Designing for Maternal and Infant Health

[00:00:00] Jared: Hello everyone and welcome to the Med Design podcast where we like to highlight the journeys of medical innovators. This week we have the founder and chief scientist of Couplet Care, Dr. Kristen Tully with us. Dr. Tully has spent the past decade conducting research on patient safety, breastfeeding experiences, parent infant interactions at UNC and Duke.

She's also used these findings to create a company in Couplet Care that develop solutions for improving mother and infant health outcomes. So most notably with their bassinet prototype that they're still working on. Dr. Tully was also an early participant in what has now become our med design modules.

So she's already part of the med design family . We just can't wait to hear more about her journey. So welcome Dr. Tully.

[00:00:37] Kristin: Thank you Jared. And it's wonderful in particular to be here with you, Ty. And I feel like , we are connected. At least we've been working together for some years now.

[00:00:46] Ty: Been in the entrepreneurial trenches together.

Absolutely. . .

[00:00:51] Jared: Yeah. So I think, we'll get started with talking about your PhD in biological and medical anthropology. I think that's really interesting. What in particular drew you into this sector of anthropology to start with? And then expanding off from there, what were some of the more interesting anthropological perspectives that you learn about that influenced your work today?

It's really unique. I would say.

[00:01:11] Kristin: Yeah, thank you. It's fun to reflect on my story and as I, get older and think about, the future, you know, Reflecting on what excites me and what drives me and why I'm here. I live and breathe this work. And with anthropology, which has been so helpful shaping my whole perspective.

And I think that's what, our approach and our values and what we recognize as important. So when I was an undergrad freshman at the University of Notre Dame, I heard that there was a really great teacher and I didn't know what he taught . That turned out to be Dr. James McKenna. He is a anthropologist and Sort of pioneer and wonderful person and pioneer in parent infant sleep and breastfeeding and nighttime parenting. And so I was super fortunate to be aware of him and to somehow get into his class as a freshman and then take everything and work over summers together throughout my undergraduate career.

Anthropology is the study of people. People across time, people right now our understanding shapes what we do and that has consequences. The one example, the first thing I learned from him was around infant sleep and how recommendations have changed and continue to do so. but, Infant positioning, whether they sleep on their stomachs or on their backs is associated with mortality. I mean with survival and it was stunning to me as someone, naive in parenting details and, I'm gonna have a younger sister, but as a whatever, 18 year old or whatever I was at the time to know, like the recommendation was to put your baby to sleep on their stomach and then with the back to sleep public health campaign, that was reversed and said, put your baby asleep on their backs. That was a significant reduction in infant mortality in this country and globally. And so I was like, whoa, what influenced that. And so there are many examples and it's, a complex story, but I think that's really shaped, what goes into that and then what we should do about it and how we communicate to the public and engage as healthcare teams. So continued to do that .

[00:03:29] Ty: Why was that the focus from an anthropology standpoint? Why the field of anthropology. What lens brought a fresh perspective to that problem. I think that's the unique part too, about your background and that you

[00:03:41] Kristin: Oh, yeah.

So there's, cross-cultural comparison. But then the biological part from my perspective is with evolutionary perspectives. Birthing parents and infants, they are a system mutually regulating, biological and emotional connected couplet pair and of course within a family and community and society. Context too. We have lots of new technology and options for how we take care of each other, and that's great in lifesaving, including I've done a lot of work around cesarean section and decision making and have a manuscript around, mis recognition of need though. So sometimes the things that make sense to everyone involved.

It's not like that it's inherently how it has to be. We build that environment and the conditions, and that's what I think, social determinants, structural determinants of health is about. The world that we are born into and live and grow and in my case, birth and parent and we continue our lives, we construct that. We as humans have, some universal components, but then it's influenced by our environment significantly and across generations and then including in real time. My work now continues with babies but really focuses on the maternal and child health because women in particular have not had a lot of attention in research. And there are lots of differences in intersecting perspectives in society, including by race and other things as well. So lots of layers there. It's fascinating and it's a really important.

[00:05:26] Ty: I mean at one point, you used the example of was it the candy rapper? Yeah. I'll say, stuck out for me the first time I heard you say that. Do you mind using that analogy just to drill down a little bit?

[00:05:37] Kristin: Yeah. Yeah. All work, our collaboration and everything, we are team and we are interdependent and very much better for it.

That analogy of the infant being the candy and the mom being the rapper. Once the, baby's born, the rapper's cast aside, which reflects some of the cruelty I think that's in what I call, dysfunctional systems. And so that candy rep or analogy that's from Dr. Allison Stobby maternal fetal medicine physician at UNC and collaborator and friend. And then I use Bell Hook's definition of dysfunction for maternity care because I think it's really helpful.

Dysfunction isn't an absolute negative judgment when we think about systems of care and not the individuals doing workarounds within them and experiencing wonderful things. But systems, as Bell Hooks defines it, dysfunction is about the love and the empathy and the connection and the skill and the resources that are there.

Too often that's mixed though with disjointed, not person focused care and and sometimes cruelty. We wanna build on what's working and we do that by listening and observing. And IDO has this, 10 faces of innovation and anthropologist, and I think that you connected me to that book Ty.

I was like, oh, look. Cause, cause I don't know, I'm just going through the world and wondering and being curious and trying to authentically connect and to not accept work arounds. We make this so we can unmake it. And so that's my like, hope.

What's so encouraging with this and including big societal things like racism and lots of forms of oppression. So again, that's where our perspectives matter so much.

[00:07:26] Ty: And Just to touch on that, I think it was early on with IDO as they were developing this concept of design thinking where one of the partners there is an anthropologist and so it was that interplay between professional designers and anthropologists to try to make sure they deeply understood the people for whom they were designing. That I think was a foundational part of how the theory of design thinking came together. And so I just remember there was this aha moment as we were in the early days of working together, where I'm like, how are we, like there's, who are you happening here?

And oh, this is why we're on the same page cuz we're have the exact same goals in mind, but we're coming through it for, through different professional journeys. Anyway, it was just a light bulb moment for us.

[00:08:09] Kristin: Yeah. And I think that's what synergy is like that. You and I and me and others who I interact with, that's what I'm seeking to be more than the sum of our parts and to you know, really understand from the multiple perspectives. You have to want to hear that and not everyone does. Again, like what's our goal here. Is it speed? Is it financial return? Is it implementing the thing that's important to me, and I think I have some good ideas, but what's a lot better than mine is, 10 or hundreds or thousands of perspectives.

Then we critically assess and act on those priorities. And so that's what I do.

[00:08:49] Jared: I think, also going into your, history and research, you talked about, inequalities and I think that was something I actually wanted to touch on today too.

And what were some of the inequities that you discovered in regards to patient safety and maternity care and maybe breastfeeding experiences as well? I thought that was really interesting because it's something that maybe is not always so talked about as well.

[00:09:08] Kristin: Yeah. And again, I think that's a choice, and so I use a reproductive justice framework for my work and that as a human rights perspective developed by black women, and it's about a lot of things that I won't, spend all of our time. There are books and, Loretta Ross and there's a, national birth equity collaborative is a very valued partner.

it's about making sure we don't infringe on people's ability to, get pregnant or not get pregnant and to give birth and raise children in healthy environments. And it's about positive rights too. Health is a positive concept, so none of us are just interested in survival, infants and with moms and mortality generally, we want people to thrive and what does that mean? And so what is in that, your definition of success changes. Everything flows from that. We want, care to be non-harmful if you're thinking about the environment, you don't wanna be getting in the way of contact and creating problems.

We want it to be accommodating. So what are our real needs and what matters most? And how do we address that? Then ideally we want it to be uplifting. We want to take good care of people and affirm them and. Dr. Stuy and I have recently written about this. We want people to be the protagonist in their stories, and so services are centered around them.

[00:10:36] Jared: That's not the norm. Would you say that there was ways that inequality was built into maternal care at some points? And are we coming out of a period now where maybe that's not the case as much? Or would you say that's still a problem in our system today?

[00:10:51] Kristin: Yeah, I don't think it's solved yet. But there's so many. I think we have increasing recognition and then broader community who are working together, I think on a national level, and then in their own communities including here in Chapel Hill. Because again, more people understand that it's not acceptable and that we can do better and that it is from our frameworks that this occurs, and so yeah that's active. We wanna eliminate inequities, which are unjust, and it's not, people as individuals to blame. Much of the work I do is around systems of care and how those are constructed and how they can be intentionally designed to be great. That's what we want. We want 'em to be wonderful and not just stop hurting people.

[00:11:41] Ty: Which is where your anthropology lens and how you, I think in some of your earlier comments as you were raising the idea that these errors happen through, I don't know, this cultural, environmental pass down of, we do things like this because we have this set of assumptions and those are systemic flaws that are baked into the system through whether through maybe in unintentional design or, maybe even nefarious intentional design. But I think it seems like some of that work is to address and rectify some of those errors in the system.

[00:12:13] Kristin: Yeah. And I'll choose my words, but when something is extraordinarily common, then sometimes it is intentional. I think a good example is, with electronic health records too, and there's so much clicking, and this is something that Dr. Shakira Henderson, who's president of AWHONN, the national nursing organization, is raised. Dr. Stuby and me, and we're working to address so much clicking, prevents the caring that everyone wants. But if the documentation is primarily for legal reasons or billing, then you know, clicking about one thing in 10 different ways, then that's how that arises.

And so we can streamline that and so that it's appropriate and clear for care coordination and for billing. when we think of value-based care, we need to really think of for whom.

[00:13:04] Jared: Absolutely. Something else you touched on, was also the built environment. I'm really interested also in what role built environment plays in supporting the needs of birthing families, but then what's the status of it and where do you feel like we can actually improve upon it? And maybe that's something Couplet Care is doing, I'm just alluding there.

[00:13:22] Kristin: Oh yeah. I got a whole list what does quality care look like? And of course it's like when you have a health question or experience or you become pregnant or you're wanting to then, like who do you even, think to call and when and then how do they respond? And so it starts, in childhood and I'd love to do more stuff in schools too. But anyway, with the scheduling and then when you come in and do you pay for parking?

Are we charging people for health ? And then you know how accessible it is physically and then with how inclusive it is, including with the images, how appropriate. There's a whole commercial determinants of health which is extremely problematic in what we advertise. And there's global standards for that which are not commonly adhered to.

But specifically, within rooms or in our case on the postnatal unit. it's interesting the size too, and I won't go on about that, but it reflects again, who we think should be there and what accommodation is appropriate. If we think that sleep matters and here's, whereas, basic human needs come in, then we would consider what the couches are like and how big those are and stuff.

One of the worst night sleep I've had is for each of our kids, and credit sleep. Yeah. It's horrible. Anyway, . Oh no. Yeah. And but not that I can be complaining. I'm not the one who .

Yeah. Dads and companions, you play a big role, and like taking care of you is important.

And that is clearly not at all, the system is not optimized and I think of course that's lower on my hierarchy because Of course. Yeah. But talking to the family as a unit preparing and then setting you all up for success, that matters. I think we're far from there. But with the bassinet, it's important for people to be able to see their babies and to pick them up and to set them down as they need to.

And it's not like a one time thing, it's intense and that's why this concept of the fourth trimester which is also out of anthropology decades ago, we've, elevated that as really important. It's a continuum of development. Babies need a lot of attention and care, and parents are born too.

it's them as a unit. So explain fourth trimester. So first, second, third trimester is when you're pregnant, right? So fourth trimester is what, roughly the first 12 weeks after childbirth. But the concept is much more important than any timing, and so it's just that, You know when babies are born, now they're breathing air and they're outside of you, and a lot of things are different, but actually not that many physiologically.

Same with the mother, a birthing parent, that's all a continuum and that continues forever. But like that transition period is really important. And so it's encouraging that healthcare organizations are increasingly recognizing what it means to be an ongoing resource through that period.

Because once the baby is born, then that's significant. Then we deserve love and attention and we need it for, again, surviving. Yeah. And being safe and well, in all the ways that is experienced. So care is being restructured to accommodate what we need as people.

[00:16:50] Ty: It seems like some of those systems break down like the hospital's set up to provide care within its walls. The best thing for the family might be to go home, but some of the critical care that extending that care into the home seems like there's some major breaks that happen, or expenses that are imposed upon the family in order to be able to extend that care.

[00:17:09] Kristin: Yeah. And around the world, most systems of care have home visits and we have that as patchwork across the United States and we have. Also, most places have midwives and community health workers and nurses to better walk with people, like in every sense of that. And to answer questions.

I think, here's something I wanna say, we have a lot of attention on what individuals need, and that's really important. But I think that I'm excited for my ongoing work to address institutional readiness to engage and to be equipped to serve. And instead of only assessing things like health literacy and considering education and of course language concordance, things like that.

Learning styles, like that's important. How comprehensible are your materials? When are you coming into the room? Is it at 4:46 AM. As we have documented, like rounding. And so it's not that people aren't good enough to understand health warning signs and to navigate. It's that it's totally inappropriate what's being imposed on them. And so that's where, I wanna be.

[00:18:25] Jared: We had a question come in the chat and someone's asking, can you elaborate more about clicks?

[00:18:31] Kristin: Oh yeah where the nurses at . So my many friends and students and colleagues what we ask of healthcare team members is, Not feasible in the condition. And we see that in their nursing strikes right now to draw attention.

It's not that there's a nursing shortage, there's a shortage of appropriate working conditions for people. Anyone can only take something for so long. And so I think that, we are reckoning with lots of pandemics right now, including, you know it's how we treat each other broadly and that manifests in multiple ways.

Nurses are the primary point of contact. They're also the greatest, component of the health workforce. There's so much education and assessments that go on, for example, in the postpartum period right after you give birth. Because we haven't structured to offer it more prenatally, I think that no one should get new information in the hours after birth.

It should be for tailoring and talking through and like affirming. But that's not where we're at right now. And so there's so many things like documenting fall risk and like people's bellies and bleeding and feeding, and those are all important. But right now it's like doing it many different ways, like a lot of detail.

And so sometimes, Out of necessity, especially when it's not adequate staffing levels, which is a persistent thing, then it's not meaningful documentation and including with narratives. There's a lot in electronic health record with disrespectful language, and that then gets passed and passed to

other team members. So as people journey through care, that's one way that biases are perpetuated and then care reflects that as people go forward. So there's enormous opportunity to think about what is needed and then let's cut the rest.

[00:20:37] Jared: Yeah. So's something that, just thinking about how like even nursing homes are staffed, right? And I've seen some nurse stories about how they have 50 patients at nighttime and they literally cannot care for everybody, and it scares me for when I'm of that age and when I need that level of care. Will we have our systems figured out better by then? I sure hope so.

[00:20:57] Kristin: It's interesting, like what sort of system is it where you need a navigator? and so that's a Dr. Monica McLemore has this framework for retrofit, reform and reimagine. So we need all three. In parallel. Retrofit would be implementing, healthcare navigators or other such interventions. Given current constraints, how can we better take care, mindfulness for coping and like how do we deal with the current situation? So that's immediate. What do we do right now? Reform is strengthening system. Requiring and being accountable for appropriate staffing levels, not just recommending, but how do we Ensure that happens and know when it's working well and be directing resources to it when it's not.

The thing I dream about is that reimagine. you know, what would it look like to continue to be supported as we age and as we need care. There's never one solution. It's a million things, that add up and it will vary for people's needs and preferences in situations.

But I think again, that's exciting. What do we want the future to be like? And I think that's Why, and make sacrifices for work too, we all have competing demands, but, I don't wanna live in a world that is structured, for some of the things. And so doing our part to change it.

[00:22:17] Ty: Yeah we've been talking a little bit about, I think, like some of the, disappointment, frustration, low morale within the clinical community, and you see some of that echoing where they're under-resourced and or even some of the incentives they're in place. Really make it to where they're overburdened with electronic health record documentation rather than caring for the patient, being able to see the patient for enough time rather than based on, arbitrary metrics that are imposed through a larger system that isn't able to respond in the moment and takes away some of that local agency. So I'm just curious what you've seen as far as addressing morale for care providers. Just as I think we've got major challenges in the system today that, you just see it echoing with, a lot of provider sentiment that you see online.

[00:23:05] Kristin: Yeah, and I wanna, my first response is that there are a lot of things that are worse than nothing too. So we should think about . What we're doing and how it's received by the intended audience. I think that's what design thinking and medical innovation in our particular case is about, is like, what are the stakeholder perspectives?

I think that we need to go upstream. Same with the retrofit. Like how do we affirm and validate that those feelings are justified, and so then what we do about it, again, there's immediate things and band aids, and then I think we go upstream. There's a human cost and there's a financial cost.

I recognize that both are important, but people are what make change and what make things happen, and so we gotta take care of them.

[00:23:55] Ty: Yeah. If anything, it's a yes and instead of an either or should be. So how do you optimize for, competing constraints?

[00:24:02] Kristin: Yeah and how do we do that radically? I mean we need incremental change, but you also have to see the future to operationalize it. And so I think that's what the reimagine is. I don't think we should have more listening sessions or stuff if we are not equipped to respond, cuz it's just wasting

more time and emotions. So that's how we should lead with resources that we are asking because we are committed and able to act on it. Otherwise, let's just keep triaging, that's also not universal.

[00:24:37] Ty: I'll just say that the perspective that you have is 180 degrees different than the tech med industry that leads with, we have a shiny new technology.

Let's go out with a technology lens and try to figure out where we can stick a robot in the ER or put some new material in place versus starting with, you could put a robot in the space that, adds all of this technology and capability that all that's doing is taking, otherwise two fingers on a pulse to check whether or not that's there.

So like some cases we've over technologized the healthcare space. Because we're leading with a tech first perspective, rather than leading with a empathy first. Making sure we're combating our structural biases first, and then looking opportunistically for the array of technologies that might be able to serve that higher purpose.

[00:25:30] Kristin: Yeah, there's always gonna be multiple levels of interventions and so there's a role and we've done a lot with text messaging and there are tools that help. and we've published, you just also need people too and so again, I agree with you that it's both.

I get concerned with AI and all this big data because, only as good as what goes into it and what people share. Also if we're wanting to think about risk profiles or things like that itself could be a risk, right? If especially when things aren't modifiable like someone's race and because it's our racist ways of engaging that are the issue.

And so again, it's like flipping the attention to how care is structured, not the people while also recognizing their needs and,

[00:26:20] Ty: yeah, absolutely. Lemme just to wander down the AI rabbit hole a bit. Like Chat GPT was GPT-3 was trained on the entire corpus of the internet.

so that built a beautiful model that was very responsive. At the same time, it was trained on the entire human internet and all of the array of beautiful things that humans say . Mm-hmm. And horrible things that humans say. There wasn't a higher calling filter to it. And so what was emerging from that early G p t three responses was horrifying.

[00:26:50] Kristin: And it's funny, not funny,

[00:26:52] Ty: exactly. Like the, it's we're, we are, it's a dark mirror that reflects, our best and worst parts of the humans.

[00:26:57] Kristin: Yeah. And so we should look into it, right? Without the filter.

[00:27:01] Jared: we've got a real interesting question here.

What are ways in which individual healthcare provider, not an OB midwife or nurse can get involved in improving the postpartum care experience and continuum of care?

[00:27:11] Kristin: Email me. I'd love to, to talk. We collaborate. And so we've got a lot of active projects around interprofessional education and I think that, you know what, I see myself as contributing to a meaningful measure from birthing parents, companions, healthcare team members, including front desk staff and interpreters and nutrition. And then two is co-developing interventions, that means co defining, I'd say the strengths, like there's so much co defining the problem and yes, but like it'd be a lot easier to just grow what's working well, so that's the same thing, but co-developing interventions and implementing and evaluating.

And then the third bucket is, accountability and how to have ongoing awareness and strategies for addressing.

[00:28:02] Jared: So I do think, we have a little bit of time left. I think maybe we should talk about couplet care a little bit. Sure. At what point did you really decide on founding, couplet care when was it the right move for you and, what kind of pieces had to fall into place for it to happen?

And how long had you been thinking about it? Since I know it started roughly in 2019, like how long before that had you even been ruminating on it?

[00:28:24] Kristin: Yeah, thank you. It's interesting like my goal is to be helpful, then what are the mechanisms to do that right as I have the opportunity to do.

And so we created prototype bassinets. Together, Ty and the Trig innovation team and colleagues at North Carolina State University and team members at U N C, and then with lots of stakeholders. And so we did that first through research. And then there was, and Ty, I think you're good with me sharing this story.

There's a mechanism for small business innovation research with the National Institutes of Health and Trig innovation led that submission because I didn't have a spin out company. That was not how I approached it. Then when you learn of pathways, then first trig led because your design company.

As that, continued to develop, then couplet care was formed to commercialize that product. So I think it's been organic and real and interesting.

[00:29:31] Ty: Yeah, I mean that was a big deal to win that SBIR grant. It really came down to did the grant awarding organization reviewers believe in the team, believe in the submission, believe that there was enough academic credibility, scientific credibility, commercial credibility to the venture to award the funding. And it was hit or miss there. Like we, got a good score on the application, but it was like on the bubble of whether or not it would get funded. Then as much of a burden as it's been to administer the grant, At the same time, it was also a signal to other non dilute funding sources that if okay, if they can endure punishment like this, we'll give you more.

[00:30:18] Kristin: Yeah. And I think that we, and me personally, we persevere as I think appropriate word because it matters, and again, when there's almost a world of infinite opportunity and we have limited time and energy, then where do we put that? And so I think that reflects our and a lot of other people's ongoing commitment and belief that this is truly needed.

I'm excited too because I hope that it is an example of how we can listen to folks and improve over time and, directly respond to people's feedback and then have it be all that much better for it. Also including integrating students and, young people more broadly in this work and we have two students who are named inventors and we have a patent issued and they significantly, contributed as did all of us as a team.

So we've got, lot of inventors and so it's novel and non-obvious, although we've been trying to make it very straightforward and user friendly and simple.

[00:31:24] Ty: I've been reflecting lately on our journey together and I was thinking back to our very first prototype, and if you think about you compare to where we are today, there was so much about that was imperfect.

But in my mind, there was a bright spot that stood out as we were testing it. It was some of the base functionality and there was a moment of delight that happened when we were interacting with it and there was additional human experience tied to the bassinet where before you wouldn't be able to rock the baby with the new capabilities that, we had a doll in the bassinet to simulate, but like that moment of just delight that you had additional ability for mom to provide care to the infant was just something new that I hadn't seen before. And it was like those glimmers of real joy and experience was something you've designed that kind of builds that foundation to then say, we've got something here.

Because if there wasn't those moments or like points of validation, then you're right. Our time is valuable. Maybe we're not actually achieving these noble goals we're setting out to achieve and that it's worth, disregarding what we're doing or, putting it down.

But because we're seeing that validation over successive generations that. Okay, we've got something here and this can make an impact. And I wish we'd gotten this out sooner because of family who were having children and wish this experience was there for them.

[00:32:43] Kristin: Yeah, and I mean I had my younger daughter during our collaboration and we have some pictures of me with my pregnant belly and reaching over and stuff.

And then when I was in the hospital, I was checked on and I pretended to be awake. I think the nurse probably, pretended to think that I was awake. Like it's, and but it's interesting. I like how you talked about joy. That's what I think we're seeking to do is grow that.

[00:33:08] Ty: You have to hold onto those moments because there's so much other just frustration that comes with it. But when you see those moments of joy that you're creating for other people, that's okay, this is why we're doing it.

[00:33:18] Jared: Love that. That's amazing. I am curious also, going back into just the bassinets that already exist in the hospitals, right?

And obviously this is innovation on top of those to innovate that, but where are those falling short that necessitated, you to step in and create your own version of it?

[00:33:35] Kristin: Yeah, thank you. I think that care is always improving and that's a good thing. I think that nothing has or continues to achieve what we offer which is, from the birthing parent perspective, independent access, and the whole range of utility that is required for safety and wellness.

So it matters not only for infant safety and that's part of my doctoral work I had set out to help with breastfeeding in particular. Important aspect of life for many people. But what came out of it even more was the infant safety. Things that come up when you are forced to navigate workarounds and to cope with not being able to, set your baby down in particular. It also matters for maternal recovery cuz even when you have vaginal birth, it is uncomfortable to say the least. Moving around and even when you have a companion present. They may be asleep when you would like. I saw some TikTok where they like said to bring into the birthing facility a dart thing to throw something

You gotta wake them up. Yeah. And so you don't wanna have to, you don't wanna to get up. You should be moving around and walking and part, including after c-section as part of recovery. But you should not be forced to do so because you can't address something. And so I think we do that in clear and special ways that I hope can be part of a standard of care moving forward.

[00:35:19] Jared: Yeah, I think just from my own firsthand experience in witnessing the studies that we've been doing on your prototype it's incredible. the impact that this can have on people's lives. This could be generational. It's something that you've talked about as well, bring generational change, and I think this can have that kind of impact on maternal infant care moving forward.

So we're getting you know, getting close on time here. Something that I wanted to pick your brain about cuz it just struck me and Ty as interesting is, you're not the biggest fan of entrepreneurship and what sort of has led you down that path to understand that you know what?

Entrepreneurship, not for me. Innovation, definitely my thing.

[00:35:56] Kristin: Oh, that's interesting. the distinction. And I think that how do we implement things that matter? There are multiple pathways for that. From my perspective, what's the fastest and most accessible? And almost everything I do is open access.

We have websites that we have co-designed And all the materials that we make and all the publications that we can cover to to share. I think that's important. The tools that we developed then, if we have a text message curriculum, then we're gonna post those. I think entrepreneurship, I'm much more in the social entrepreneur, but we need good strong business models to accomplish that.

So that is also appropriate. There are folks who specialize and know what they're doing and do that very well. And so that's why you partner just like with any project so that I can be in my happy place and inform things and, advise. So that, you want the experts and all the different domains to collaborate.

[00:37:04] Ty: I was telling Jared the story about how you and I were taking an entrepreneurship class together. There was a full day entrepreneurship class and it was one where there's content that's delivered and then there was a panel of investors who were reacting to that and providing their commentary.

It was almost like it was a sign of, I dunno, like it, it was honest for sure, but there was a comment that was made of, let me tell you about the golden rule. That the person who has the gold makes the rules. And it was like this wait, hold on. We're missing the point of this.

And yes, of course, right? Like grant awarding organizations make the rules about how the grants are funded. Investors make the rules about how their money is spent, obviously. But I think at the same time, in an entrepreneurial journey, It's very easy to lose sight of what's important versus figuring out how to make the funding source happy in the short term versus achieve the long-term vision that they're signed up for in the first place.

Yeah. And so I think that's where so much of entrepreneurship loses sight of pursuing a short-term business model or a short term financial projection at the cost of the mission and the overall vision for where you go.

[00:38:18] Kristin: Yeah, it's what's the overall package? We've been well supported and I'm so grateful to to find people for whom this sort of work makes sense. That's interesting around, control and power is what you're talking about. I've heard that too with regards to data and, including with electronic health record, it's like whoever has the data is driving this. I think we should stop being so extractive and like again, lead with resources, or at least with transparency.

That is what can be heartbreaking when , there's not alignment with the agendas. So then you make an informed choice. If you're clear about things, then you decide whether to engage or not. And of course that reflects many layers of privilege to be able to walk away. I think that's important in what we all, again, deserve to be able to navigate.

[00:39:13] Ty: it sounds like a way to allow local choice to be able to opt in or opt out of some of this data capture that we're not having a choice about. Is there a radical way to have a, completely transparent pricing system, a transparent way that your data's being used, or to have sovereignty over your data, which currently the individual doesn't.

[00:39:33] Kristin: With UNC Health, we have a new site on UNC health.org around screening, for example. And, we say, and this came outta the research, people worried about how information might be used, including against them. We share those results and then we made a page that say, do I have to answer?

Like you don't. And you can access information on resources without that. But, disclosure can be helpful but it's up to you to decide and that's what autonomy means. The other thing I wanted to say with regards to funders is that we have been successful in shaping research and funding structure.

There's policy on lots of levels, including what we require of each other through the process.

[00:40:21] Ty: That's inspiring that it's a two-way street, where that sentiment we heard was indicating it was a one-way street. From a control standpoint, but rather that it's a two-way street that you've been able to be successful at shaping some of that policy of how funding decisions are made, which it gives me hope.

[00:40:38] Kristin: that's good for every reason, and I think when you have a, clear, strong team. Nothing is better than a shared purpose, and then having the ability to operationalize, advance that together meaningfully.

[00:40:50] Jared: Yeah. And I think, as we're, really wrapping things up here, something that in, preparing for this and talking to you that I realized is that, a lot of time when we think of medical innovation, myself personally, when I thought of medical innovation, I thought of entrepreneurs, and I've realized that, it's actually, separated.

You know that you can be both, but at the same time, you don't have to be, you can let entrepreneurs be entrepreneurs and innovators be innovators. For those generation of young innovators that are coming up next and they are solely, trying to focus on innovation over maybe the business side of things, what do you have as far as advice goes to those people that are just starting out that want to get to where you are?

[00:41:26] Kristin: I think good mentors, right? People who you admire, you enjoy. And also our frameworks. I think that again, is what is most important and then defining our goals and that is always multifaceted, like what do we want people to know and feel and have happened? Then what are the roles of various tools With that and then we don't have to know everything.

We just have to have the structure to engage and to demonstrate worthiness and of holding those stories, and that's what I think anthropology has trained me for is like things in context and the reality and getting at it in multiple ways. Cuz even if you talk about nighttime parenting, for example, there's like social desirability, like people want to be seen as a good mother or parent.

And so they believe that too. It's not lying. I think that design thinking to me is part of like research justice. Which is what are the questions or the unresolved things that matter to people and how can I be a vessel or a mechanism to advance this?

And I think I'm, far from achieving that. But that's a good goal to have. So that's my recommendation.

[00:42:44] Jared: I love that. I love that being vessels of change as innovators. And I think, on that note, I think we'll wrap things up. Dr. Kristen Tully we really appreciate your perspective and I think we all learned a lot today.

So thank you for taking the time out and joining us. For everyone else that's listening and wants a little more resources about how to become medical innovator, check out md.trig.com and you can find out more information about the med design modules that we have to offer that Dr. Tulley also experienced in the early stage as well. On that note, just have a great week everyone, and thank you Dr. Tulley once again. Thank you. That was fun.