Design Groundwork for Healing Spaces

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AJ: [00:00:00] Welcome to Once Upon a project where we uncover the untold stories behind extraordinary design projects.

I'm your host, AJ Perone. Today's episode is a bit different. We're talking about a project that doesn't yet exist as a building. But has already begun transforming lives. It's a groundbreaking wellbeing initiative focused on congestive heart failure, and it all started through an unlikely collaboration between a design firm, a healthcare system, and an organization devoted to creating happiness.

Joining me are Nancy O'Brien from Experience Happiness and Deanna Hokinson, who at the time worked for the clients. Hennepin Healthcare and Hennepin Health. Together, they've embraced experience-based co-design, a process that turns the people most impacted by a problem into an [00:01:00]active co-creator of the solution. So welcome ladies. I'm so happy to have both of you here today. Let's start with you, Nancy. Can you tell us a little bit about experience, happiness and the happiness practice?

Nancy: So in regards to experience happiness, um, we're on a mission to. Eradicate burnout and improve wellbeing and performance by cultivating inside out authentic happiness because as it turns out, our authentic happiness is our superpower.

AJ: I know everybody's. I'm kind of wondering what is authentic happiness like if you had to explain, ' what you actually learn through the happiness practice, what, like in a paragraph, what would that be?

Nancy: our innate ability. To cultivate our serenity and our excitement about life, regardless of outside forces. There's a lot of outside [00:02:00] forces. but our internal wellbeing, we are 100% empowered. Accountable for creating and this blend of serenity and excitement. Though those two emotional states seem that they are opposite, the combination is powerful because that serenity comes from each and every one of us being okay with who we are.

Who we are is over always changing. It's supposed to change. But when we're grounded in being okay with who we are, then we can meet any one of life situations with excitement because like, okay, what am I gonna do with this? This is what's presenting in my life right now. And we are the co-creators of our life experience each and every moment.

And with the happiness practice. It's not another thing to do. It [00:03:00]cultivates a new way of being from the inside out. There are five principles of happiness that people learn and practice over time that develop new neural pathways. So what's like you're changing out your operating system as a human being and you're shifting from being a human doing that thinks and gets really tired at times to a human being who feels and is energized by life.

AJ: I think that's one of the biggest things that I've learned from you, Nancy, in this program, is that you can have more than one emotion at the same time. Like, that like blew my mind. It's like, wait a second, I can be tired and happy and sad and angry all at the same time. That's amazing. There's, there's a lot that goes into the practice, which we don't have time to go into today, but I, I would love for you to transition and talk a little bit about your work as trauma aware and burnout reducing.

How does that intersect with [00:04:00] design and healthcare?

Nancy: You know, I kind of backed into this happiness work, um, because I've been traveling all over the globe, improving employee and customer experience.

And I got off the plane one night at the glamorous Minneapolis airport. After being on the road probably nonstop for 10 years, and I went to refresh myself in the restroom and I didn't recognize myself and I wanted to kill myself, so I had suicidal ideation. And what I know now that I didn't know then is I was suffering from all the 16 signs and symptoms of burnout.

And the interesting thing about burnout, it is different than stress and it is not tied to a mental health pathology. However, depending on how long you're kind of in the state of burnout, it can lead that way. But here I was suffering and so part of just kind of reclaiming my wellbeing started with. [00:05:00] Redefining happiness, that it wasn't out there, it was in here. And then you come to find out that in the world of doing experience, strategy, and experience design, strategy and culture have to coexist and all.

Culture is, is a sum total of how we feel about ourselves and others in any given situation. So if we had this beautiful customer and employee experience strategy, but our culture is based on people who are suffering and feeling depleted, it doesn't matter how great that strategy is, it's not gonna happen.

AJ: Oh my God. We hear about that all the time when we're looking at spaces and it's like somebody creates a amazing employee headquarters. That's beautiful and striking, but the culture. Is rotten to the core and people don't like, even though it's beautiful and aesthetically pleasing, [00:06:00] and a lot of amenities, doesn't matter if everyone there is burnt out and has this collective feeling that they're not making a difference.

Right?

Nancy: conversely, the opposite is true. You can be in environments that from an aesthetic standpoint, not so great, and yet people are thriving,

AJ: So Deanna, you were the client on this project, right? So tell us what your role was and the problem you were trying to solve.

Deanna: I was a program manager on the population health team, for Hennepin Healthcare, but I supported work that would impact. The members of the Hennepin Health Insurance Plan. I was tasked at, building out a new model of care for people with congestive heart failure from the Hennepin Health Plan.

And, and they wanted me to use co-production as the methodology. And so one of my colleagues said, you know, we really should bring in [00:07:00]experienced, human-centered design. we've worked with DreamBox and Nancy O'Brien before. You should connect with with Nancy.

And so I did. and the rest is history. We, they, Nancy and DreamBox. I awarded the contract too to co-lead this work

AJ: DreamBox is a part, is a studio a part of RSP architects. And so Nancy, you've been working with RSP and DreamBox for for many years and bringing your methodology to that, which is very unique for an architectural firm to have something like that. So tell us more about what was the problem you were trying to actually solve?

Deanna: Yes, so we were trying to create. A new clinical care model for people with congestive heart failure in the context that they knew that just the medical side, clinical side wasn't working because there was too many [00:08:00] social determinants of health that the patients or residents, um, if we're talking about the community, um.

Had that they were dealing with. And so they wanted us to bring in a model that would look at everything, look at the whole complete ecosystem, um, for everybody.

AJ: And why would in an insurance company be interested in that? That's what I'm really wondering.

Deanna: Yes. Because they wanted to improve the health of their members, right. I mean, for an insurance company, it's always awesome if you have healthy members

AJ: what do you know about congested heart failure that maybe the public doesn't know?

Deanna: well, especially with this population, aj, we learned so much because it's the Medicaid population and for this, group that we were supporting at Hennepin Health, they're also very highly, [00:09:00] unhoused. And so we learned so much about the impact of being unhoused on their health because many, many things take priority or as equally important in their health as actually taking their medication, maintaining their weight, drinking the fluid.

Levels they need to drink. Those are the things that the healthcare system is really focused on, right? Your weight, your diet, your medication compliance. But the patients are trying to focus on, I need food. I don't have food. I need a place to live. I don't have a place to live. I just wanna feel safe, And so it was that whole intersection that needed to come together. Figure out what can we do to help improve the lives of these folks with congestive heart failure, as well as everybody in that ecosystem. So [00:10:00] that's, that's why we brought in experience-based co-design with Nancy and DreamBox to bring in the lived experience of everybody in the ecosystem.

So the doctors, the nurses, the so social workers, We also, um, paid our gentleman with three gentlemen with congestive heart, heart failure, that two of which were homeless and one was living in a one bedroom studio apartment, and we paid them to walk with us on this journey of building what would work for them.

AJ: Wow. You know, I, I often wonder that when, when you go to the doctor's just for a regular checkup, right? And you get like the printout at the end and it tells you all the things that you should be doing, all the fruits and vegetables that you should be eating, how much you should be walking every day, and all these things that you should be doing.

And I know. For sometimes with a person, even with a lot of means, that's, that's a [00:11:00] hard thing to accomplish, but I could only imagine how difficult that would be if you were homeless or if you had other, conditions that were layered onto it. So, so this was the cohort you were looking for, right? It was unhoused men with congested congestive heart failure.

Deanna: correct. Mm-hmm.

AJ: So Nancy, maybe you can help us understand. Why an architectural firm like RSP would work on a project like this.

Nancy: I've been. Working with RSP architects for about 17 years in this little studio called DreamBox. Again, architecture designers are brilliant and they wanna like create these wonderful spaces, but they aren't always given the luxury. To understand what the needs of the people that will be using those services are. so I get to come in and do that work and I do a lot of man on the street interviews and I do a lot of deep dive, you know, conversations.

I do a lot of [00:12:00] observations or whatnot, but mostly I equip the client to see things through a new lens so anyone can learn the art and science of experience design. And once, you know, kind of the, the. Basic tenets of experienced design. You're gonna use it for your dinner parties. You're gonna use it for, on that next project, you're going to use it for, you know, Thanksgiving

dinner.

Um, because experienced design is rooted in brain science, and brain science is how we all operate.

AJ: It is. And that's many times the missing piece in architecture and the design process is really that understanding. what happened next? Nancy, can you walk us through what you actually did to, to do [00:13:00] this experience-based co-design?

Nancy: So one of the rules of experience-based co-design is you can only move at the speed of trust. And that is very challenging for a lot of organizations because most projects have a begin, end, a budget, a resource, and with experience-based co-design, you really cannot do the next step unless your cohort in this case are three men.

Are ready for the next step. And they all three needed to be ready kind of at the same time. And it was really interesting to watch them support each other to be ready to take the next step together. You also are trying to really understand the true lived experience. And so it took a minute for them to be open and vulnerable with us to [00:14:00] say, you know, I don't take my medicine because it makes me pee and since I don't have a place to stay, the last time I peed on the street, I got arrested.

AJ: wow.

Nancy: So, I mean, we are hearing all this, right? And nothing we can really do about it. So here's the other tricky part around experience-based design. Do not solve early,

like I think a lot of designers wanna say, well, that's the problem, so let's just do that.

The thing is, you gotta stay in the question long enough to know what you're really solving for

AJ: And that's painful, isn't it,

Nancy? It's painful for me to say the

question. I'm telling you, and I love my designers. I love UAJ. I love all the designers that I get to work with at RSV Architects, but you wanna solve the problem quickly. And it was so interesting because we spent a year with these men and you know what they wanted most was a community.

Hmm.

Nancy: [00:15:00] They didn't want us to solve for the peeing in the street.

They didn't want us to solve even their homelessness. They wanted to solve for their loneliness. but that took us eight months to get to.

AJ: Wow.

Nancy: But that led to us piloting the first congestive heart failure Wellbeing Center because these men, they're like, you're not gonna improve my heart condition like that.

You're just not, you're not gonna solve homelessness, you're not gonna solve all these other things, but what you can solve for is my loneliness. And equip me with tools like the happiness practice so I can be okay in the context of my chronic condition, in the context of homelessness, in the context of not having, um, the right food or the diet.

AJ: it seems so obvious, but it's not like if you said, you know, you need to help these people become more healthy and they're homeless. Like, oh, well, yes, we could just make a [00:16:00] community and, and get them to be less lonely. Like, of course that makes sense, but it is not the first thing you think of when you're like trying to solve for the problem.

Nancy: And it was interesting because we never knew where these men were gonna be. And we would text them, can you still meet today? And where are you? And we would be picking them up on the street corner or picking them up at the library or picking them up, you know, wherever they were, so that they could be together.

And the. You know, Dean and I, you know, would have our agenda. Let's accomplish this with our three wonderful men today. Oh my God. Every, every time We just had to throw that out the window. Be, because what we were observing is them helping each other. Like it was everything from, you know, you gotta take that med before you have lunch.

Because if you take it after you have lunch, dah, dah, dah, dah da, or you gotta make sure you go to that shelter before four o'clock. 'cause after four o'clock they were helping each other live with this [00:17:00] chronic condition

AJ: Why do you think that sense of having a community is so powerful.

Nancy: Because we all wanna feel seen.

AJ: Mm.

Nancy: It's a core need. As human beings, we wanna feel seen and understood, and from that we just might get to feeling supported.

AJ: Mm-hmm. You know that, that does make sense to me because when, when my son was diagnosed with autism at the age of three, we went through, they sent me to all these support groups, and people would be sitting there devastated and no one was being proactive. And sometimes we were put in these support groups where the parents had children that were actually dying.

And you're like, oh my God, what do I have to complain about these? These parents have children that are dying. And I found it very unmotivating until I surrounded myself and made my own parent group Imagine that, of parents that [00:18:00] were looking for medical answers and. We had so much fun and we were always so excited, and we'd go to conferences together and we would go and, you know, rally at the capitol and go meet with senators.

But we were all, we were all in it together and we understood where everyone was coming from and we were all trying to proactively make things better. And that excitement was really contagious. So I can see how this would work. So how does that translate then, like Deanna, for your goals, like understanding that was kind of the aha.

How, how does that translate to, to treatment

Deanna: So, so what it led to was building out a pilot of a, well Congestive Health, heart Failure Wellbeing Center. So it automatically brought in that sense of community, but it [00:19:00] also brought in that Whole Person Care model because they could get their medication checks, they could get their weight taken, they could meet with a dietician, they could get a massage, they.

We had a peer-to-peer support group so they could just talk with each other and like, like when we just worked with the guys, that talking with each other was so helpful. So we brought that as a big part of it. Um, and really that ongoing learning from each other and that sense of community was. Really one of the biggest parts that they absolutely loved.

at the same time being able to get that clinical support,

Nancy: you know, the hospital wanted an. To make changes to their clinical care model. Right. Because that's what they do. Right. And then the Hennepin County Social Services wanna improve, you know, social worker, you know, support 'cause that's what they [00:20:00] do. but the patients just wanted to have a better day, whatever that looked like for them.

Right. And. We would listen to the conversations between the social worker and the uh, um, providers. And the providers and the social workers would get frustrated because the patient in this context didn't share everything. They didn't share that they were houseless, they didn't share that they weren't taking their meds. And then we go back to the men and say, so why don't you share? And they were like. They can't handle it. They're burned out. So these wonderful men who have congestive heart failure did not share and reveal what was going on with them because they picked up on the burnout of their physicians and providers and the social workers.

So they withheld information

Deanna: They just didn't [00:21:00] wanna add to their level of stress

Nancy: I mean, what's the doctor going to do about homelessness?

Deanna: So that's why we, we brought in the happiness practice as also a part of the Wellbeing Center. Not just for, the folks with congestive heart failure, but for everybody in the ecosystem.

AJ: So even the doctors and the

Deanna: Doctors and the nurses

AJ: oh,

Deanna: mm-hmm.

AJ: everybody's in it together.

Deanna: Yep. In their own cohorts, because having that, their affinity is, is a big, you know, important part of the practice.

AJ: So Nancy, from your perspective, what are the things that you think would shock. the average person in the public or a designer that we don't know that you guys learned.

Nancy: I think I would like people to understand that the process is the product. We don't get what we want. We get. [00:22:00] How we are. So when we are compassionate, we receive compassion. And I think no to no fault of anybody's.

I think we're on kind of this, let's just get stuff done. In projects and opportunities, but When you take a moment to pause and allow people to really be.

You get more wisdom and more insight and more information in order to co-create the new solutions, but you gotta check everything out at the door, you know, because you, you've gotta stay in the question long enough to have the solution reveal itself. And there's too many times on a design project you already know it's gonna be a building, it's gonna be this many stories, it's gonna be this many square feet.

And oh, by the way, the furniture better ma [00:23:00] match the color palette of a logo. I mean, there's, there's a lot of things in a design project that are kind of given to you, but have you really taken the time to understand how people are, how do they feel now? How do they wanna feel and how can the. Design of space, support the emotional needs, not just the rational needs, but the emotional needs of the people that will be interacting in that space.

AJ: not to say that it's cookie cutter, I think designers and architects always want to be. Creative. It's the lack of time and the sense of urgency. We're in this Amazon Pace world that it's like, just click a button and you'll get it tomorrow.

Right. And I think that's, it's really hard for. Designers to number one, find the time, find that [00:24:00] space to be creative. And you know, this whole exercise that you guys did was all about listening. And I see that getting missed on so many projects that it's just like, oh, we did something like that. We're just gonna take that and run that over.

And it's like, oh my gosh, you have no idea what you're doing. You're totally missing the problem 'cause you're not listening to the users of that space. So what's your advice? from both of your perspectives?

Deanna: I would say, um, definitely bringing in people that have the lived experience of what you're working to solve for is critical. You can't do it without them and be successful. You just can't.

and that, like Nancy said, it's moving at [00:25:00] the speed of trust. So depending on who you're, you know, who you're working on the initiative for, that could take a lot of time, and it did in this case.

Nancy: The reality of their lived experience. I mean, these men are sick. I mean, there were times that we had planned to meet with them and you know, two of them were in the hospital, you know, so, again, you know, aj, you know this. It's like the project starts, we gotta be up, you know, we got 3D three weeks to get, you know, visioning done.

We got three weeks to get conceptual design done. We got three. You know, there's this pace of a design project. And Deanna probably had to go back to her leadership team like three times and say, we're not ready for that next step yet. We're not ready for that next step yet. You know? So you have to have some strong leadership to really want to understand what the problem is and really want to solve for it, not just get a project done and check the box. [00:26:00]And that's where I would say, in addition to what I. Totally, um, support deanne's notion like have people who are living the experience on your team and pay them just like everybody else is getting paid. 'cause everybody else is getting paid to be on the project team. But also don't go it alone. I think there's too many times that facilities is running a project, but what about HR coming to the table?

What about talent management? What about culture? bring the ecosystem together operating towards one in-frame. So it was really interesting because when I first met Deanna, all I got was this text message with a picture of a, a project charter.

That was it. It wasn't an RFP, it wasn't anything, it was just a picture of a project charter and, and it was kind of like, okay, well these people are sick and the health plan doesn't want 'em to be in the hospital 20 days out of 30. So you're thinking you're trying to reduce hospital stays. Well, we're six [00:27:00]months in and we find out, no, that's not the case. The health plan is perfectly fine having. The people in the hospital 20 outta 30 days. So it was all these things that it's like, are you all even on the same page?

Deanna: Nancy, let me, let me just add in here to that. 'cause you make a great point because it's like, it depends on if you're the health plan or

if you're the healthcare system. cause the health plan doesn't want 'em in the hospital,

Nancy: I.

Deanna: but the healthcare system, that's how they make their revenue. So

AJ: It's competing priorities.

Deanna: yeah, the competing priorities.

Exactly. But for the patients. They just wanna be well and not have to go into the hospital. So it's this whole paradigm shift that I think as a, as a healthcare system we're in right now, there's so much that can be done to develop

whole person care models, but the healthcare system has to change.

AJ: And [00:28:00] that's a lot to ask for, but it's. The model that you guys have done doing this

project has actually given people a pathway and show the benefits of, of designing it from that human centered approach. Um, so what's next? What's next for this project? What's next for both of you? Tell us what you see for the future.

Nancy: I do think experience-based co-design will be. The new way going forward, our current systems are crumbling. Our healthcare system, our education system, I mean, the old ways are crumbling. And for us as humans, we get to invent the new ways. And I do believe that every industry and every organization.

Will be invited to create the new [00:29:00] solutions with a more human-centric approach. And to realize that we need to look at, um, the totality of not only the human beings, but look at the totality of the ecosystem. It's interesting, aj, because you reference your son. I, I have a son with similar, with different but challenges. I wrote a four page letter to Governor Wallace the other day. 'cause I'm like, the system is full of confliction. Like the policies aren't in alignment, the processes aren't in alignment. And my son, who is very smart, but you know, compromised on some level, says, mom, what do people do without you? Like if somebody doesn't have you? Navigating the system and aj, I think your son would say the same thing. And so we can't [00:30:00] stay in our own swim lanes anymore. We just can't. We're gonna have to jump

out of the swim lane, jump out of the pool, and

we're gonna have to get in the ocean and say what works now for everybody.

AJ: It's so true in so many ways. I'm, I'm really excited that you wrote that letter and

I can't wait to hear if he responds. so Deanna, what about you?

Deanna: Yeah, so I, I mean, I agree with absolutely everything Nancy just said, and I, I absolutely think that using experience-based co-design methodologies in healthcare when we're dealing with patients or residents, depending on what part of the system we're in, needs to happen. It needs to happen regularly.

So you know, my background also is Six Sigma, I get that we need to have efficiencies and productivity is important and all of those things, that's a part. But when it comes to

[00:31:00] clinically taking care of patients, we need to keep the patient in the front, right.

It can all be about efficiencies and productivity.

So there's a lot of change that just needs to continue to transition, and I think that co-designing through the lived experience is the way to go.

Nancy: And I would just add with a focus on

true wellbeing, you know, what does it look like if everyone thrives in the ecosystem?

AJ: And thrives, and it's not about survives. We were laughing on a team the other day that we were all feeling really stressed out and we're like, we just gotta survive 2025. And I'm like, that's a terrible, terrible thing that we have to say. It should be, we should be thriving in 2025, not surviving in 2025, but sometimes it feels that way.

Nancy: that's when we had to check ourselves. So that goes back to the happiness practice. When am I [00:32:00] being a hostage, a happiness hostage. When, when am I placing my authentic inside out? Happiness outside of myself, right? When, when the project gets done or when the person down the hall finally remembers my name or, you know, whatever it is, right?

What, whatever we're placing outside of us thinking that, oh, if only that changes, then I will be okay. Because again, we do not get what we want. We get who we are. So our greatest responsibility to ourselves and to each other is our internal state of wellbeing.

Culture eats strategy for lunch. But burnout eats culture and strategy for breakfast, lunch, and dinner. So what you were just saying about, you

know what your team was talking about, just survive 2025. That is code for burnout. So what are you gonna [00:33:00] do, right?

AJ: Yeah. No, we had to, we had to come up with a new plan, so we didn't feel like that. So

Nancy: Yeah. 'cause that's code for burnout. Yeah. When people say, not one more thing. They are redlining towards burnout and burnout is

very dangerous. It's a dangerous place to be. And very common.

it's a second pandemic.

AJ: Especially in design and architecture.

Nancy: designers and architects want to create these beautiful places and spaces for people to thrive. But the business model of design and architecture does not allow that to be. So I think there's a lot of designers and architects that kind of feel like their soul can't be in their work anymore because there's a production engine that has taken over and it's almost identical to healthcare.

[00:34:00] Most providers go in with this. Soul of service to help people heal. But healthcare too has become a production engine. And so the healer, right, that people were born to

be is kind of stripped away.

AJ: Deanna, do you see that?

Deanna: Yeah.

it's so hard to keep providing the care at the level that you want to

when you aren't doing well yourself, right? You're just going through the motions, the best you can.

AJ: I think we can all un relate to that.

So any last words for our listeners

from each of you

Nancy: Love yourselves well, so you can love others. Well.

Deanna: Yeah.

Love that. I, I would just add too, like this work is not for the faint of heart.

It's hard work.

and you need to like, I think we've said this [00:35:00] a million times, but moving at that speed of trust

Nancy: there's people really wanting to

do wonderful things, and policy will get in the way.

but you've got to see the suffering, and then you have to have those voices talk to the leadership.

AJ: Well, Nancy and Deanna, thank you so much for showing us how design can heal long before a space is ever built. Your work reminds us that when we listen deeply centered, lived experience, and design with not for.

Communities, we can change lives in profound ways like you have to our listeners, if today's conversation inspired you, share it. Keep listening, keep collaborating, and keep creating spaces, programs and possibilities that make people's lives healthier, more equitable, and more full of joy. A huge thanks to our brilliant production team.

Rob Schulte, [00:36:00] Rachel Santor and Verity Lister. And if you love this episode and wanna hear more like it, head to surround podcasts.com, your hub for design stories that matter. We'll be back soon with more design stories. Until then, keep dreaming big, keep pushing creative limits, and we'll see you on the next once upon a project.