Philadelphia native Dr. Stephen Klasko is a licensed obstetrician and gynecologist, a relentless Twitter user and avid blogger, a former DJ, and all-around funny guy. He became president of Thomas Jefferson University and CEO of Jefferson Healthcare System in 2014. Within three short years, Klasko cultivated a $110 million gift from the Sidney Kimmel Foundation. He added several design and medicine departments to the university, a design track to medical education, and grew Jefferson’s physical plant to 11 associated hospitals across the Delaware Valley, employing 25,000 people.
Klasko is author of two books with a third on the way. He was recently editor-in-chief of the medical journal Healthcare Transformation. The doctor has been the chief executive officer of three academic health systems and the dean of two of America’s medical colleges, including the Jefferson family of institutions. At each location, he has built programs to develop the clinicians of the future, and, with the recent sweep of Philadelphia University into the Jefferson University fold, he is potentially building the medical college of the future. The merger of Philadelphia University and Jefferson University has combined annual revenues exceeding $4.8 billion–more than 28,000 employees, 7,800 students, 6,000 physicians and practitioners, and 4,000 staff on faculty.
Thomas Jefferson Healthcare and Sidney Kimmel Medical School are headquartered in some interesting buildings around the city–the Old Federal Reserve Building at 10th and Chestnut Streets, for instance–but the built environment is only one piece of Klasko’s vision for the future of healthcare. A sci-fi fan since childhood, Klasko enjoys imagining what the next iteration of health care might look like if he can just disrupt the current status quo. He has done a deep dive into design to solve medical problems like obesity, malnourishment, and diabetes. Can we solve these outsized ills with design thinking, design processes, and design practice? Stephen Klasko thinks we can. I recently spoke with the good doctor via email to ferret out his thoughts on smart design and the shape of 21st century healthcare.
HJ: How do our physical surroundings effect health outcomes, if in fact they do?
SK: I think of “surroundings” a little differently. To me, the best location for health and health care delivery is where I am. So a “surrounding” may be where I live, work, or go to school, but it may also be my TV, laptop, or phone.
We’ve spent a century building great hospitals and clinics and doctor’s offices, when we should have been thinking about health where we are. Technology now makes that possible. So, yes, that means the built environment should be healthy, but it also means health should be available wherever in that environment I need it. I will know we are successful if in the future people cannot describe physically where Jefferson is because we will always be within reach.
HJ: What impact does the physical environment have, if any, on post-surgical patients? On mental healthcare? Does your answer hold across other medical departments such as heart, cancer, reconstructive surgery, orthopedics, and chronic illness?
SK: We have to reframe medicine itself. It’s not just about meds and surgery. It’s about the experience of life, enhancing health, and appropriately tackling disease. At Sidney Kimmel Cancer Center, we have an endowed center, the Neu Center for Supportive Medicine and Cancer Survivorship, which will recognize the importance of the psychosocial, spiritual, and built environment impacts on cancer prognosis.
HJ: Can you comment on your so-called “Netflix model” of business for healthcare. Does the model indicate a vanishing point for brick and mortar hospital facilities, clinics, and other healthcare facilities? With relationship to this model, please expound on teleMed possibilities.
SK: Again, I want people to answer the question, “Where do you get your healthcare?” with the answer “Where I am.” The future of health is your home and kitchen and bedroom and yard and at work and school. But there are lots of companies doing actual physical space work in hospitals, like the calming rooms for MRIs. Again, that’s a commercial world that has big money and we’d need someone who tracks them.
The breakthrough for Netflix was recognizing that the product was entertainment, not the store. The breakthrough for hospitals will be recognizing that the product is health, our care and caring. 86% of health spending is on chronic conditions, which go off the rails in the evening, on weekends, in school, at home. That’s where and when healthcare needs to be. We will want and need highly specialized hospitals, but for fewer things. I recently touched on this idea in a recent blog post, “Stop Waiting for Healthcare’s Twilight Zone to End.”
HJ: Is online learning as valuable as in-class experiences for medical students? Is there a value to the physical plant? If so, are there certain things that could help promote learning? Or, are students encumbered by things that surround them, including other students?
SK: I love libraries that have ditched stacks for small group rooms. All professional and medical students need to learn to work in teams and to work with people in professional environments, but also in communities. I’m proud of the Pew-funded ARTZ collaboration in Philadelphia, where students use art to understand Alzheimer’s.
This is true of higher education as well as healthcare. There is no ivory tower. Students want to learn where they will work. Pretty soon we will have an IBM Watson or a Google Brain next to us that will be better at memorizing things much better than any human. Why accept medical students based on memorization and being better robots than the robots? We need to choose them based on human qualities—self awareness, empathy, communication. Much of that cannot be taught online.
HJ: What kind of environments are needed for clinicians to perform well? I’m thinking about University of Pennsylvania’s critical care unit for heart patients. The rooms are packed with both freestanding and wall mounted medical equipment. The room I visited could have been a surgical suite, I suspect. To the family, visitors, and the patient it was a dreary and depressing sight, however.
SK: Being in a hospital can often be a hectic, anxiety-ridden, or even intimidating experience for patients and their loved ones. If we can minimize that discomfort, even a little, we are doing a lot to increase the well-being and care of our patients. With the ability to interact with in-room speakers that are connected to the IBM Watson IoT Platform, patients can take control over their hospital stay and the overall experience with operating lights, window blinds, asking questions about hospital facilities, or even getting background information on their physician.
The in-room speakers will be connected to the IBM Watson IoT Platform that taps IBM Watson cognitive computing and natural language capabilities, as well as provides the ability to easily access hospital data that is relevant and important for patients and the types of questions they typically may have about their hospital stay.
For example, patients can request information (“When can my brother visit me on Tuesday?” or “Tell me about my doctor.”) request specific actions (“Play waterfall music.” or “Make the room warmer or cooler.”), trigger actions (“Remind me to get up and walk every four hours.”), and have an interactive dialogue with the speaker (“Conduct a survey and record the responses for my nurse.”) all which can help make a patient’s hospital stay more comfortable, relaxed, and enjoyable.
When asked, most people say they want to die peacefully at home with loved ones. But most people die in hospitals surrounded by machines. We have to understand dying differently. It’s not always the time for expensive, heroic action. It’s a time to reflect, maybe celebrate, maybe show gratitude, maybe express sorrow. At the same time, I’ve seen miraculous work done in ICUs leading to renewed decades of life. As a society, we need to talk about these moments in time. In fact, as part of our new IBC contract, we are working on a “hospitals at home” concept that will allow us to do most things we do at a hospital at a patient’s home.
HJ: Do spaces such as labyrinths, alters, and other spiritually-based designs have a place in healthcare?
SK: When I wrote my book, We Can Fix Healthcare in America, we talked to more than 100 people in all corners of the healthcare system. Inevitably, people with long-term, life-threatening conditions spoke of how hard it is to admit fears. “How do we talk to our children?” But they also say it’s hard to talk with doctors about those fears. I’m a big believer in understanding global health and bringing other perspectives to our care for people. Spirituality is a powerful way that people talk about living and dying. The Marcus Center for Integrative Health that we started in Villanova is working to dispel the myth that pills and surgery are the only modern ways to keep people healthy.
HJ: Let’s talk the future, a place you seem to spend considerable time if your writing is any indication. How will changing or disrupting our existing hospital-centric healthcare model effect our built environment in malls, corner stores, neighborhood community centers, drive-in retail operations, K-12 schools, higher learning facilities, and the like?
SK: We’re seeing the collapse of traditional retail stores just as healthcare is heading to retail medicine. My prediction is healthcare will go the way of shopping–online, virtual, and personalized in new ways. Jefferson will go into retail in a big way, both online and physical, especially once personalized medicine and genomics takes hold. I see Jefferson Centers for Human Longevity in modern malls. You will be able to get your genes evaluated right next to the jeans stores!
HJ: What’s the role of user experience and virtual reality in medicine and healthcare?
SK: Those are different. Healthcare will become based on “user experience.” How we experience our own health and care delivery will determine our choices. I do believe the next generation of telehealth will include holograms, robots, and avatars.
Virtual reality offers the ability to move beyond time and distance boundaries. You might talk with your team from thousands of miles away, but also at one time even though the clinicians are speaking at different times. You ask for help at midnight, and the avatar of your doctor can respond right then and right there.
HJ: Telehealth? You don’t literally mean phoned in medicine, or do you?
SK: Telehealth could be a phone, a sophisticated medical device, a set-top box on a TV, a smartphone app, an email based app, a dashboard generated by a wearable, or an avatar with any mode of transmission and response. In the future, healthcare won’t need a modifier. This year, Kaiser Permanente, the healthcare insurer, broke the 50% line–52% of patient visits were virtual. Kaiser had more than 100 million patient encounters. That’s a lot of virtual visits in need of design thinking.
HJ: Are there other kinds of built environment vernaculars that figure into your idea of a “disruptive” healthcare model?
SK: The built environment needs to help us transcend time and space. Students in any field don’t need to move lockstep through classes based on classrooms and semesters. They need the journey to understand a field of thought and an experience that gives them value. Much of that journey is with other people, potentially with simulation, potentially in work environments, and potentially in neighborhoods and homes. I also believe in reversed roles, that is, having patients act as mentors for medical students and nurses, evaluating them on their empathy, listening and communication skills, before bad habits get imprinted into their DNA.
HJ: Do you envision an actual medical Genius Bar like Apple stores?
SK: Yes. the only question is whether it will be delivered with a hologram, avatar, or real person.
HJ: What products, devices, furniture, indoor and outdoor space need to be created to provide better health outcomes? What conditions will those fresh designs help ameliorate?
SK: The list is infinite. Once you start by understanding the user, everything is open to redesign. Our head of JeffDesign, Bon Ku, observes that once you teach design to medical students, they see everything as an opportunity for innovation. Some are obvious: Wheelchairs and stairs. Some are abstract: How to create examinations that factor in augmented intelligence so we don’t test what you can look up on Google. But to me, the exciting re-envisioning is the home itself. Suppose your kitchen was your health center? And your television the doctor’s office? In my former role at the University of Florida, we developed a dancing wheelchair in combination with a former designer for Pininfarina for special needs folks.
HJ: Let’s talk about the physical street, sidewalks, traffic light control systems, dense urban architecture. Does any of that figure into the future of healthcare?
SK: There is already a lot of work on the “walkable city” and the “rollable suburb.” I’m ready for the “virtual city.”