The Love Metric

Healthcare has a habit of overlooking the obvious. In this episode, three innovators share how they are addressing some of medicine's most persistent blind spots, from a vital organ that has gone unmonitored for decades, to a fragmented system failing new mothers, to the children whose voices rarely shape the digital tools built for them.

Todd Dunn, CEO of Accuryn Medical, shares why the kidney remains one of the least monitored organs in acute care settings, and how better real-time data could support clinical teams managing critically ill patients. He also introduces the concept of "think flow" (understanding how clinicians think, not just how they work), as a foundation for meaningful healthcare innovation.

Melissa Hanna, CEO and co-founder of Mahmee, explains how her company is working to improve the fragmented experience of pregnancy and postpartum care in the United States, where maternal outcomes remain among the worst in the developed world. From doula support to remote patient monitoring, Mahmee aims to connect the dots across an often-disjointed episode of care.

Michael Preston, Executive Director of the Joan Ganz Cooney Center at Sesame Workshop, reflects on what it means to design technology truly centered on children, including why kids themselves should have a seat at the design table, and how Sesame Street continues to help families make sense of a rapidly changing world, including AI.

Episode Resources:

Competing Against Luck: The Story of Innovation and Customer Choice

Responsible Innovation in Technology for Children (RITEC)

LitLab.ai — curriculum-aligned decodables and fluency practice!

AI and Us | Digital Well-being - Sesame Workshop YouTube

Connect with Todd Dunn:

Todd Dunn LinkedIn

Accuryn Medical Website

Accuryn Medical LinkedIn

Accuryn Medical Instagram

Connect with Melissa Hanna:

Melissa Hanna LinkedIn

Mahmee Website

Mahmee LinkedIn

Mahmee Instagram

Connect with Michael Preston:

Michael Preston - Executive Director of the Joan Ganz Cooney Center

Michael Preston LinkedIn

The Joan Ganz Cooney Center Website

The Joan Ganz Cooney Center LinkedIn

Sesame Workshop Website

Sesame Workshop Instagram

Connect with us:

KidsX Website

KidsX LinkedIn

Children's Hospital L.A. Website

Children's Hospital L.A. Instagram

Transcript

SPEAKER_01 0:01

Welcome to the Dose of Optimism, where I talk to the optimists in healthcare. My name is Omkar Kulkarni, and I work at one of the world's best children's hospitals where I lead innovation. I started Kids X, which is a premier international startup accelerator for pediatric innovation. And over the years I've met thousands of startups, investors, and innovators. Every one of them has a story, and every one of them is optimistic about the problems they're solving. On this podcast, you'll meet amazing people who will share their stories and what makes them optimistic about the future of healthcare. A little note before we get into this episode. Please talk to your own physician about your health or the health of your children. All right, let's get started. My first guest is Todd Dunn. If you've worked in hospitals or health systems over the last few decades in innovation, you've probably come across Todd either at a conference, on listening to a podcast, articles that he's written on social media. He is a really intelligent and accomplished person in the world of leading health systems to try new things and to bring new solutions to the hospital market. We have a great conversation teed up, in which we talk about how hard it is for hospitals to try new things and how important it is to engage hospitals in something called the customer benefit metric. He's got his own fun term for it, which I'll let him introduce on the interview. But Todd's a great leader in this space. He's actually taken a lot of that leadership to a company called Acura and Medical. I've noticed of late he's become really focused on kidney care. And at the end of the interview, we'll talk about what he's doing with Acura and Medical and how he's taking all of his learnings from the world of health system innovation into leading this company to help transform kidney care for patients across the country. In all parts of this country. What are some of the biggest learnings you've had as somebody who's been a leader in this space?

SPEAKER_03 2:30

One of the ones I'll remember forever on Carr was from an anesthesiologist at Inter Mountain Healthcare. And he showed me two medical vials that looked exactly the same color of the bottle, same color of the top. And there was a little V written on one and nothing on the other one. And he said, Todd, if I give the wrong drug, it will likely kill the person. And I said, Bill, why are you telling me that? He said, Because one, you should never make decisions about what goes on in the context of care without visiting it and seeing it for yourself and finding out what people struggle with. The other thing he taught me was really interesting. He said, Too many people get stuck on workflow. And Todd, what I think the real thing to do is understand think flow because we often think before we work, or we've built such a pattern that we don't have to think much, but we still do work. He said, So make me a promise that when you're innovating, that you'll go to where the problem is and that you will do your best to be empathetic to how the clinical teams think, not only individually, but collectively. And that's one of my biggest learnings that I've had my entire time in any type of innovation role was to go see, be empathetic, but try to understand how thinking happens in that context.

SPEAKER_01 4:03

So give me an example of think flow. It's interesting. So what would it look like for you to go into some care environment and not just how people do the work? That's the workflow, but get into that think piece. I'm really curious about an example there.

SPEAKER_03 4:18

I was in an OR in Charlotte when I worked for Atrium. And I was in there for an open heart procedure and all of the monitors up on the wall. And the doctor was very accommodating to me being in there. And I asked him, So can you tell me what you're thinking about during the surgery as you're doing the procedure? You got all these things around you. What are you thinking about? And he said, Todd, I glance up occasionally and I look at very critical things that I need to know. And I said, What do those things tell you? What makes that important to you? My point, maybe Omcar, is I want to know what causes certain things to be important for them, but I like to ask questions. What do you think about as you start the surgery? What do you be concerned most about during the surgery? And so I asked that of the surgeon, I asked that of the CRNA. Same question as we go up to the ICU, I would ask, what concerns you? What are you worried about? What struggle do you have? And that is in the thinking work. So it's just certain types of questions I would like to ask so that they paint a little bit of their mental movie before they paint a picture of their moving movie, the workflow.

SPEAKER_01 5:36

Your boys are baseball players. If I were to just go watch a baseball game, I would see a bunch of things happening, a bunch of moving on the diamond. But what I would miss is all the things people are thinking, what the pitcher's thinking, what the batter's thinking, what the basemen are thinking, the catcher's thinking, what the manager's thinking, right? All these different people are thinking things that you can't necessarily see, but you've got to know what they're thinking if you're really trying to innovate and come up with something new. So that's a really interesting thing about healthcare, is you've gotten into this space.

SPEAKER_03 6:09

I also think Omcar tells them that you care about more than just looking at things generically that you're trying to walk their world without telling them what to do.

SPEAKER_01 6:20

Because ultimately it's the mental load of what a person does. If you can help them solve that, that is going to be much more impactful. That's that empathy piece you're talking about. You and I talked about the traditional customer benefit metric, which I think you've got a fun name for. And I think that plays into this, right?

SPEAKER_03 6:40

So in Clay Christensen's book, Competing Against Luck, he talks about a customer benefit. But our mutual friend Roy Rosen taught me a really interesting thing long ago, back even when I was at GE, he talked about the love metric. And take, for instance, ambient listening. We did some homework around this. And we asked some of the clinical team members if this works perfectly, what would you love for it to change for you? One doctor said, I would love to be able just to go to my daughter's volleyball game and not be distracted. Another one said, I would love to just be able to cook dinner with my wife and not worry about catching up on documentation. So the benefit metric isn't typically the surface answer that we often seek from maybe a cognitive ease perspective. But what is it that they really would like to see happen in their lives as a result of the work? What do they want to see transformed? And this one doctor wanted his evenings to be transformed from being interrupted by documentation to having time to cook dinner with his wife or go to his daughter's volleyballgame. So that's what I mean by it is what is the real measure? The measure for the health system may be that the doctor could see a couple of extra patients every day. And we often get lost in those. The problem is, do we get lost in those while neglecting what benefit the doctor or the nurse, the APP, et cetera, is looking for? So it's really important to figure out what's the love metric, what would you love to see changed versus just what does the system want to see improved?

SPEAKER_01 8:33

And if you're going to just look at the workflow, looking at ambient scribes, for example, you'd miss all that, right? You'd see, yes, this is time savings. Yes, if you're capturing better notes through the summaries, yes, if you're seeing more patients in the course of a day. I mean, these are all things that you see. That's what the workflow dictates. But I think the beauty of customer benefit is that's where adoption, that's where stickiness around new technology adoption really plays a role because people are gonna adopt something because it gives them an intrinsic benefit, not necessarily because it makes the system around them more slightly more productive or make more money. I mean, they may find alignment there, but ultimately what motivates somebody to do something may not necessarily be what is about saving steps in a workflow or finding a few extra dollars of revenue. It may be something much deeper, more personal, like you point out.

SPEAKER_03 9:23

Yeah, and there's a way we've often heard about the five whys. Yeah. Why is a really invasive question. It's puts people in a defensive mode. If I ask you, where did you go to school, by the way?

SPEAKER_01 9:38

I went to George Washington University.

SPEAKER_03 9:40

If I ask you, for instance, why did you go there? Typically the first word you will say when I ask you why is because. And that word is really a defensive word. It puts us on our guard, or as someone argue, in our lizard brain. If I were to ask you, what criteria did you use for picking GW, your answer would most likely be more thorough. So rather than the five whys, maybe we say, so what criteria did you use? And you say, Well, it was close to home. It had a really good program in business. Then I could ask you the question, what was important about you being close to home? And then you may say, I have a younger sister who I wanted to see graduate. So many different answers. And again, and the reason that came to mind for me on car is your question about customer benefit. What would that look like to you in your day-to-day life? What would that measure be versus why is that important to you? It's a bit of a different way of going about it. Why makes the person defensive? What gets them into a deep dialogue? And it sounds like a minor nuance, but they do this in FBI interrogations, et cetera, so they can really get to the heart of what they need to learn. And as innovators or transformation people like you and I want to be better and better at each day, the value of that question helps us get to the depth that our customer, whoever we will serve through innovation, needs us to get to.

SPEAKER_01 11:14

So I'm gonna try it out on you. I know that you're dedicating that this next chapter of your career focused on the kidney and how we can do that. And I've actually wondered the answer to this question. I'm gonna try out your method. So, Todd, what motivates you to spend your time focused on kidney health and kidney care? Having seen the problem. What is the problem and what have you seen?

SPEAKER_03 11:38

The first way I learned about it was spending time in an operating room with the CRNA and anesthesiologist at the top of the bed. And she invited me in, which was wonderful. And you really need to know perfusion in the OR. And she said, Todd, look under the bed. So I looked under the bed and there's this gravity-fed foli catheter. And that word often escapes as it's gravity fed. It's just a urine collection tube, and you don't know when the patient necessarily produced it. So you don't know your fluid outputs. You know your inputs because you're looking at the head of the bed and you've digitized the heart, the brain, the lungs, fluid inputs. And so in the OR, you start to see the struggle that they have knowing perfusion in the OR. Then you follow the patient to the ICU, and they're still using the same old gravity-fed foley catheter invented in 1936. Even for kids, that's what we still use. And we also use a serum creatinine test to try to determine if the kidneys are in trouble. And that test misses a lot. And it only tells you if your kidneys are already in trouble. So fundamentally, the problem is we've given our clinical teams very old and outdated technology to manage a vital organ. There was a moment in my home four years ago where a dear friend came over. He was actually helping us remodel our kitchen. And he was a transplant patient. And he told me about his story of getting really sick and his kidneys getting damaged in the hospital. And so when you read that 3.2 million people a year in this country get an acute kidney injury, and that if you get one of those inside of a hospital, you're five times more likely or higher to be a chronic kidney disease patient than someone who didn't have an acute kidney injury. That's the other one. So I watch these clinicians try to take care of you the way that their heart and soul wants to. And yet we give them outdated tools. And just like you as an innovator, that drives me crazy because these are beautiful people who want to take beautiful care of you that need the right tools. And then the other one is seeing just the human harm. And I really just caught the bug about the kidney to the degree my wife nicknamed me Captain Kidney. I just have this passion for wanting to transform what is just the most archaic way of understanding a vital organ and give the same equitable treatment with monitors and catheters and other solutions the way that we give to the heart and lungs. The kidneys are the mirror to the patient's health and the ICU. So why haven't we digitized it and the vital sign, the way that we have for the heart and lungs? Just makes no sense to me. So I'm kind of on this deeply held personal mission to do right by clinical teams and do right by patients. And then the financials of hospital systems really worry me. This country needs hospitals to be solvent, viable. CMS is now declared acute kidney injury or harm, which means they'll pay you less for some of these patients. And I just like to prevent bad things from happening for those three groups. And that drives me every day, buddy. I appreciate your question.

SPEAKER_01 15:12

Let's bring it all home and bring it all together. What's the love metric? Who loves it and why? Where's the biggest customer benefit?

SPEAKER_03 15:19

Let's break it into a couple of buckets, maybe. The financial benefit is acute kidney injury drives longer length of stay. It's proven in so many studies. Higher re-admit rates, and you even advance to dialysis, which is already a PSI 10 quality problem that costs hospitals at least$20,000 when that happens. So they would love to see improved operational metrics or reduced length of stay, et cetera, that relate to the problem. Because as AKI three stages escalates, your length of stay is higher. And we give you all the insight to help you prevent the escalating harm to acute kidney injury. It's just like us telling you your pulse ox is in trouble. We just tell you your fluid output isn't working. The other one for nurses, they don't have to manually manipulate a gravity-fed foley anymore to try to get urine flowing. They get stuck because of gravity and they don't have to manually document. And we've done some stock prime and motion studies. If that takes about five minutes per bed per hour, so the nurses love not having to worry about giving the doctors accurate fluid outputs on the hour, and they love not having to eye a bag and come up with a measurement, et cetera. They love it. In the OR, the teams love to know perfusion. And in the ICU, the doctors love to be able to have a more accurate understanding of fluid status. The ins and the outs, and the more accurate that they can understand fluid status or fluid balance or the lack thereof, the better care they can take care of you. Those are the three groups I think about collectively as we walk through. And of course, chief quality officers want to report that the quality of their patient outcomes are getting better every year.

SPEAKER_01 17:14

From an executive standpoint around finances and quality. But if I were to guess the biggest benefit, it's similar to the scribe, in my opinion. I think it's that cognitive load. If you I think AI is going to do this, if it can take some of that cognitive load off of a nurse who has a thousand other things that he or she has to navigate and manage. And if it can quantify, imagine having to monkey around with these catheters and the urine output, it's probably not high on the list of what they find joyful in the work they do. The stress of having to be accurate around inputs and outputs, because it is a vital data point for the care of these sick patients. Being able to take all that away and give them more confidence in the information they're putting into the chart, they're telling their peers and clinicians, and perhaps less time navigating a foley, all of that, I imagine, just creates such benefit or value to that nurse. In addition, of course, the finances, financial officers happy and the quality people are happy. But I imagine that nurses probably love this thing because it's given them something that is, again, to your point from earlier, you may not see in the workflow, but it's perhaps giving them something that is part of that think flow that uh they really enjoy. I share two fun things.

SPEAKER_03 18:35

When my team and I collaborated with our clinical friends at HRIM to become a customer of Acurion back in late 21. As we deployed them, I was walking the halls and we bought 20 something to start with, and I found them all lined up in a hall, and there was a label. I'll send you this to your email. A label that the nurse manager put on there, do not remove from the CTICU, the cardiothoracic ICU. So the nurses loved them so much that the nurse manager tagged them. The reason she had to tag them is because nurses were coming from other floors to get them. They wanted to use them. They were pulling them into their think flow and workflow. And then I knew I had tagged a love metric somewhere. The other one is on the contrasting side of this. I was speaking to an intensivist just a few weeks ago, and he was so frustrated because he was doing rounds really early in the morning and he didn't have accurate urine outputs. And he said, Todd, I'm so frustrated. I look forward to having the units because, and he told me this quote the kidneys are the mirror to a patient's health in the ICU. I must know accurate outputs. So the cognitive burden that he went through when he walked into that ICU, and because there are nurse shortages in a lot of places, an ICU nurse has over a hundred tasks an hour to do, there's no way that we can ask them to keep up with everything. It's just not right. And so we just take all that work away, that cognitive burden and that work burden away from, like you say, monkeying around with a foley and having to worry about documentation.

SPEAKER_01 20:21

Well, yeah. That paints the picture, right? You got people fighting over this thing, and you've got doctors talking about how incredibly important it is. We have all this data about all the other organs except the kidney.

SPEAKER_03 20:35

Yeah. If you honest to goodness, next time you walk to the hospital, look at the head of the bed in the ICU, especially a cardiac ICU. Everything's digitized. Can you imagine literally the standard being, hey, get me their heart rate once an hour, or hey, track the fluid inputs every hour, or put that pulse socks on, give me a readout every hour. We would never think about it because it's a vital sign. A lot of people are arguing that urine is the vital sign of the kidney. What else is, right? It's certainly not a creatinine test. So I just think we need to bring the kidney into the modern day and give it the same equitable attention from a monitor and a catheter that we've given to our other organs. And it will make it much easier for our clinical teams to take really good care of you. And then you'll have accurate data because we're FDA cleared, we're the only one in the space that is. You'll have accurate data as input to any type of AI work you want to do around predicting of patient deterioration or understanding fluid balance or fluid status in a unique way. There's so many things when you envision it. Imagine how different things. Would be if we had this over 10 years ago, like we did the Swan Gans Catheter and heart monitors.

SPEAKER_01 22:06

It feels like table stakes for making sure that you've got the data you need and appreciate that you're what's your wife call you? Captain Kidney. Captain Kidney. Captain Kidney. Todd, thank you so much. I appreciate you coming on and sharing your wisdom about the kidney, but also just how to innovate in our healthcare landscape.

SPEAKER_03 22:28

Thank you. And if I could, I don't know that there are more sacred places on the earth than a children's hospital. So thank you and your team for all you do. Very important.

SPEAKER_01 22:43

My next guest is Melissa Hanna. I've known her for over a decade. I remember when she was first starting this company called Mommy, and I thought it was a great idea. She was inspired by her own mother, who has been a clinician leader in this space for I think her whole career. And she's brought that concept of supporting moms through pregnancy and in the year after their baby is born to a new level by building this virtual and brick and mortar business that's incredibly successful, making a huge impact in terms of clinical outcomes. She has a JD in an MBA, and you hear that when you talk to her. She's got a real practical sense about what is possible, how to build a business in a very methodical way. And with what she's doing with mommy, that they're they're making tremendous impacts on the communities that they serve. I hope you'll enjoy this interview with Molysow.

SPEAKER_00 23:43

The United States ranks last in quality and first in cost amongst pure nations in maternal and infant health. Said otherwise, we spend the most and we get the least in return. We have the worst results for all of our major investments in technology and care and treatments and innovation as it relates to moms and babies. And that seems really wrong to me. And it has for years, and it's why I started the company, Mommy, to make the US the best place in the world to give birth.

SPEAKER_01 24:15

And so how do you do that? How does mommy help the process?

SPEAKER_00 24:19

We've identified a number of issues in the maternal and infant healthcare industry. And we're working with partners of all sizes, from individual providers and nonprofit organizations, local practices through hospitals, integrated delivery networks, health plans and systems. So folks all across those challenges, I think of them simply as there's a whole list of things, but those issues are fragmented data and uncoordinated care. And these two things drive really great disparities in care, clinical outcomes, and exorbitant costs associated with caring for moms and babies. And the results are disproportionately worse for Black and Indigenous mothers and Medicaid beneficiaries. What mommy is doing is creating an ecosystem where these kinds of challenges can be solved collectively. We provide the software, the payment innovation, and the service capacity to address maternal and infant health care needs across the entire episode from conception until baby's first birthday.

SPEAKER_01 25:31

What's an example of that, Melissa? How would a mom interact with mommy?

SPEAKER_00 25:36

Mommy provides the wraparound care experience that supports the mother-baby dyad across that entire episode and connects back into their primary care, their obstetric care, and their pediatric care experience. So folks typically enroll with us somewhere between first and second trimester for access to dualist services, registered nursing support, remote patient monitoring, lactation care, mental health support, and nutrition coaching. So those key wraparound care services are offered directly from mom and me. But what we offer the industry broadly is the ability to support and engage this family all the way through pregnancy, through labor and delivery, and then all the way through postpartum up until baby's first birthday. So while the patient is getting access to those wraparound care services that we uniquely provide as a bundled experience, what we're also doing is we are managing, we're generating, and we are leveraging a longitudinal data set to identify risks and needs and opportunities for better care experiences for that family, for that mother baby dyad, all across that point in time. And then working with our plan partners and our system partners and our physician partners to make sure patients are getting access to all of that care. So while we don't provide all of the medical care ourselves, we play a really key role in understanding the patient journey and the patient's clinical needs and helping manage the engagement and the utilization through that entire episode.

SPEAKER_01 27:08

Now, you take care of patients who are both commercially insured as well as those on Medicaid. How did you crack that? How did you get into both public and private health plans?

SPEAKER_00 27:18

We take care of commercial and Medicaid populations. And our community is about 50-50 between those two populations. So really good representation across the board, but it's taking years to do it. I have been working with industry leaders in health systems and in plans for quite a while. I started the company a decade ago. And to be honest, I was left out of many rooms initially when I tried to pitch this vision and say that we could be a platform solution.

SPEAKER_01 27:49

What were they not believing could be possible?

SPEAKER_00 27:52

Well, I think coming back to those two big challenges in maternal health, the fragmented data and the uncoordinated care, those are things that people are very familiar with in this field. No one would say that this is a unified, coordinated experience for new and expecting parents. Everyone knows it can be really clunky and disjointed for them. What I was saying was that we could fix that. And I think that people wanted to believe it was possible, but were understandably cynical about that happening because maternal mortality in the United States has risen year over year for over three decades. So it's a problem that has not gone away and has not been solved despite everyone's best efforts.

SPEAKER_01 28:35

If you think about population health, you talk about a mom who may have multiple children and you look at the health of the mom, you look at the health of the children as they grow in out of infancy. How is mommy thinking about longitudinal data and population health?

SPEAKER_00 28:51

It is a really big challenge. And as you pointed out, we just don't have that. It's not how our systems in the United States typically talk to each other. It's not how our EHRs are connected together, and it's not how data is being tracked historically. But I'm optimistic that this is changing. I'm seeing more of these kinds of connections happen across the industry and our company is committed to being part of the solution. So what we're doing is we're creating that longitudinal data set for this particular episode. If we have a better sense of the maternal health history and clinical needs of a particular patient during pregnancy, we can start to create a more personalized and impactful care experience for that pregnancy and delay limer delivery and postpartum experience for that patient. And it will start to inform how uh neonatal care and infant care is delivered as well.

SPEAKER_01 29:44

Beyond babies, Melissa, can you give us an example of that? I'm curious what that personalization could look like.

SPEAKER_00 29:50

Let's say we have a mom who's enrolled in care and maybe she signed up for doula support, particularly. That's something that spoke to her, and she'd like to have prenatal coaching and have a doula at the bedside during labor and delivery. But our data on this patient is also revealing that there's a history of hypertension and cardiac concerns prior to pregnancy. This is already flagging in our system for a need for support beyond doula care alone. So that might have been the bright, shiny object that drew a patient into the mommy platform, getting access to doula care, but there's a bigger story to be told here around the clinical risk profile and the needs of that patient. And so through mommy, we can administer an LTE connected blood pressure cuff for ongoing management of blood pressure and other concerns associated with that. We can engage this patient in remote patient monitoring with our registered nursing team, doing check-ins and managing symptoms that may arise during pregnancy and augment the care or the birth plan for this patient and do all of that while layering in the dual care that the patient actually signed up for. And we can engage the clinical partners in a more comprehensive approach to care management for this patient, knowing that a history of hypertension that predates the pregnancy itself creates impact in that pregnancy and labor delivery experience and also creates risk in postpartum. And that's exactly what we're trying to do is mitigate that risk, especially during the most vulnerable and high-risk window, which is in those first 30 days postpartum after delivery.

SPEAKER_01 31:23

I've heard you talk about that first 30 days. Walk me through what actually happens to a mom after she's discharged. What does that first week look like? What are those first 30 days look like?

SPEAKER_00 31:32

Yeah. So we're providing a lot of emotional and psychosocial support through labor and delivery with attendance by doulas at these births, and in the first few hours and days postpartum, providing doula care right then to that patient. Those are some of the first people that are engaging with patients in postpartum. And we think about doulas as providing during that time is not just that emotional and psychosocial support for this family, but also being the eyes and ears to identify early risk that may not otherwise be caught by a clinical provider who isn't going to see that patient for the next few days until baby comes into the pediatric office for their first visit, and certainly for the first few weeks until an OBGYN visit is scheduled, which can happen several weeks later after labor and delivery. So during that window of time, what mommy is doing is managing blood pressure concerns, engaging the patient. We call them periodal risk assessments, just asking a couple of key questions that are relevant in the first, second, third, and fourth weeks postpartum that can really quickly flag whether recovery is trending in the right or wrong direction. We also are messaging with patients. We're doing virtual appointments, and we have clinic locations where people can come in to get support around infant feeding and lactation care and also postnatal recovery with dual support. So there's a number of different ways that patients are engaging with mommy in the first 30 days postpartum. And we are often the first to spot risk during that window of time and create opportunities for outpatient intervention, which ultimately avoid the readmission to the hospital that might otherwise occur.

SPEAKER_01 33:08

You talk about doulas. It's an amazing profession. At the same time, it's perceived to be a luxury for a mother going through the pregnancy and birth. You've got a different perspective in mommy, right?

SPEAKER_00 33:20

That's exactly right. We see doulas as being a critical component, critical player on the patient's team throughout this episode. And they're not there to diagnose or provide medical treatment, but just to walk that path, be on the journey with the patient, be a sounding board, an advocate, and help the patient build confidence in their own pregnancy and post-partum journey. But also, it's really important to just have another party that is present to support this patient and identify needs along the way. And so where I find dualists to be very powerful is that if they see something, they're going to say something. And they're able to speak up and advocate and identify opportunities for other clinical care team members to be able to step in and provide support in a more proactive manner. I think that it's really promising that more and more dual care is now being covered by insurance, both commercial and Medicaid. This signals that the industry generally is identifying these same benefits that I just shared. And I'm optimistic about this too, because I know that as more and more folks identify the need for families to have this kind of support available to them, the more it's going to be a cost-effective option. It absolutely should not be a luxury to have someone who is there to check in on you, support you, answer questions, and really engage the rest of your care team appropriately in supporting you in this experience.

SPEAKER_01 34:41

Now, C-sections, particularly for first-time moms, there's a lot of work happening in that space around education, around elective C-sections. I believe mommy's doing some work in that space as well around patients that are otherwise not high risk, historically would have elected for a C-section. Walk me through what you're doing in that space.

SPEAKER_00 35:05

Yes. C-sections are a big challenge in the United States. There are a lot of people in this country that are delivering via C-section. In some cases, it is an essential need for that particular delivery. And in other cases, it might have been avoided with a different birth plan, different education and support, different clinical considerations along the way. We're not independently as a company determining whether someone should or shouldn't have a C-section. And we're certainly not against medical intervention where it's needed. But there's a lot of different parts to maternal and infant health care that really can't be independently controlled by any one player on the team. C-sections is one of those things. What we look at is the broader story of this patient's care and this patient's clinical risk profile. And to the extent that we can support this patient in getting to term, we can support this patient in having as low risk of a pregnancy as possible and support the patient in being able to fully participate in their labor, there's a good chance that a C-section can be avoided under those circumstances. So I'd like to think about it first and foremost: how do we help people stay pregnant longer, get past that 37-week mark so that they are in a term delivery window? That's the first part of this. The second part, the question we ask ourselves is how do we help this patient feel more confident in their birth? So confidence in birth allows for the patient to participate, to feel that they know what's going on with their care team, with their body, with their baby, and they can be actively involved in consideration and decisions that are being made in these high stress moments during labor and delivery.

SPEAKER_01 36:46

And you find success in this, right? I think mommy is shown to have reduced, at least amongst your population, uh, some of these c-section rates.

SPEAKER_00 36:54

Absolutely. So we see a 20% reduction in C-section rates in our population for this exact reason. Not every C-section can be avoided, and not every C-section shouldn't be avoided. But there's definitely cases where a different path was possible if we can solve for some aspects of the experience overall. So that's what we work on. And it relates also to our preterm birth rates, which are very low in our population. We see a meaningful reduction, 50%, 55% reduction in preterm birth rates. Again, I joke we keep people pregnant longer, but there's a lot of different things that we are able to do along the way, walking that path with the patient throughout the pregnancy that can optimize for a pregnancy making it past that 37-week mark. And that's something that I think doulas have been demonstrated to be a very important component of.

SPEAKER_01 37:41

I've read that you are starting to look at brick and mortar locations. And for such a tech forward company, what's the decision to include some brick and mortar options for your patients?

SPEAKER_00 37:54

We've actually launched a number of different locations across the state of California. We have 11 different clinics right now, and we continue to grow. The decision around that relates to the way that we partner with community-based providers, physician groups, and hospitals in these regions that we serve. And what we found was that a small clinic space that is designed for doula care and lactation care to happen in person, co-locating those kinds of spaces inside of obstetric clinics, pediatric clinics, local hospitals can be such a powerful way to engage the community of new and expecting parents in that region. So we have these locations, they're little pop-up clinics. They're very beautifully designed for prenatal and postpartum support, specifically for doula and lactation care. They're often really accessible because they're in the hospital you're going to be delivering at, or they're in the doctor's office that you're going to for obstetric or pediatric care in a community center that had some extra space where we can pop up a mommy clinic in. And these spaces, they're designed to be comfortable and safe and welcoming spaces for new and expecting parents to receive this kind of support. It doesn't replace going to your doctor's office. It's really a compliment. And it drives a lot of patient satisfaction and patient engagement. We want to be in touch with patients. We want them to use the services that are available to them through their insurance plans, through their employers, through their hospitals. This is a great way to do it. So it's been a really successful strategy for us, and we're going to continue growing with that. Even though the reality is that virtual care is a really wonderful way to drive access, when it comes to mother baby care, sometimes you just want to meet up in person.

SPEAKER_01 39:37

There's countries in Europe, the Norway, the Netherlands, Switzerland that have some of the lowest maternal mortality rates in the world. Do you think we can get there? Do you think we can get our country, our public health system, to a place where we can be as good as some of these high-performing places?

SPEAKER_00 39:54

I hold out hope that we can do it. I think that it's a toll order for the United States. It's a very difficult challenge to overcome the level of fragmentation we have here. It's just how our systems have been designed. They're much more disconnected from each other. You go to the OBJN for your maternal care. You go to your pediatrician for your pediatric care. They're using different systems, they're using different technologies, and they're taking care of different patients in each of their systems, right? The mom and baby are symbiotically connected, physically and emotionally and spiritually. Our current system in the United States doesn't really recognize that very well. What I like about efforts that I'm seeing happen around the world that are producing really great outcomes is that they're finding ways to manifest that reality inside of their healthcare models, to recognize that mom and baby are connected and their care needs to be connected too. So it's going to take us a long time to get there, but I think we're moving in the right direction.

SPEAKER_01 41:01

Melissa, thank you so much for what you're doing and all the amazing, innovative, and optimistic hope that you bring to maternal care in the United States. This next interview is a fun one. So Michael Preston, I've known for a while, and he has a fun job. He works at the Joan Gance Cooney Center at Sesame Workshop. The Sesame Workshop is the creator and producer of Sesame Street and many other amazing programs for young children, typically age three to five. He's a senior vice president and executive director there, and he's leading all sorts of work around research and innovation. They really think about how kids that are really young can live healthy lives in the digital world. And he's bringing a lot of experience from his background into this role, including roles at the New York City Department of Education. In this conversation, we talk about the importance from their perspective of actually including kids in the design of their programming and the design of their products. They are working with young children, preschoolers and elementary school kids, design the programs that you see, and their approach to it using design thinking and human-centered design is something that he is championing. And I think it's a really interesting approach towards user-centered design, specifically with young children.

SPEAKER_02 42:28

Tell us what you do. Thanks so much. And it's great to be here on your podcast. So I lead the Joan Gans Cooney Center, which is an RD lab inside Sesame Workshop, the nonprofit organization that makes Sesame Street and does a whole lot of other things. We are focused on the world outside Sesame. So what we get to do is bring the principles and the ways of working and the ideas we about what we want for kids out to the broader tech and media landscape outside of Sesame. So in some ways, we are an advanced research organization where we look into the future and try to find all the new technologies and help shape them so they're better for kids and help companies do a good job, but also to bring those ideas back to Sesame too. Sesame, as everybody knows, was one of the early innovators in the TV space. And over our 56 years as an organization, we have continued to bring the same child and family centered perspectives and goals into everything we make. So we were early in personal computers and the internet and everything else. And it's a really kind of a repeatable act for us at Sesame and also the CONI Center as the outward-facing research arm to keep doing the stuff that we do.

SPEAKER_01 43:42

I imagine it's got to be fun to be able to work in an organization from which there are probably memories you have from your own childhood. So much of things from our childhood just have disappeared. And it's got to be cool to have a day job that allows you to play in the environments or the environment. imagination from your childhood.

SPEAKER_02 44:02

Absolutely. I was among the first generation to experience sesame. And at this point, pretty much everybody who works at the organization can count themselves as having grown up with it, which is quite a privilege. It's funny after I've been there for seven years now. And so I it's it's just the office when I go in, but I love having visitors come and giving them the tour because it reminds me of how special a place it is.

SPEAKER_01 44:24

I just assume you're working with Bert and Ernie and Big Bert. I assume there's other humans working there with you.

SPEAKER_02 44:30

Yeah, there are humans. And Bert and Ernie, you know, they have a lot of accrued vacation times. So they don't come into the office as much as they used to. But in all seriousness, our office does have more Muppets than yours. And what's so cool about it is that our show continues to evolve and reinvent itself. There's a whole new vision for the show that's currently out the new season. I really encourage everybody to check it out. For example, there's a whole experience inside one two three Sesame you can move up the stoop and into the building and get on the crazy elevator and have fun inside the building. So I think that with the our creative team is amazing and continues to like find new ways to reach kids, tune to habits and expectations of today's audiences and also just keep delighting audiences.

SPEAKER_01 45:12

That's amazing. On your side you use human-centered design to really understand children, understand your viewers and your audience and help design for the future, right? What are three things that make you excited and optimistic about the future?

SPEAKER_02 45:28

What a great prompt at a time when I think we're all feeling a little depressed about the future. There's just a lot going on in this world and it's very challenging. And I think we show up every day trying to figure out how to make things better. And what we can work on in the digital space is includes a bunch of things like meet those criteria. Like the first thing I would say is increasingly when I say child center design there are certain practices that roll up to that. And the one that we're most excited about is this idea that children can be partners in design. There's a lot being written about these days and more examples are showing up of kids, younger kids, older kids at the center and at the table of design practices. And increasingly folks see that the kids are shouldn't just be folks who test a new product idea at the end just to make sure they like it or maybe they could tweak it a little bit but rather having children come in early to share really unique perspectives and insights that only they can offer our design team when you when you do it with a design team if they're not familiar with this process first of all it means for little kids you're you know you're sitting around the rug together and you're using paper and markers and everyday objects to express ideas together, but also this idea that it can be very democratic and very fun and that the kids are going to be eager to drive and tell you what they think. And usually the ideas are just different from what the adults would automatically assume. And they're also very likely to be honest and share their likes and dislikes in a way that's refreshing.

SPEAKER_01 46:59

Give an exact Michael of a time when you walked in perhaps thinking a certain thing and the kids gave you a very different perspective.

SPEAKER_02 47:06

Yeah there's so many every session has something like this like kids most of our projects are focused on learning of course not ed tech sometimes ed tech but sometimes more informal things but there was a reading app we worked on with a partner fantastic organization and they were targeting older kids like upper elementary kids who were they call reluctant readers like kids who weren't necessarily reading as fluently as their peer group one of the topics that came up was embarrassment and how kids just didn't feel good about it. And some of the more gamified elements that the product team were experimenting with or proposing the kids rejected like they didn't want necessarily flashy things that they could show off about their progress or anything that kind of called attention to just the the way things were for them. They didn't want to be sharing accomplishments with other folks. They just wanted to be supported in a really productive way and they just thought that the sort of trappings of gamification were superfluous and really just got to brass tacks with the design team, which I thought was helpful for them to understand.

SPEAKER_01 48:10

Okay so child centered design totally get that and love that it's part of how you think about developing product and developing your next series of creations because we do that with adults as you point out but it's hard to do sometimes with children. I think people skip that step and assume the parents know what their kids want and they ask parents and focus groups but really working with kids is important and it's great that you're doing that a lot and to the point where it's influencing your product.

SPEAKER_02 48:38

So that's one what are a couple other things that are making you excited another one is an idea that we call wellbeing by design which is just a way to get people to think about it in the context of all the other biodesigns out there. You see a lot of things like safety by design and so forth as many frameworks that companies and design teams use when they have a particular and state in mind for users. And this shift toward well-being I think is partly in response to a broader narrative and evidence space around kids' emotions and feelings and just an overall experience of the digital products they use. But there's also an opportunity space of defining well-being and then from working from that to create design patterns that actually could lead to those outcomes. We're involved in a project called Ritech, the Responsible Innovation and Technolen project which was the collaboration between UNICEF and the Lego group and first it started with a global research project to find out what kids around the world define as their own subjective well-being and then I'm talking about countries all over the world and then to validate those ideas in digital play in more countries and then to land on a framework that basically expresses what well-being looks like to kids. So of course you would assume it includes safety and security because that's really foundational and you have to have that but other things that came up include things that you wouldn't be surprised kids want autonomy in their digital play. They want agency and choice they talked about emotions helping to recognize and regulate their own emotions sometimes kids want to get really excited sometimes they want to relax competence so like feeling of growing skill and as they learn how to do things and get better relationships. Obviously social connection belonging are key and creativity so encouraging curiosity imagination though those kinds of things come up a lot probably none of those are surprising to you but what happens then is we take a framework like that our colleagues at UNICEF created a design toolbox and our work at the CUNY center has been to propagate this to industry. So we actively work with designers like I was saying uh in the about voices but also to really help translate these kinds of ideas into actual things we have a fellowship the Wellbeing by design fellowship so that we have all tons of case studies of people working at big companies and little startups and nonprofits who have already deployed this kind of stuff. So it's doable but I think articulating what it looks like and making it really accessible and actionable for designers is the name of the game. And so we're very proud of our role in this project and hoping to create a big community of folks who want who care about this stuff and want to do it.

SPEAKER_01 51:15

That's great. I imagine you're looking at all children and thinking about how you can make sure that we're always thinking about their wellness which is really neat.

SPEAKER_02 51:22

Absolutely is songbed therapy one of the innovations. They're amazing and we love having a Sesame partnership with them.

SPEAKER_01 51:32

Kids X connect the dots it was really cool. They're a great example right so what they're doing is they're trying to figure out how to create a gamified experience to make it exciting for children to move and to be physically well and healthy. It started and continues to be oriented around kids who have injuries or recovering from surgery and they're trying to recover. But through the work with you all I think they've discovered there's a whole world of children who are otherwise well and movement and activity is a core part of development and healthy growth. And gamifying that for them and particularly leveraging the world of sesame is great. And I think it's been a great example of how you can take something that could be so oriented around those that are sick and thinking about taking it to the full population of kids who are thankfully mostly healthy.

SPEAKER_02 52:29

Yeah that's amazing. Sometimes the most inspiring innovations come out of a design for some kind of underserved or specific need or population. But then once you find the recipe for creating something really great it can scale and become useful in all kinds of other ways too.

SPEAKER_01 52:47

Yeah I mean I think one of the tenants of design is extremes right you want to try to sometimes design for extremes of populations and so this is an example of that I think yeah for sure.

SPEAKER_02 52:58

Obviously you want Elmo to help kids do their physical therapy. So that's just a natural should be helping everybody with their physical therapy not just young children. That's true. It wouldn't be a conversation about technology without talking about AI and for us it's in in the news it's unavoidable everybody's talking about AI and what it's going to do to society, institutions, life on earth small things. So we take our unique perspective around centering kids and trying to to center on our values and our goals, what we want for kids, which is again the space that we feel is often underaddressed in these kind of conversations when the new technology takes over public consciousness and the affordances become more important than the impacts. And so as we get impressed by the every new release of the new capabilities or what it can do or take away it's this kind of strange feeling of having things displaced or taken away from us. Oh my gosh how amazing it can do all these things for you. It can enhance your experience it can augment your abilities but at the same time it also can feel like it's diminishing or taking away and it's hard as it moves so quickly to think about what to do to design around it or protect or whatever kind of orientation you have to it. So I in the moment we're kind of in learning mode and we've been studying a lot AI has already been involved in lots of the product teams we work with it drives the back end of a lot of the products we work with in some ways there are fascinating and wonderful learning tools for adaptive and personalized learning. There's so many great ways to use data assessment data that can be rendered back to an educator or family member to just know what's happening with the kid or suggest next steps or things that would be really productive their creative engagements. We've worked with a startup out here called Litlab that creates amazing custom decodables to help kids learn to read based on science of literacy work and our partnership with them was really fun and useful. So there's lots of stuff that I think is going to be awesome for education and for sporting kids. But at the same time it's there's always this question or uncertainty or feeling of potential like displacement because it seems to be moving quickly and it's hard to wrap your head around it and it keeps like doing the things that you thought you could do. And so carving up a space of what's uniquely human or uniquely for children is a challenge. I think it's actually a good challenge because humans are kind of lazy and we're willing to give up stuff if it's if it can be made more efficient, which makes sense. And the theory is it'll oh we'll just free up our time to do other things. But at the same time, what do we want to preserve if we're helping kids learn you don't want to take away the productive struggle or the friction that helps kids learn how to think like writing writing is an act that helps you learn how to think don't take away the writing have them make mistakes and have to correct them don't just correct them for them like that kind of stuff. I think we're still a frontier where we're trying to define what that is and preserve it or preserve relationship. Like obviously social development is critical for society and if everybody's bewitched by their device and a virtualized experience of connection what does that mean? It's probably not great. We already know we already have some early evidence that it can break those things and that create a reduced version of experience and so the long-term developmental impacts of that are unknown. So again I try to have a positive framing let's center the things we want and let's like really go for designing for them and define what's uniquely human and or uniquely child centered and like help elevated and design around it. But at the moment it's it feels very uncertain.

SPEAKER_01 56:28

One of the things I've always loved about Sesame Street is when there's complex things happening in the world Sesame Street does a great job of explaining it to kids but also to everybody when the pandemic happened it's the first place we went to explain what was happening in the world when the racial justice conversations were happening following the pandemic a lot of great programming there. And most recently we saw in Sesame Street with my youngest a great ex explanation of artificial intelligence designed and aimed for things Julia's the character and she explains it to kids and it's great to see because understanding it is the first part of being able to live with it, manage it. And so I will put it in the show notes but there's a great Sesame Street clip about AI what it is and what it means for kids.

SPEAKER_02 57:22

Yeah I love that clip and how it just gives you an example of a case study that families could relate to and see how it can be a supportive resource instead of this sort of mysterious magical thing right.

SPEAKER_01 57:34

Michael thank you for joining the show it's really funny that you and I both grew up in the same town in New Jersey.

SPEAKER_02 57:41

Before we close what's your favorite thing to do in this little town in New Jersey if you're from my town which was heavily Italian in the early part of the 20th century and you know this but uh there's a lot of pizza to be eaten in our town and next time you visit I'm hoping that we get to have a slice here together.

SPEAKER_01 58:01

Sounds great. We'll do it and we'll talk about Elmo. We should just invite him because I think Elmo enjoys pizza too sure he does. Thank you again for joining and always fun talking to you about the cool stuff you're doing. Thanks some cards great chatting with you. All right thank you for joining us for your dose of optimism make sure to check out our show notes to get more information about our guests and the work they're doing. Visit our podcast page on the Kids X website to join our podcast community and to learn more about pediatric innovation. Thank you to our sponsors and to our presenting partner Kids X. Please subscribe wherever you get your podcasts and remember it takes a village to make sure our kids grow into healthy adults so volunteer at your local library help out at the community center and if you're so inspired donate to your local children's hospital. Alright see you next time the content views opinions and information presented on this podcast do not reflect the views of Children's Hospital Los Angeles or of the sponsors of the podcast