Operational improvement through problem solving and efficiency

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In this episode of Well-Being at Michigan Medicine, Chief Well-Being Officer Elizabeth Harry, M.D., welcomes Chief Transformation Officer Amy Cohn, Ph.D., to discuss complex health care issues, operations research, provider well-being and staff scheduling.

A significant part of the conversation touches on operational improvements, including a key example of improving a call system at Michigan Medicine. 

Cohn’s team identified that excessive messages from a centralized call center were frustrating providers. Through collaboration with staff, they discovered that while many providers wanted these messages reduced, others found them valuable. The solution was to switch from a push to a pull system, where providers could access important information when they needed it, reducing interruptions while still enhancing communication.

In the interview, Cohn and Harry discuss a holistic approach to problem solving, emphasizing collaboration, respect and ensuring that staff can perform their roles effectively and with a sense of agency.

• Profile link: Amy Cohn, Ph.D. 
• Learn more about the Center for Healthcare Engineering and Patient Safety (CHEPS)

Transcript

Dr. Elizabeth Harry:         

Today, I am so excited to be here with Dr. Amy Cohn. Dr. Cohn is an Arthur F. Thurnau professor in the Department of Industrial and Operations Engineering at the University of Michigan, where she also holds an appointment in the Department of Health Management and Policy in the School of Public Health. Dr. Cohn is the faculty director of the Center for Health care Engineering and Patient Safety, or what we will refer to as CHEPS, and the Chief Transformation Officer at Michigan Medicine. She holds an AB in Applied Mathematics, magna cum laude from Harvard University, and a PhD in Operations Research from the Massachusetts Institute of Technology.

Her primary research interest is in the application of operations research tools to solving operational problems in health care, including patient access, staff scheduling and provider wellness. She values teaching, mentoring, having a positive impact on society through her work, and helping to foster a vibrant, diverse, nurturing community of scholars. She and her husband, Jonathan, are the proud parents of two sons, Tommy and Peter. Amy, welcome. I'm so happy to have you here today.

Dr. Amy Cohn:                   

Hey, Liz, it's so fun to get to chat with you today.

Dr. Elizabeth Harry:         

Thank you. Well, as we kick this off, I did sort of the formal intro, but can you tell us ... So first, I just have to tell people that you were one of the reasons I was so excited to come to Michigan Medicine. I love what you do. I love that your job exists. And could you tell us a little bit about who are you and how did you get into this very unique niche that you're in?

Dr. Amy Cohn:                   

Yeah, that's a really good question that I keep trying and trying to explain to people where I came from. I joke that whatever room I'm in, I don't quite fit in, but that that's kind of a secret superpower. My first job was actually in the trucking industry. And somehow, that matches up with solving complex problems in health care. I'm really interested in complex systems and how what we think is the problem is often not really the problem, but just a symptom of the problem.

And I think more than anything else, I think of myself as what my kids call a GSD, which we'll politely say is a get-stuff-done person, that the engineer in me just really wants to fix problems. And health care, unfortunately, has lots of problems that we need to fix. And so I'm incredibly grateful to have a position at a university like this one where we have so many different talents and depth and breadth in so many fields, so that someone in engineering can come together with someone in medicine and improve patient care and provider well-being and make sure that our staff have what they need to be able to do their jobs.

Dr. Elizabeth Harry:         

I love that. And I love the vision to have your role exist and to bring that expertise together. And I also love the way that you bring learners into that space, because I think we're going to need more and more people skilled up in this as we go forward in health care. And with that in mind, how have you and those that you're teaching seen operational inefficiencies contribute to burnout among our staff and clinical care providers?

Dr. Amy Cohn:                   

That's a great question. I think there are so many different answers to that. And part of what we need to do is understand not only there's more than one cause, but how do we prioritize those causes? And how do those causes intersect with each other? So I think for me, the fundamental issue is our collective humanity, that we start with the notion that we're not doctors or nurses or medical assistants or respiratory technicians, we're people. And so we come to work not only as someone who's going to do their job, but as someone who had to get their kid on the bus this morning, or as someone who discovered that they'd run out of milk, or someone who got a difficult phone call from a parent, and people who are living in a world that is complicated and challenging.

So to me, it all starts with recognizing that we don't necessarily know what each other is experiencing and therefore the grace and the patience that we need to bring to our work. When you then step into things that are more within our control, I pay a lot of attention to, first of all, a sense of purpose: that we all work to pay our rent or our mortgages and to feed our families. But you come to a place like the University of Michigan and to Michigan Medicine also because you really care about what we do here. Ironically, the more you care, the more of yourself you sometimes end up giving up or losing, so that people who are really committed to doing their job well, whatever that job is, from our custodial staff up to our senior leadership, they are all contributing to how we care for our patients.

And when there's an obstacle or a barrier to that, it comes against your core values. The reason I'm here and the reason I'm taking time away from my family or from my hobbies or from my sleep is to care for patients. And that's being blocked in some way. And so I think for me, that sense of agency, am I able to do my job in the way that I value, underlies ... We can talk about in basket, and I'm sure we will. We can talk about processes, we can talk about hierarchy, but that core element of, "Can I do the thing that I came here to do? Can I be valued for it? Can I be respected for it? Can I be trusted with it," for me is just under everything that we see here.

Dr. Elizabeth Harry:         

Oh, that's so good. I love that piece about the more we care, the more invested we are, the more that friction impacts us. And that can be a bit of a reframe for us when we're really experiencing that friction on what feels like a really big level and it feels like, "Oh, I'm really being blocked here and this feels really hard for me to be able to do this thing that means so much to me," that the flip side of that is that means we care so much. That's why it feels that way. And just remembering that shared sense of mission and purpose is so beautiful. And so, yeah, I'd love some examples. So as you've been floating in and out of all these teams that you and your team have gotten to go be part of and get to see, what are some common operational issues that your team has tried to tackle?

Dr. Amy Cohn:                   

That's a great question. And there are so many big problems, but most of those big problems need to be solved by solving many, many little problems. And so, one of the things that I tell my team, which is not only faculty, colleagues and staff, but as you mentioned, we include lots of students to contribute to these problems. And sometimes there's a feeling of, is this enough? And I say, "If one patient, one family has one better day, take that win. Go home with it, brag about it to your friends. And let's get the next patient."

So some of the things that we've done in some ways feel small, but at the same time feel really powerful to me for demonstrating how to solve problems well. So I'll give an example from our call system. I think for a lot of staff and faculty, a centralized call system can be a source of frustration, because we want to be as personalized as possible. And we want to be able to have relationships, and we want the complexity and the richness of those relationships to show in our work. But there are also lots of very valid, important reasons why certain things become centralized.

And so a while back, we saw a situation where there were a lot of messages that were going from the call center and the triage nurses into the providers. And we started with this idea that, "Boy, those messages feel unimportant or wasteful," in the sense that they didn't feel like they were conveying important information. And it was one more thing added, another grain of sand added to the pile for providers in terms of, "And here's another message I have to deal with." We started talking to people and we went back through the history of why this was happening. And what we realized was it looked like these messages really weren't value-added and they could be dropped.

And what I think is most important about this story is before we dropped the messages, we went and we talked with lots of people. And in particular we said, "Let's find the doctors who are getting the largest number of these messages and talk to them." And many of them said, "Oh yes, please, please, please make these go away." And a couple of them said, "No, this is actually a really valuable thing for me, because it's a way of having more information about my patients. Don't take away that connection that I feel."

And so what we were able to do is to basically change kind of a push to a pull. So instead of everybody getting these messages all of the time, interrupting whatever you were doing at the moment, we created some reports that you could pull whenever you wanted to. And that was a way to say the information's available to you, but you get to control it. And in the process of going physically to all of our different clinics and sitting down and talking with people, we also learned about ways that not only could we make that information available to them the way they wanted to receive it, but we could actually enhance it. And so that was a really nice example of being able to say, we're not going to take something away from some people to benefit other people, but we're going to lift all of the boats.

Dr. Elizabeth Harry:         

Yeah, I love that. And I also love how your team had to address this tension between customization and sort of broad strokes, right? Because ultimately if we're trying to make a big impact, and we're going to do that at the system level, at times we have to flip switches, where we turn something on or we turn something off. There's always going to be people that don't love that, right, that they're like, "That was part of my workflow," or, "I really liked that."

And so I love this idea of giving people the opportunity to customize. And they may have to go out of their way a little bit to say, "I want more information." But if our default is saying, "We know everybody's overloaded, we know the grains of sand or the cognitive load for everybody is already too much, so we really have to make sure everything they're getting is value-add on the whole or for the larger population," and if there are people, smaller groups that feel like, "Hey, that's really value-add," but the majority don't, then trying to pull that information away. That's fantastic. And so then how do we communicate to everybody, "Hey, this option is here if you want to pull this information and if you want to do this work around"? What does that look like?

Dr. Amy Cohn:                   

It's all about communication. And part of communication is recognizing that different people get their information from different sources. Lots of us live in our email, but some staff might not use email at all. And maybe for them it's posting something in writing on the break room or putting signs on buses. I also really valued the fact that in part because we had this tremendous resource in our students to be able to have the time to say we're going to go out and actually meet with the people most directly involved and listen to them as well as communicating out to them what we were thinking of changing.                                    

And I think sometimes we benefit from saying, "I've heard you and I understand that for you, this actually is going to be a step backwards, not forwards. And let me attempt to share with you why that's to the betterment of the larger good, so at least it doesn't feel like this arbitrary, we just changed something. We didn't care that it affected you. We didn't even bother to find out it affected you and you're stuck with it." Again, that powerlessness that I think is so frustrating, but to say, "Sometimes you're going to be the one unfortunately getting the short end of the stick, but other times you're going to be the one that gets what you need at the cost of making things a little harder for other people." But really coming back to the, what is the core thing that you need, and can we try and meet that core need?

Dr. Elizabeth Harry:         

Yeah. And what I love about the work that you do too is it is really engaging the front line and saying, "What works for you? What doesn't work for you?"

Dr. Amy Cohn:                   

Absolutely.

Dr. Elizabeth Harry:         

You're always the one to say, "What's the data? We think this might be the problem, but what's the data? How many people are getting those messages? How much of this is actually a problem?" But the other piece that you guys add and that your whole team adds is this sort of evidence-based framework around, how do systems work best and how do people work best? And some of my favorite stories that you've told are around when you're engaging your students in these brainstorming sessions. Can you share with us a little bit about how the students get to be involved in thinking about some of these solutions?

Dr. Amy Cohn:                   

Yeah, we have lots of different modalities or mechanisms to involve students. So one of them is within CHEPS, the Center for Health care Engineering. This is not academic in the sense that they're doing a senior design project for credit, focused on their education. It is a wonderful, wonderful, really sort of miraculous synergy that this work we do is such a great experiential learning opportunity for them. But we hire students as paid members of professional teams working to solve real problems. This year we had 500 applications to fill 12 empty slots, and 50 students from the summer all asking to come back.

Dr. Elizabeth Harry:         

And these are engineering students?

Dr. Amy Cohn:                   

These are engineering students, public health students, nursing students, pre-med, data analytics. I keep wanting to get some anthropology or sociology students. But what we also do is a seminar series that's open to the public and it's fairly unconventional in that in the past when we started this, we would bring ideally an engineer in who had solved a problem in health care operations to talk about what they did. And those were great talks and we really valued them, but that exists in a lot of different forms.

What we're doing now is we're bringing in a clinician with a problem. And they start off by talking a little bit about the challenge of finding an inpatient psychiatric bed for a child in crisis in an emergency department, or the difficulty in ensuring that maternal care access is available to women independent of their socioeconomic and medical needs, or how do we handle in-basket challenges? And the speaker comes in and gives some context and really sets the stage not only for operationally what's happening, but also why it's so important, how many women die in childbirth, or how many days a child can wait for an inpatient bed.

And then I call it flying monkeys: throw anything out there that might be a crazy idea to try and help solve this in a way that people coming from a traditional clinical background wouldn't think of. And usually the flying monkey ideas are terrible ideas, but they trigger two things. One, "Oh, that idea won't work because I forgot to tell you about this other piece of the puzzle." So it's a way of eliciting information. But the other is, for example, we can't actually use flying monkeys to deliver pharmaceuticals to rural communities, but we could use drones, right?

Dr. Elizabeth Harry:         

Yeah.

Dr. Amy Cohn:                   

And so those kinds of connections, I find so valuable. And that includes challenges of well-being, right? How do we think about organizing the work that we do in innovative, creative flying monkey kinds of ways to take some of that weight off and to bring more of the joy and the satisfaction to our work, and also the recognition of what we need, not just to do our job, but to be whole and healthy people?

Dr. Elizabeth Harry:         

I love that it's almost like a Shark Tank for trying to solve problems. And from my perspective, it seems to be the missing link. It seems to be the piece that we haven't done in health care globally, if we look at how we solve problems. And so from your lens, from the way that your brain has been trained to look at these problems, when you look at the way health care has sort of historically solved problems or tried to approach these things, what do you see that's sort of done well? And where do you see areas of opportunity or areas of bringing in more of this sort of systems thinking?

Dr. Amy Cohn:                   

This is a question that I've been thinking about so, so much. And I want to use a medicine analogy. When you're trained as a physician, you learn how to treat diseases, right?

Dr. Elizabeth Harry:         

Mm-hmm.

Dr. Amy Cohn:                   

But you also learn how to diagnose. And one of the things that's so challenging and why you need to spend time learning to diagnose is because the human body is a system and that a human being also lives in an environmental ecosystem. So I can't just understand how your heart works, but I have to understand how your heart interacts with your lungs and your kidneys and your liver, and how treating your heart is going to have impact on your liver. Whether you are in medicine, public health, engineering, we're taught to solve problems. We're taught to treat the disease, but we're not taught to diagnose.

And where I view the biggest challenge and opportunity right now is in diagnosing our health care system. So the simple example that people so often point to is we have tremendous overcrowding across the nation in our emergency departments. And if you just looked at sort of the symptom, you might jump in and try and solve that problem by making your emergency departments bigger, hiring more ER docs, training more ER docs. In many cases, what we really need to do is to get more inpatient beds or to improve our discharge processes, because so many of those patients in the ED are actually bored and waiting to get admitted.

So whether it's how do we provide better care for our patients or how do we provide better care for all of our employees, I'm interested in that kind of step back to say, "Well, the problem is information technology focused, or depends on challenges with IT. And it depends on how we pay for health care, and it depends on our physical structure, and it depends on our resource." All of these lenses need to be brought together to be able to say, "If I want to fix problem A," or really not problem A, "challenge A, if I want to make emergency care better, if I want to make provider burnout decrease, there are lots of different angles I can come at it from." How do we dissect through data, through observations, through systems thinking to say, "But if you give me this heart medicine, you're going to damage my kidney. If you start to treat this piece of the emergency department, you're going to make access and ambulatory care go down."

Dr. Elizabeth Harry:         

I love that. And to expand on sort of the metaphor you're using, one of the criticisms of health care in general right now is that we do do a lot of the treatment and we do do the diagnostics, but that in clinical care we're not doing as much of the prevention as we could. And one of the things that I'm really fascinated about, both in clinical care, and you mentioned us all being humans and wanting to prevent illness, but also with the well-being lens, thinking about burnout, our office is really curious about, how do we go upstream and prevent the things that are driving burnout?

And so in addition to this idea of how do we diagnose what the problems are, how do we then proactively build structures with human design in mind, with human factors in mind so that we understand that we're bringing a whole person to work and that they have limited cognitive bandwidth and that they are impacted emotionally by things that happen to them, and that the function of the team really matters? And that if we can come at it from a preventative lens too, then ideally we get to a place where we're not having to go back and retrofit so many of our systems.

Dr. Amy Cohn:                   

Yeah, I really love that image. And it brings me back to how we think about this sort of scoping of problems and this sort of input, throughput, output. What happens before the problem? What happens during the problem? What happens after the problem? So for example, when we think about provider burnout issues, I think it's helpful to think about, "Well, let's begin not trying to fix things, but to understand the domain."

So for example, all of us get to work somehow, whether it's driving, taking the bus, parking, walking. How we get to work affects our ability to do our work. And if I have to leave an extra hour early, because otherwise the parking lot's filled up, I'm already going into my day stressed. I'm already going into my day possibly late because it didn't coordinate with the daycare schedule, or it didn't coordinate with the traffic.

And so I think we tend to be reactive to problems: "Oh, my staff are really having a hard time because we've had three snow days this week. What am I going to do to try and get things back to normal?" But we also need to be prophylactically sort of saying, "Okay, here's a category. What happens before and after my employee arrives and leaves work? How can that impact their well-being and their ability to do their jobs? What are the things that happen during the day?"

We know that certain people have to work in environments that can be physically taxing, whether it's a surgeon hunched over for long periods of time, or a custodial person with heavy things that they're moving around, or IT. We use IT all of the time. It's an incredible tool and resource. Can we also anticipate, what are the different sources that can cause problems? And so I think that helps us to recognize and then to distribute. As an industrial engineer, I can't really do very much to help improve people's ability to manage their child care, but I might be able to recognize the problem and help to connect with people in our School of Education to think about innovative ways to deal with unusual work schedules that many of our employees face.

Dr. Elizabeth Harry:         

Especially after the Surgeon General's recent warning on the stress related to parenting, which I think for those of us that parent was not news, but it was nice validation to see.

Dr. Amy Cohn:                   

I think that kind of comes to this layering of the onion: we're an academic center, which means that many of our employees will be moving from other locations. Academic medical centers at the clinician, faculty level, draw people from around the country. I certainly came to Michigan specifically for this job. No grandparents nearby, no close friends that I had a long history with. That presents a different need that we can anticipate before someone even accepts the job and moves here.

Now, those needs might be different from some of our staff who have a long-standing ... grew up in Michigan, extensive family, but they have a different set of needs as a function of their work. Maybe they don't have the flexibility and hours that faculty tend to have to be able to shift their work to say, "I'm going to spend Sunday working on this grant proposal or project so that I can go to my kids' school performance during the week." So I think as we view ... And we've talked a lot about parenting, in part because you and I both have children and share a lot of history with that. But when we think about elder care, when we think about people who are employees who also have disabilities, when we think about our employees who want to train for marathons or have beautiful gardens or just want to have balance in their lives, what are the ways that we can anticipate the places that we're likely to see stressors in their work?

Dr. Elizabeth Harry:         

Well, and I love this concept of preventative care, anticipation, proactivity. That's best practice. I think that's where we want to get to. And again, I think was a really big draw for me for coming here, because of the interdisciplinary approach and the ability to partner with people like you and think about this. And most places don't have roles like your roles. And a lot of places don't have the infrastructure to have this interdisciplinary team where we have students competing to be part of this process to fight to solve these problems.

And so if you were to talk to leaders at other organizations that maybe don't have this level of support to think about some of these things in a different way, what advice would you give them if they're really wanting to do what we're discussing and prioritize well-being within their own teams, within their organizations in this very sort of proactive way, acknowledging that proactive way may feel really far off? It may feel like right now we're just trying to put out the fires, and that getting to a place of anticipation sounds glorious and also very hard.

Dr. Amy Cohn:                   

As academics, dissemination of our work is really important. And so I've been spending a lot of time trying to capture and struggling with this idea of there are things that just are the way my brain works as an engineer. And after many years of marriage to a wonderful, wonderful husband, I realized not everybody's brain works that way. And things that I just take granted to get stuff done can and sometimes need to be taught. And so part of what we're trying to do in our work right now is to say, "Can I take a step back and say, 'What are the things you consciously tried to do here?' And can we write those things down in a way that we can share with other institutions? Can we build more partnerships?"

I mentioned we have 50 students showing up. Actually, this afternoon is our kickoff for the fall semester. We'll have 50 students across levels of education, discipline, career interests, all coming in. We turned 450 away. Can we be building partnerships where some of those students are doing this work, especially in an age where we can do so much virtually now? Can we be sharing with institutions that have lesser resources? Can we be partnering with students from those institutions to come here for a summer and work with us and bring those ideas back? But I think a lot of times it's fairly simple things. It's just digging deeper and asking questions: "What are the reasons that this is happening? Okay, you've come up with your list. Come up with two more. Think really hard. What else could it be? Don't take things for granted at a superficial level."

And then the other thing that for me is so incredibly valuable is the network that I've been able to create here. There are issues that I'm dealing with, and I might go to the chair of cardiology and ask questions, and I might also go to a friend and colleague who is a practicing clinical cardiologist, but I might also go to the stress testing clinic and just spend the day sitting. I might meet with the clerks and the schedulers and I might watch to see how patients arrive and talk to the patient family advocacy group to just say, "What am I missing? What am I missing?"

One of the things that I've learned that's been so helpful to me is anytime I sit down with someone to get their insight and to share with them what we're doing about we're going to change in-basket messages or we're going to change some ways that we schedule patients, "What didn't I ask that I should have asked? What didn't we talk about that you think is important? And then who else do I need to talk to?" And people will say, "Oh, you should also talk to somebody in the ambulatory space. That's affected too. Here's a name. You should talk to somebody in finance or rev cycle." So I think a lot of this stuff isn't rocket science. And I say that tongue in cheek as someone who's literally published work in rocket science. It's not really complicated machine learning models. It's not elaborate optimization models. Those can come in handy at the right time in the right place. But so much of this is just listening and asking the questions.

Dr. Elizabeth Harry:         

And taking the time, right? I mean, it's so easy to be in a really reflexive space where we are just putting out fires and sort of reacting. And in order to do what you're talking about, we as leaders in health care have to be really proactive about protecting time to be able to go do that observation, to be able to go do that listening, to really have that sense of what's happening and what are these moving pieces.

I'll often talk to folks if I give a talk around cognitive load or something, and sometimes I'll hear from people that the perception is that someone, somewhere is sitting aware that they are inundated with all this stuff and allowing this to happen to them. And what I usually say is, "There isn't anyone that knows exactly what your experience is like because it's so complex," to your point, "because there's so many inputs to the final output of what is one person's experience in the workday." And then no Machiavellian person sitting around saying, "Ha, ha, ha, they're having a terrible day." But it's sort of this confluence of all these things that come together that no one could really anticipate the meta property that is the experience that they have in their work unit. And only they can understand that. And so as leaders, it's really incumbent upon us to be able to take that space and protect that space, to be able to go out and see and listen and hear all this. So I love that approach.

So you've mentioned so much about where we are, how we got here, all the pieces that are coming to play, that we're humans doing a hard job. There's a lot of stuff that happens being a human in the world, and there's a lot of stuff that we're all facing in the world right now, too, that's adding to that. And then you mentioned a lot of external pressures, too, that health care is facing: reimbursement, et cetera. Looking at all of that with the lens that you have, how do you envision the future of well-being in workplace evolving over the next decade, maybe ideal state and then maybe things that we need to watch out for to make sure that we don't go off the rails?

Dr. Amy Cohn:                   

It's a great question. I love to think about having a magic wand. And one of the things that I've learned is in the same way that so many of us can catastrophize, we look at something and think, "And then this could go wrong, and then this could go wrong." I sometimes play the game of be as ridiculous and extreme in your thinking positively. What are the things that if we had flying monkeys or unicorns, what are the things that could be?

And so I think it's a great exercise to start with, what would it look like to have true idyllic health care, which would largely be preventative and not getting sick in the first place, and when you are sick, getting care that is effective, but also family-friendly and financially viable, all of these other things? And that in turn wrap around our ability to ensure that our providers across all levels, everybody who contributes, feels engaged and supported in that.

In the more concrete realm, there are a couple of things that are sort of cornerstones for me. One is standardize absolutely everything that you should, and not one bit more. We've talked about this a lot. There are lots of things that we as human beings have standardized. If you've ever driven to work and then realized a minute before you pulled into the parking lot that you had a dentist appointment and you had just autopilot driven to work, being able to have that autopilot is largely what helps us to function in the world.

What I see so often is people, and I think this is one of the big stressors, is this desire to protect, desire to control, desire to have ownership. We sometimes use the term micromanage, which is one of my least favorite expressions ever. People are typically doing that, not because, "I want to answer every single patient portal message," but, "If I don't answer every patient portal message, then how am I sure that I'm not answering the small percent that are really important?"

And so where I see opportunities, whether it's through job redefinitions and sharing of responsibility, whether it's technology like AI, like large language models, the idea of saying, "If I can take the low risk, low variability, low importance stuff off of your plate, then your time expands." So if you think about having 100 messages in your inbox, you're flying through ... I don't know how many times I've come out of a full day of meetings and I'm just going delete, delete, delete, delete, delete on all of the junk, and I accidentally delete something really important as I'm clicking through. If you were to have some sort of a mechanism to prioritize those messages, sometimes that mechanism would fail and an important message might get shunted aside, but that already happens. On the other hand, if you could say to me, "These 10 messages are the messages that are most likely in need of your expertise, that are of importance for you, and that no one else can do this," and I were to do those 10 messages first, that actually makes a big difference.

And so we have to find this balance of allowing people autonomy and control over their work, but clearing out the noise so that the work that I do is work that really only I can and should be doing. And I think that includes a lot of redefinition of what our respective roles are. Is that the best use of your particular talents and skills and training, or is somebody else better at it, frankly? I mean, I think sometimes we act as though we're pushing down work, and I don't view it as the top is too important to do the next level. It's they're not good at it. We all have something that ... in my idyllic health care system, everyone would do work that they're really good at, that is important, and that are recognized and valued for.

Dr. Elizabeth Harry:         

Oh, that's so good. And what I love about what you're saying too is this idea of trust in your team, you have to trust one another, and a learning system. So if I accidentally delete an important email, I have to go find it, I have to learn from that mistake, I have to be willing to accept that I'm not 100% infallible. And we have to have some of that resilience in our system too, so that if we have someone from a particular job class maybe make a mistake on a task, is our response, "Okay, that job class is no longer going to do that task," or is it, "How do we learn? How are we learning system and how do we grow?"

And so I hear so many wonderful reflections of our values at Michigan Medicine in that vision, where we're growing together and we are inclusive, and we're really looking at, where is your zone of genius and where is your zone of genius, and how can we give everybody the task? And you're right that I think there's data to support that when we give tasks to folks ... for example, if we give a lot of administrative tasks to physicians, that actually is dangerous, because it puts them at more risk of cognitive errors in the thing that they are trained to do. And so you're right, they're not good at it. It is not where we want to put it.

Well, as always, Amy, I love chatting with you. I always learn things. I always feel so motivated and inspired, and I get very excited. If someone is listening to this and they want to get involved or they want to learn more, where should they go? How should they reach out?

Dr. Amy Cohn:                  

Sure. And that can include anything from a student wanting to apply to work with us on problem solving, or someone who wants to come to one of our seminars and do some brainstorming. The easiest place to start is probably the website for the Center for Health care Engineering. And so that's just CHEPS.engin.umich.edu. Hopefully we'll put that link in with the podcast as well. People frequently email me, and my email's easy. It's just [email protected]. I think that's probably the only way to find me right now.

Dr. Elizabeth Harry:         

Yeah. Well, those are good ways. That's great.

Dr. Amy Cohn:                   

So have your way with it. Yeah.

Dr. Elizabeth Harry:         

That's wonderful. And you were talking about disseminating this information. Where can people go to find some of these stories of some of the success stories? Where are you guys trying to disseminate some of these stories?

Dr. Amy Cohn:                   

That's always a challenge because we're in this multidisciplinary space, so we're trying to have as much at least grounded in that website. So many of our projects are written up there. We have links to journal articles that we've written in peer-reviewed publications on both the engineering and the clinical side. We frequently speak at both the and the clinical conferences. So I've had undergrad computer science students go into the national meetings for ob-gyn or cardiology, which is really great. And likewise, I've had medical students presenting at computer science forum. And then as much as possible, I'm trying to visit other health systems, to give talks at other universities, to co-advise PhD students in other schools to try and just share this way of thinking about the work that we do.

Dr. Elizabeth Harry:         

That's fantastic. Well, thank you so much for taking the time to share it here today.

Dr. Amy Cohn:                   

Thank you, Liz. It's always great fun and exciting and inspiring to brainstorm and then go back out feeling energized. I think that's what we're all looking for, is to go to work feeling excited and that we have hope of doing something good today.

Dr. Elizabeth Harry:         

Yeah, absolutely. Well, I think with you around, we do. Well, thank you so much, Amy. I really appreciate it.