The hidden ingenuity of nurses: Q&A with Anna Young

In her TEDMED 2015 talk, MakerHealth CEO and Co-Founder Anna Young describes how she is bringing rapid prototyping tools into hospital to enhance the natural, do-it-yourself problem solving abilities of MakerNurses, frontline clinicians, and patients who innovate to improve health care. Using a maker mindset of hands-on problem solving and experimentation, nurses, respiratory therapists, medical residents and patients in the MakerHealth network are reinventing medical technology. We caught up with Anna to learn more about her work, and what’s on the horizon for MakerNurse and MakerHealth. 

Q: Are there any recent MakerNurse innovations that you are especially excited about?

A: The most impressive projects we hear are the ones that launch from idea to prototype in less than a week! When we launched MakerNurse, nurses reached out sharing their ideas. Now, nurses are calling us to share their prototypes! Some of the recent nurse-made projects we’ve guided include: home care devices for improved patient hygiene, a custom patient support pillow, and a toy bear modified to support a PICU patient’s ventilator tubing.

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Driscoll Children’s Hospital, Corpus Christi, TX

Earlier this summer, Driscoll Children’s Hospital in Corpus Christi, TX, one of the MakerNurse Expedition Sites, performed an incredible operation to separate two conjoined twins. From surgical planning to the patients’ rehabilitation, the process was full of health making that made us so proud to be working with Driscoll. The surgeons modified two toy dolls to match the anatomy of the twins and 3D printed a model of their organs from a DICOM file to help with surgical preparation. The nurses created custom, color-coded surgical caps to identify the clinicians for each of the twins: one team wearing purple and the other team yellow. During the rehabilitation, the Occupational Therapists and Child Life Specialists built an interactive mobile from PVC tubing, custom dimensioned around the bandage constraints of the twins.

For this care team, a maker mindset and access to prototyping tools helped them care for delicate, high-risk, N=1 patients. The innovations at Driscoll – the surgical models, custom caps and PVC rehab mobiles will never be commercialized because the market is too small. If you think about it though, the patient doesn’t care. So with a MakerHealth toolset and mindset, this team in Corpus Christi is reinventing care.

Q: You started your journey with nurses. How did MakerNurse grow to reach other health care professions and patients through MakerHealth?

A: Our academic roots at the Little Devices Lab at MIT had been looking at the science of medical making for a long time in hospitals in Nicaragua, Nigeria and Ethiopia. We got a huge shot in the arm when the Robert Wood Johnson Foundation supported the translation of our research framework for international health making into a framework for finding frontline MakerNurses across the American health care system. In the US, nurses are natural hands-on problem solvers and leaders in making, but they don’t operate alone in their tinkering. As we roll out the MakerHealth Program in hospitals, we are working with doctors making surgical tools, OTs and PTs creating adaptive devices and even police teams joining the community by 3D printing lock jigs. We’ve created on-ramps and just-in-time learning blocks to help all staff inside of the hospital learn the skills needed to prototype.

This same model of medical prototyping and sharing grew beyond the hospital walls. We saw with a parent in Ohio, who refused to wait for Medicaid to kick in to reimburse a walker for his daughter who has an endocrine disorder. Instead, he rolled up his sleeves, went into his garage and transformed his grandmother’s adult walker into a child-size one for his daughter. Bonus, he spray painted it purple. Her favorite color. This is the heart of health making, people who are driven to create solutions for the patients closest to them.

Q: What are today’s grand visionary plans of MakerHealth?

A: Health making is revolutionizing the way care is delivered in hospitals, clinics, and home care divisions across the globe. Patient-made machines are changing the provider-patient dynamic. The solutions by frontline staff are making care better and more affordable. Everyone is working to get rid of the black box of medicine: hidden engineering, hostage data and runaway prices. When the status-quo medical device becomes too cost-prohibitive, we see emergency response teams in Seattle respond by rolling out their own DIY kits. We are driven to show health systems how to move these health prototypes into clinical care. Right now, medicine is a temple of evidence raised practice. We’re bringing back an experimental mindset where everyone gets to ask the questions-and everyone gets to build the answers. You need tools: so we are going to continue to grow our hospital makerspaces, we’re writing new types of medical and nursing school curriculum, and folks can now order prototyping kits shipped to their home. We are reinventing health care one maker at a time.


annayoung_blogcaption MakerNurse co-founder Anna Young describes how she is bringing rapid prototyping tools into hospital units to enhance the natural, do-it-yourself problem solving abilities of nurses who innovate to improve patient care on a daily basis.

A Culture of Health Includes Everyone

This guest post is by Sam Vaughn, TEDMED 2015 speaker and Neighborhood Change Agent in the City of Richmond, California. You can watch Sam’s TEDMED talk here.

Sam Vaughn 2A person can have a healthy heart and diseased lungs, or a healthy brain and kidney failure. Would you consider that person healthy? Society is quite similar. Until we create a culture of health that is inclusive of all citizens, we cannot consider ourselves a healthy society. Thus, we cannot create a healthy society until we deal with issues of personal security, like crime and gun violence.

As I mention in my TEDMED talk, at the Office of Neighborhood Safety, we identify individuals who are most likely to be perpetrators or victims of gun violence. We work with them through a program called the Operation Peacemaker Fellowship, a seven-step process to help them become self- and socially-aware of their roles in society, and to affirm their God-given and Constitutional rights to happy, safe and successful lives. Perhaps most importantly, we meet and accept them where they are, with no judgement, and recognize the social, structural and strategic injustices that they have faced most of their lives. We challenge them to accept that, despite those injustices, they still have a responsibility to themselves, to their families, and to their communities to do better.

The first step of the Fellowship, and one that is vital to our success, is for us to build a relationship with these individuals. Most young people don’t care what you know until they know that you care. Once trust is established, we create a LifeMAP with them, helping them see that a different future is possible by showing the changes that others have made. We help them envision a future as bright and fulfilling as they can possibly imagine, and we connect them to resources and service providers that can help make that dream become a reality. We connect them to mentors and coaches, a group we call Elders, who are older successful men of color who have successfully made changes in their own lives, and are now reaching back to help others.

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Sam Vaughn, Devone Boggan, and Fellows on a retreat at the Teotihuacan Pyramid of the Sun, Mexico City.

Additionally, in a step riddled with great risk but even greater reward, we take the Fellows on trips around the globe, to help them see how good life can possibly be and get them addicted to living. The catch to this amazing travel opportunity is that they must travel with someone from what would be considered a “rival community.” As they begin to see themselves, and the world they live in, in a different light, they start to see each other differently as well.

Because we believe hard work should be rewarded, we provide a stipend to our Fellows, a practice that is seen as controversial by some. Critics frequently disparage this, claiming that we are paying criminals not to commit crime. Let me counter that by saying that, when I was young, my parents would give me $5 for every “A” I got on my report card. Were they paying me to go to school? Absolutely not– they were rewarding me for working so hard. We aren’t paying these young men for what they aren’t doing. We are rewarding them for what they are doing.

Our final step is to introduce our Fellows to mainstream society and the workforce through subsidized employment. In this stage, they develop a strong work ethic, effective workplace communication and the skills of being a team player. Eventually, they become employable by their own means, without subsidy.

Frankly, our goal is to provide these individuals with what every young person in this country receives when they grow up in a healthy, nurturing community. We’ve been successful. Of those who have participated in our Fellowship, 94% are alive, 84% haven’t been injured by a firearm, and 79% have not been suspects in new firearm-related crimes. During the period of our interventions with these youth, the city of Richmond, California has experienced a 66% reduction in firearm assaults and a 55% reduction in firearm related homicides between 2007 and 2015. By attending to these young men who are and have been traditionally underserved and abandoned by the mainstream services platform, the City of Richmond is creating a culture of health in a once dangerous city that is today a much more desirable place to live, learn, work and play.  

Bridging the Gap: Neighbors Supporting Neighbors in Harlem

This guest post is by Manmeet Kaur, Founder and Executive Director of City Health Works — a nonprofit, social enterprise that aims to close the gap between hospitals and communities in Harlem.

Manmeet KaurIn order for health to flourish, we need people in our lives that make us feel supported and accepted. Social support is essential to well-being and plays a fundamental role in one’s ability to make healthier choices—it is a critical aspect of making health a shared value. Unfortunately, only half of adults in the U.S. report getting the social support they need. Those numbers are even lower among minority groups and those with lower levels of education and income.

In many countries around the world, however, communities already employ effective approaches that have demonstrated impact. In Cape Town, South Africa, for example, I worked with a nonprofit that hired people from the community and trained them as peer health educators to tackle chronic health issues. This is where I first witnessed the power of peer education and the ripple effect such educators have not only on an individual’s health, but also on other aspects of their lives.

When I returned to my hometown of New York City, I immediately saw the potential to adapt this model of health care delivery from abroad and apply it to my neighborhood here in East Harlem. This is a neighborhood in which life expectancy is 9 years lower than the life expectancy of residents of midtown Manhattan. 50% of healthcare spending in this community is on only 5% of the population. The level of chronic illness in this community is so great that clinicians struggle to deliver the high-quality care patients need. They often aren’t able to support patients through the necessary long-term nutritional and behavioral changes to keep chronic illness under check. They are completely overburdened.

That’s where City Health Works comes in.

Inspired by community health worker innovations from South Africa, City Health Works engages community members to serve as the bridge between the doctor’s office and the real challenges people with chronic illnesses face on an ongoing basis. We don’t replace traditional medical care. We simply fill a gap between the health care system and the everyday lives of the people that system is meant to serve.

We start by finding and employing individuals living within the neighborhood who have a strong sense of empathy and good listening skills, are non-judgmental in nature, and can speak to shared life experiences. We train them to become health coaches: we teach them how to build relationships with their patients and truly get to know their needs, which often go beyond health and health care. In addition to receiving training on basic health care in a clinical environment, health coaches learn how to make referrals to services like banking and housing, and recommendations for recreational activities, such as local walking groups, knitting clubs, and bingo nights.

Hospitals and clinics can refer patients directly to us. They refer individuals who struggle with multiple chronic diseases and the stressors of poverty, old age, physical and mental limitations, and language or literacy barriers. Most of them experience depression and struggle with social isolation.

We pair each patient with one of our health coaches so they can receive personalized support and the resources they need to make healthy choices. Initially, there is some hesitation on the part of patients. Health choices are, after all, deeply personal. But once they learn that their coach is from the same neighborhood, they grew up down the street from them, or they even live in their same housing complex, they become more comfortable. Trust is assumed and they open up.

Today, our health coaches meet one-on-one with more than 300 patients in East Harlem on a regular basis. Over the first two years of the program, we measured depression levels amongst our patients and found that simply having a health coach who visits them regularly had a huge effect on their social and emotional well-being. Coaches have a powerful ability to motivate their patients, help them build self-confidence, and strengthen their ability to manage their lifestyle and medical care. We are proving that adding extra support for those who need it most not only saves money, but saves lives.

By adopting practices from outside of the U.S.––an approach for which the Robert Wood Johnson Foundation is now actively seeking proposals––City Health Works has been able to provide critical social support for the people in New York City who need it most. We are changing attitudes about the role of community, fostering health as a shared value, and changing our patient’s expectations about the level of care they should be getting. By fostering an engaged community, we are breaking through the walls of isolation and building a Culture of Health.

Promoting Health Equity by Choice

This guest blog post was written by Dr. Mary Travis Bassett, the Commissioner of the New York City Department of Health and Mental Hygiene. Dr. Bassett spoke at TEDMED 2015.

mary-bassettNew York City is one of the most diverse but racially segregated cities in the United States. Neighborhood segregation and structural racism, including poor housing conditions and limited educational opportunities, have led to unacceptable health disparities in our city. In turn, these health disparities have led to many lives – mainly the lives of poor New Yorkers and people of color – being cut short.

On average, New York City residents are expected to live longer than the average person in the United States. However, within the five boroughs, health outcomes can vary substantially from one subway stop to another. Average life expectancy rates can obscure those worrying variations between neighborhoods. In places like the South Bronx and Brownsville, Brooklyn, where I first lived when I was a little girl, people can expect to live lives about 8-10 years shorter than a person living in Manhattan’s Upper East Side or Murray Hill.

The usual explanation for these unhappy odds is that people in these neighborhoods are making a whole series of bad lifestyle choices. They eat too much, don’t exercise, smoke, drink, and so on. I’d like to challenge everyone to think differently.

Instead of thinking that people in Brownsville live shorter lives because they are choosing to eat unhealthy foods and choosing not to exercise enough, let’s think of how a lack of choice can impact a person’s health. For example, people don’t choose to live in a neighborhood where it’s unsafe to walk or exercise outside at night. People don’t choose to rent an apartment in a community that does not have a grocery store nearby. No one chooses to take a job that pays a wage impossible to live on, let alone live healthy on. The problem is not lifestyle choices that are bad for one’s health, but having too few choices that negatively affect a person’s health.

When we think about health, we have to think about restoring choices. For people to live healthier, they need good housing, a more livable wage, a good education, and safe spaces to exercise. All of these help build a neighborhood where people look out for each other. To achieve health equity, we have to confront all of the factors that affect a person’s ability to live a healthy life. That’s why as health commissioner, I will use every opportunity to speak out against injustice and rally support for health equity.

Our new initiative, Take Care New York 2020, seeks to do just that. It is the City’s blueprint for giving everyone the chance to live a healthier life. Its goal is twofold — to improve every community’s health, and to make greater strides in groups with the worst health outcomes, so that our city becomes a more equitable place for everyone. TCNY 2020 looks at traditional health factors as well as social factors, like how many people in a community graduated from high school or go to jail.

Additionally, the City’s investment in Pre-K for All will go a long way toward addressing the inequalities we’ve seen emerge so early in life, which reverberate across the lifespan. Investing in early childhood development is an anti-poverty measure, an anti-crime measure, and it is good for both mental and physical health. For example, the number of words a child knows at age 3 predicts how well he will do on reading tests in third grade, predicts his likelihood of graduating from high school, and so on. Early investment is key to undoing decades of injustice.

I believe that achieving health equity is a shared responsibility, and we can only accomplish real change by working together. This is a big challenge, but I am hopeful. New Yorkers are fortunate to have a Mayor and an administration that is committed to addressing longstanding inequality. Every city needs such committed leadership if we are to see a day where someone’s ZIP code does not determine their health. I hope you will join us on this pursuit of equity.