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How Clinicians Can Effect Systemic Change

March 10, 2019
J. Andrew Chacko

BOSTON, Mass.— J. Andrew Chacko, MD, MSE, FAPA, sees big problems with the state of health care and medicine today.

“Rampant undiagnosed and untreated mental health care problems. Skyrocketing costs of providing health care. Alarming rates of clinician burnout and suicide,” he listed, explaining to attendees at Elevate at Psych Congress why he was there to present a session on a concept called design thinking.

“These problems are really big but I’m here to tell you we can do something about it,” said Dr. Chacko, a private practitioner, medical innovation and design consultant, and founder and principal of ChackoMD in San Francisco, California.

Change, he said, is sometimes thought of as a big and scary thing.

“I agree. It is scary and hard,” he told attendees. “But I’m also hear to say it’s gonna happen one way or the other and it’s gonna be a lot less scary and a lot less hard if we’re in driver’s seat.”

Another argument people in health care make against working for change is that they are too busy, he said. But oftentimes, they are too busy doing things that are not efficient and don’t help patients, Dr. Chacko said.

Design thinking is a modern-day buzzword that in essence means bringing creativity to problem solving, he explained. It can be applied to anything from planning the best 40th birthday party to revamping healthcare.

He laid out three steps to solving a problem: fully understand it, which is tantamount; ideate, or come up with ideas, while pushing the boundaries of what you think are possible; and prototyping, which means quickly trying something out before you commit to it.

Using Design Thinking to Improve Mental Health Care

Failure is a part of innovating, and it shouldn’t be feared, Dr. Chacko told attendees, noting that chemotherapy and many drugs have been discovered through processes that included some failure. Failure is accepted and seen as part of success in design, but that is often not the case in the health care system, he argued.

Fear of failure pigeonholes people and stops them from trying new things, he said, urging people in positions of leadership—formal or informal—to create an environment where people feel safe to fail.

He left the audience with 4 missions:

• Be unreasonable. Identify things you have resigned to accept and think about how you can challenge them.

• Embrace the fear of failure in your personal and professional life, or at least recognize it.

• Introduce at least one person to someone else that you think they might find valuable, with no thought of personal gain.

• Meet someone new.

Healthcare happens at the point of care—between a provider and a patient, he said, and everything else in the system is there just to support that interaction. That means clinicians have be the ones to spur needed changes.

“It’s got to be us, because what happens when we don’t do it? We get the system that we currently have,” Dr. Chacko said.

—Terri Airov


“Re-Designing Healthcare.” Presented at Elevate by Psych Congress: Boston, Massachusetts; March 10, 2019.

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