it's a behavior that you develop. Um, and when it's, you know, just like we might pull out the email tool, basically, we're going to send an email to somebody to communicate with them when we are trying to get more ideas. Like if we pull that out naturally rather than, you know, uh, oh, wait for an innovation project to, you know, do the, the affinity clustering. It's like, not at all like that, it's very much a daily or a weekly way to engage staff, engage colleagues, even something really small. You just, I just need some, I need some additional thinking on this and it can be so helpful to your own thinking, uh, and moving anything forward. Really. Yeah. Nice. And your third example
Today, so we'll house here. The third example is, um, this is a tool that I use a lot for, um, brainstorming and prototyping. Um, and it's, uh, I don't know if there's a name for it, but it's just draw your idea. And so, um, and I'll show you guys some examples in a moment, but, um, uh, you know, what we did when we were doing no good deed goes unnoticed is we were trying to understand the medical assistant experience. Just like what is a day in the life look like? So we brought, we brought the whole group together and we just passed out markers and paper and we said, okay, everybody just draw a draw a day in the life of like the worst day at work. What does that look like for you? And, um, the idea was to like use a different side of the brain.
Like I think it's the right brain, um, you know, just to like get a lot of creativity. It also, um, I also love drawing because it taps into like, um, a type of empathy that you can't really necessarily capture with words. Um, because it, people are showing you like, you know, what it looks like instead of describing it. Um, and so I'll just show you guys some examples. So this is, um, this is our medical assistant Thomas. This is, um, his worst day at work. This is just so powerful. You can see he's on his hands and knees like hair on fire. He's saying, why, why, why? Like the phone is ringing off the hook here? Um, and it, this was just so powerful to be like, listen, like, you know, as a doctor in my life feels really crazy and chaotic at work, but like, that's also true for our medical assistants.
Their jobs are so hard and stressful. And then here's just another one. This is our medical assistant. Leslie, we'll see like, you know, she got arrows all on her body and like this long agenda and, um, all of these things that she needs to do. So I think, um, really that exercise of having people draw their experience was like so powerful. And so we were able to take those drawings and then empathy map with kind of how we process the exercise that we use to process the experience people were telling us about. And so, um, so I think that that's an example of using drawing, you know, just to capture an experience, to get some empathy. Um, and then next week I I'm going to lead a session, um, to use drawing for prototyping. So that was like kind of drawing for brainstorming. And, um, but I think you can also use it to prototype.
Cause I I'm, I'm going to be working with middle managers in our organization to create like a monthly meeting, like a shared, a shared or safe space for the middle managers to just be together and have some peer support and professional development. And so I'm going to bring that group together and ask them like, draw what that would look like. And I'm, I don't know what I'm gonna discover, but, um, I think it'll be a really powerful and interesting. And I, and I I'm, you know, I'm hoping to get something really vivid out of it that I might not be able to get from affinity, clustering or popcorning or whatever other tool. Like, I really want to understand what this looks like.
Yeah. Nice. I mean, I think the other thing that the, um, drawing does is once they've drawn it and you did the empathy map, but once they've drawn that it can be used as a reference for describing the experience and it comes out easier because they, well, this represents this and they expound on it and they're able to express themselves versus everybody just looking at them and saying, what's your experience like, you know, that's a very different way of being able to describe it, uh, having something that's tangible and external that people can reference. Um, and usually people go ahead, sorry, sorry.
And really validating. I mean, cause you know, we, when we did the drawing with the medical assistants, we, um, we asked everybody to just stand up and share out their drawing. And so similar to affinity clustering, we saw these themes bubbling to the surface, like, um, kind of shared experiences and then everybody could see like, yeah, that's how I feel. I, you know, so, um, I think just validation that comes with that, is it really powerful, too
Awesome Blake, you're incredible in kind of being able to share this and why it works and uh, really appreciate you. You're doing this.