When we think of innovation, we often gravitate towards new digital solutions. Even when well designed, the technology and workflows associated with it may create obstacles to efficiency (and the dreaded “workaround”). In certain use cases, analog, old-fashioned designs can be more powerful than new digital innovations. Whether digital or analog, incorporating human-centered design principles has never been more critical for healthcare organizations.
In part two of In Network’s podcast feature Designing for Health, Nordic Chief Medical Officer Dr. Craig Joseph and Head of Thought Leadership Dr. Jerome Pagani continue their conversation with Chris McCarthy of ILN Coaching and Consulting. He discusses the origins of the Innovation Learning Network, plus, Chris shares his views on the disruptive nature of nudges and real-world solutions to healthcare hurdles. He also talks about the term ‘digical’ and thinking big about human-centered design.
Listen here:
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Show notes:
[00:00] Intros
[01:19] The pros and cons of digital design
[09:32] Not forgetting the end user
[15:01] Designing the Innovation Learning Network
[18:25] Publishing Innovation Within Information Technology and Healthcare with Lyle Berkowitz
[21:56] Taking human-centered design to the next level
[28:45] Designing for more than just the individual
[30:51] Applying systems thinking to healthcare
[35:30] Starting ILN Coaching and Consulting
[35:50] Three things so well designed, they bring Chris joy
Transcript:
Dr. Craig Joseph: Chris McCarthy, welcome to the podcast.
Chris McCarthy: Thank you. Happy to be here.
Dr. Jerome Pagani: Dr. Joseph Kaufman from MIT Lab talks about nudges that can turn into noodge, you know, a way that technology can become interruptive or disruptive. And it sounds like, we were just having a little conversation about it, it sounds like you've seen some of that same.
Chris McCarthy: Yeah, for sure. I mean, the modern way of building an app right now or a digital experience is to incorporate nudges which seems very innocuous when you have one app that is gently nudging you to do the right thing. But when you have 14, 15, 16, all of those nudges are now, you know, kind of like rolling up to a punch. And then we have this constant real-time barrage of interaction with our colleagues and friends, whether it's text messaging or Slack or MS Teams. Way back, you would type a memo, be super thoughtful. Then we went to email, where you don't have to be as thoughtful, but you know, they weren't likely going to respond in two minutes, they were going to respond soonish. And now everything is in real-time. And so, whether you're living your everyday life or you're at work, any time you try to be thoughtful, you're being interrupted. You're not allowing your brain to decompress and form new creative thoughts and new sparks. Because just when the spark’s about to happen, ding, somebody interrupts you over here. And because the dopamine release happens in your brain, it's exciting. And you want to see what this ding is. It's a pretty vicious cycle that I, you know, maybe we'll get into tech for good soon, but I think some more modern ways of development is starting to think about how do we break ourselves of attention-grabbing techniques, because that's what all modern tech is built, on is a way to grab your eyes and pull you into the tech. And sometimes that's done for good because you want them to have the health benefit because they have to do whatever you're pulling them to. Often, it’s done for nefarious things. Are there other ways to achieve the outcome without grabbing someone's eyeballs and dragging them out of their everyday life or their work experience? I think that's what a lot of us are thinking about.
Dr. Jerome Pagani: We know that's cognitively expensive. I mean, you have to engage, that kind of task switching means you have to engage the executive system over and over and over and over and over.
Chris McCarthy: Yeah, I mean, from a completely different example, like one of our big innovations at Kaiser Permanente was around medication administration and helping nurses not get distracted passing meds. One observation, I documented a nurse being interrupted 28 times. She had medications in her hands.
Dr. Jerome Pagani: Wow.
Chris McCarthy: And 28 times. And so, the cognitive load of restarting a process even just one time is hard. And so, one of the big successes was a clothing design solution. It was a sash, a very skinny sash. And you’ve probably seen them, joggers wear them to be seen. When medications are passed by nurses at Kaiser Permanente hospitals, they put on a jogger sash, and everybody knows that this is the only time you cannot interrupt a nurse because they're doing something deeply important. And now we're seeing things like, you know, the iPhone, do that with the focus feature. You can focus for one hour. You just click it. And so, I think we're all recognizing that these innocuous interrupts that are good for one thing, when you have a thousand of them happening, it's actually not good at all.
Dr. Craig Joseph: This, the red sash reminds me of the red line around pharmacists on the floor who were either putting the meds where they belong or actually compounding meds. And with the concept of if someone's within that red zone, you know, that ten square foot area, you're not supposed to interrupt them.
Chris McCarthy: Yeah, we stole that idea and also put it around all the areas where nurses prepare meds because if it's that important for a pharmacist to prepare the meds, why isn't it that important for a nurse to pull and prepare the meds to put into the patient's body? So, from that observation of how pharmacists do it, we pull that onto the nursing units and mapped out the areas where if a nurse is in that zone, do not talk to them, do not interrupt. You can't even go into the zone, like, that's their zone until they leave.
Dr. Craig Joseph: Yeah, it's great. So high-tech design is a red line on the floor, but it achieves the purpose. And that's really the beautiful thing about usability and user-centered design does not need to be high-tech. And oftentimes, we forget that, especially at a high-tech consulting company in the healthcare sphere, and sometimes the best solution is actually just some paint or a red runner's sash.
Chris McCarthy: That's right.
Dr. Craig Joseph: It is not spending, you know, $3 million for software change.
Chris McCarthy: Yeah. And I mean, I think that is some of my angst over many years is still growing that I think when people think of innovation, especially in healthcare innovation, it automatically gravitates to digital transformation or digital innovation. And I think that is very shortsighted for the reasons you just said. And in fact, some of the best solutions, I think, are a combination of all of that. So, a process innovation with a space innovation and a digital innovation, those all reinforce each other to get an outcome. But I think it's lazy to pin it all on digital. Like, we think that if we just put out the right digital tool, everything else will just fall into place. That is, I think, very short sighted and it's overly hopeful and kind of unfair to the tech to try to accomplish all of that.
Dr. Craig Joseph: Chris, that's great. I am just getting a note now from the leadership of my company which says that technology is the solution for all problems and multimillions of dollars for things that might work is a great idea. So, I just wanted to clarify that with you, Chris, and I'm sure you agree.
Chris McCarthy: You know, if it's 1995 …
Dr. Craig Joseph: And that’s all the time we have, Chris.
Dr. Jerome Pagani: So what I'll say is working at a high-tech consultancy that has focused on the implementation of technology for a long period of time, I think that gives us the same perspective that you're talking about, which is that it's really about the people in combination with that technology, and it's not always the newest or the sexiest or the bells and whistles that do it. It's about what works for the people in the system.
Chris McCarthy: That's right. And my very good friend Zayna Khayat came up with this term that I shamelessly have stolen over the years called “digical.” And it's the fusion of digital and physical. And it's a good reminder that we are using digital tools in physical spaces. And so, keeping in mind where the work is happening, where the interaction is happening, the things that are around them, I mean, and in some way like that is that is where I think a lot of digital falls apart. If you go into someone's home and watch them use a digital tool, you can see that their home is either perfectly designed for this or is a disaster. And so, you may give them the best tool, but if their home is in disarray, can they really use this tool in the effective way, in the controlled trial way, that this tool was studied in. I love this concept because it's not just a reminder that the digital tool is used in a physical space, but how do the two complement each other, and how can you co-design both of them to be complementary?
Dr. Craig Joseph: So Chris, you had mentioned that you created this brilliant technology, brilliant workflows for users, spent hours, weeks doing it, left with the understanding that it was going to make everyone's lives better and improve the care of patients, and then returned several months later to find that folks were using it maybe not the way you intended or maybe not at all, and that was disappointing. What has changed? How do you not fall prey to that problem?
Chris McCarthy: Yeah. So, a couple of things. I think one is the way we inherently involve users in a human-centered design process. I think at its best, users are becoming co-creators, and so they are taking on the responsibility of the success or failure of the work itself. And so, I think that's one way that it doesn't just get signed off on and goes on a bookshelf. The other is that they are investing their time. And so just the fact that a set of nurses are spending more time on a solution is also upping their acceptability of using that solution. And the third, the third piece of this is that, you know, co-creation co-design is best is when a user and, in this example, nurses contribute their idea that gets built out and prototyped and implemented and there's even more desire to see these things go. So, the old way is I would watch you. I would go away and, in a conference room in a black box, design it, come back, you'd sign it. That was business process re-engineering. Human-centered design is the users at the table. You're hanging out with them. They're contributing their thoughts and desires and wishes. They're prototyping with you. They're testing with you. And all along, their desire to see their work means something keeps going up and up, and then those that can be told to other nurses. So even though other nurses may not have participated, or other users didn't participate, knowing that people like them participated, and in fact, we will often feature those nurses to be the front people for implementation and they'll be the front people on, you know, the documents and we'll send them off to conferences to talk about the successes of this. All of that is a part of a rapid scale-up plan. All of that is about making sure that future users see themselves and the people who created it, and all of that allows for a better implementation.
Dr. Jerome Pagani: This is great because we get asked all the time, you know, what's the secret to scale? We have a pilot X, Y, and Z, and you're pulling on, I think, what is part of the secret sauce. And we mentioned some of this. I don't know if Greg told you we're writing a book. Of course, that's why we're here. But some of this is in the book that we've written. It's that idea that you're starting with your end user in mind by engaging them from the beginning, there's no way to deviate from that. You're trusting your experts. They are the experts in the process that they're engaged with on an everyday basis. And as you said, you basically have champions built in, and that builds you credibility with them, but also with the rest of the organization.
Chris McCarthy: Yeah. And that does take sophistication. So, it takes a much longer-range term than a project. So, you know, I think a lot of organizations will do a project, and then it'll show some value. And now they've got to figure out what to do with it. And so now they spend six months or a year or longer figuring out, okay, we had the success. Now, like, how do we, what do we do? And all of that time, the original solution starts degrading because you're moving away from the point of when it worked and you're starting to lose the fabric of all the people and passions that were part of this. So instead, if you go end to end, you have your design process linked right up with your rapid scale-up process. The very people from the very beginning who were involved with this get to be a part of the total implementation, and you use them as a throughput all the way through. But if you put a gap between the design and the implementation, and this happens everywhere, like I don't know why executives don't expect to be successful, like, it's almost like, wow, you guys scored. Now what do we do? And so that's one of my key strategic questions before we start a project is what are you going to do if we’re successful? Like, what's the plan? And if there's no plan for success, we can't start the work because I need to know that after we do all of this, that you have a plan.
Chris McCarthy: And I think innovation, as we talked about earlier, can sometimes fall on the playful, creative, and I’m not pooh-poohing any of that. But the purpose of all of that is value. And so, you have to implement you have to have a plan for success.
Dr. Craig Joseph: So, Chris, at some point, you had learned and stumbled into this idea of innovation and applying principles of design to healthcare and to workflow processes and were curious about what others were doing. And so, you tried to, it sounds like, designed something like, I don't even know, maybe some sort of innovation learning network. Did you ever follow up on that Chris?
Chris McCarthy: Well, you know. Yes, I did. So actually, back in 2005, my boss at the time, my long-time boss, she was the chief nursing officer of Kaiser Permanente, Marilyn Chow. She got a grant from the VHA Health Foundation. They were handing out these innovation grants. She applied for one to basically connect innovators. And they awarded the grant to her. And then she came and knocked on my door and was like, “Hey, you have a minute?” She's like, “I got this grant and I need to hire a person to run it. And I want to share with you the job description because I think you'll make it much better.” And I was like, “Okay.” I was like, “Well, let me take a look at it.” Sound like, oh, this is terrible, terrible, terrible, terrible. Mark it all up. And I was like, “Here's what I would do.” And then she's like, “Oh, here’s that.” She slid it back to me. She's like, “Hey, what do you think about you doing this?” And to be honest, I was loath to do it. You know, this was like the innovation consultancy at Kaiser Permanente, we were just hitting our stride. Like I talked about the brass rings I finally got, I’m doing design work. Super excited. I did not want to be diverted by connecting with a bunch of people. Like I just wanted to get in there and start building and designing and working with patients and clinicians. But as I started thinking about it, what I thought was most interesting, who else was doing this kind of work? So, I started thinking about like, who else in the world? And so, at the time, it was Mayo Clinic. They were about four or five months ahead of us on this journey. And it was interesting with Mayo Clinic, the same people that trained us, trained them. And so, we were like these weird distant cousins of like the same language and methods. But one is an integrated care delivery system of Kaiser Permanente, and the other is, is the more traditional model of medicine at Mayo Clinic. And so that was fun. They said, yes, to be a part of this. And I found a few others. And so, using the grant dollars, I was like, “Well, let's just like take the grant dollars and fly everybody for two meetings. Like, we'll make it super easy. We're just going to people show up and we'll share best practices on what we're learning on innovating in healthcare.” So that grant was for a one-year period At the end of the one-year period, there were ten organizations, all ten of them asked, “Can, how can we keep this going?” So we flipped it from a one-year grant endeavor to an ongoing membership-based organization. Over the years, it grew up to 40 care delivery systems, foundations, design firms, sharing innovation, knowledge. And there was always a deeper level of connecting human-centered designers in these organizations.
Dr. Craig Joseph: That worked out very well for you. You were able to meet one Lyle Berkowitz and edit a book, and I'm curious to know how that came about.
Chris McCarthy: Yeah. So, Lyle did an innovation tour, so he came to visit our innovation lab at Kaiser Permanente. It's the Garfield Innovation Center. It's an amazing place. It's a warehouse with a fake hospital, a fake home, all the latest technology of Kaiser Permanente and future technologies. And it was a place that allowed us to simultaneously innovate on space, process, people, and technology. So, kind of like the holy grail of bringing it all together. He had heard about this place, came to visit, and was convinced leaving that he needed to join the ILN. That is where our relationship started. And he's one of the most innovative people I know. I mean, his brain goes a mile a minute, and he's constantly coming up with new ideas all the time, which I deeply appreciate. I invited him onto the board, and then over time, we kept showing up at the meeting, planning out the next sessions, how are we all going to gather, how are we going to share. At some point, I think three years into it he's like, “We know a lot and we know a lot of people who are doing great things in healthcare and specifically healthcare IT. What if we design the next ILN in-person meeting to invite as many people who would want to contribute to a book?” So, at the in-person meeting, we carved out a section, and about 20 people showed up, and we were basically like chapter, author, chapter, author, chapter, author, chapter, author. And so basically, we got this network to write up its best work, and we packaged it in the book. And I think we did something clever as well. We created a fictional family, and the fictional family experienced every chapter. So, the opening of every chapter started with a family, the same family. This family had a lot of problems because they ended up in many different hospitals and had many different health IT experiences. Before you learned about what this organization did or the technology they were talking about or the methodology they were celebrating, we wanted you to see the effect on a patient or family's life. So, every chapter had about two to three pages of a story, a narrative, so you could feel in real time what this thing felt like. Then you got to the chapter, learned about medication administration or learned about health navigators or learned about advanced uses of electronic medical records.
Dr. Craig Joseph: That’s great. And I have the title of the book, Innovation With Information Technology and Healthcare. That is a grabber of a title, and I think it might still be available. I'm not 100% sure.
Chris McCarthy: It is still available on Amazon.com for sure. I will say we had much sexier titles, but it turns out when you're writing these kinds of books that your ability to create sexy titles is not necessarily wanted or appreciated. So, a much more clear title was what was required.
Dr. Craig Joseph: We don't have commercials. we've established that. If we had a paid tier, that's where we would talk about some of these sexier titles that were not allowed. But luckily for you, we have no such paid tier. So, you learned a lot stumbling through design principles and ultimately working with IDEO and other organizations. And then, through the Innovation Learning Network, discovered what others were doing and ultimately came to the conclusion that, wow, human-centered design is a thing. It's not just opinions about how things should be, but it's, it certainly is that, but based on science, we know how humans work at some level, and we want to apply some of those principles to get people to do the things that they know they want to do or that we know we want them to do. And that's human-centered design. And you have some thoughts on taking that to the next level.
Chris McCarthy: Yeah, let me tell you about one important aspect of the ILN which started the contribution to a more advanced thinking on human-centered design. So, the premise, the early premise of the ILN was on coopetition that we could go farther together than alone. And we use the analogy of a biking peloton. So basically, in a race, in the Tour de France, the best and worst riders can't do their best without each other. Like the whole group, they draft off of each other. So even the worst person in the group does way better than if they were alone. And the best person certainly does much better because all that energy of the draft translates into the whole group. So, we use that analogy and the concepts of coopetition, one to get seemingly competitors to be comfortable sharing with one another, but then to the next step, helping each other and realizing that there's a broader ecosystem. And when one of us does well, we can all do better. And in fact, the problems and challenges are so vast that wouldn't it be interesting if one organization worked on one thing and another on another and you started swapping the prototype types to give everybody a leg up on their journey so that all of our patients can do better? So that starts setting up this beyond a single product or service, adding a particular set of value to a particular patient and system, which, that’s human-centered design. Like you're really trying to design something that a human, a user, really wants. So, they will fork over their dollar for that benefit, and so the organization gets the buck, and the user gets the benefit of using whatever was created for them. So that's kind of a very classic capitalistic, product-driven view of human-centered design. And we have to remember that's where humans, that our design comes from. When you start thinking about the collective and all of us doing better, you know, it starts breaking down kind of the very simple ways of thinking about design. I have a problem. Let me design something for it. You start moving into things like systems thinking and systems design and thinking more holistically about your singular design for this one patient and how it fits into the totality of the system. So, I think, you know, from the Innovation Learning Network, we started getting this ecosystem understanding of challenges and how we can help each other and share. Hopelab Foundation, who was a member of the ILN, had a new role that they were posting for a VP of design and strategy, and I had always had a crush on this organization. I knew them for over ten years. They were doing some really cool stuff. They're the first organization to prove in a randomized controlled trial that a video game can improve life. This was a game called Remission that helped young cancer survivors live longer because they played this video game. They're just a cool organization. They blend design and academic rigor to create digital products. So, when this role was posted is the only time I felt like I could leave Kaiser Permanente. So, when I left Kaiser Permanente, and this is a very weird backstory, ILN ran under the umbrella of Kaiser Permanente. When I took this job, ILN came with me under the umbrella of Hopelab, because both were members and were talking about this ecosystem for the good. It was probably one of the easiest lawyer moments ever. The lawyers of Kaiser and the lawyers of Hopelab thinking they're supposed to fight over transfer, and they're like, “Is anybody upset about any of this?” All to say the ILN moved over to here, and the journey continued for the ILN. But my journey [changed] at Hopelab, because, at the same time, Hopelab started getting deeper into systems thinking and really starting to think about what are the most important challenges that you can solve for that might transform a system if you change it. And when you start thinking in the broader good, and you start thinking about systemic change, human-centered design is not enough. If you only anchor on what an individual wants, you may unintentionally mess up the system. You might not, but you might. I've been using a terminology called “humanity-centered design,” which is human-centered design. It is the anchor on the individual, but it's placing anchors also maybe at the family level or the community level or the society level. Like, you don't need to anchor everywhere, but by having multiple anchors, you are not automatically optimizing for the individual. You're solving for the optimization between what the individual needs and wants, but maybe what society needs and wants too. And so, you're getting impact, positive impact for both, not just for one.
Dr. Jerome Pagani: I think this brings us back to the conversation we had around value and designing for value. Human-centered design is very focused on ways that are very positive. The experience for the caregiver, the experience for the care receiver, value to the organization. But what you're talking about is community-centered design being part of a design focus that focuses on a larger outcome.
Chris McCarthy: Yeah, yeah. And it's trying to also prevent, again, these unintended consequences of a seemingly good individualistic design. So, the classic example right now, which I'm sure we've all heard a million times, you know, Twitter, or social media, but let’s stick with Twitter, is a beautifully designed human-centered experience. A person, an individual wanted the ability to shout their voice out into the world and be heard. And that's what Twitter allows. That's what they designed against. What we didn't add to that like was, well, what does the community need or society need? And if both those anchors were used, we may have ended up with both the ability to share our voice, but also have it modulated against community standards. But that's not the solution. That's not the design that we have right now. Right now, most social media, we have the ability to put stuff out into the world any time we want with very little moderation. And we see the consequences of that. We see the consequences of trolling. We see the consequences of bullying. We see the consequences of misinformation and fake information and lies being propagated because it was all designed for the individual. It did not take into account what the effect on society would be.
Dr. Craig Joseph: Yeah, that's great. Now, what is this website that you're talking about? Where do we find this, this social media that you speak of?
Chris McCarthy: It needs to be created.
Dr. Craig Joseph: Ah.
Dr. Jerome Pagani: You touched on applying systems thinking to healthcare, how does that relate to the idea of people as systems and incorporating a larger perspective of that system of things that support or can detract from their health?
Chris McCarthy: Yeah. So, the way I think about it is when you are mapping the system, and it's never a lone wolf activity, it really only works when the system participates. So, first of all, you need to define your system. And the second piece to that is getting the many stakeholders to participate in some way and recognize their contribution to why the system is the way it is. So that is perhaps one of the hardest parts of systems thinking and systems mapping is first, building the map is quite complicated. So, if it's inside of an organization, then it would force each of the departments to understand and recognize its contribution to how great it is or how awful it is. And ideally, the willingness to figure out how to stop contributing the awfulness and accelerating what's so awesome about what they're contributing. So, this is where, like when I talked a little bit about the ILN with the ecosystem approach and starting to connect people in a coopetition kind of way, to me, the best outcomes of systems thinking is that it's in some way community building. I better understand what you are contributing and what you are contributing, and I know what I'm contributing. While it feels good what I'm doing, I now realize that it's actually at the detriment of the whole system. So how can the three of us now work together to create something that's more meaningful for the system? So, it gets into the ecosystem, and it gets into cooperative design, which is much less about the individual. And that's a hard pill to swallow for any organization or any community to say, I'm willing to step back and maybe stop doing what I'm doing.
Dr. Jerome Pagani: The idea of having a map of that entire ecosystem reminds me of the Steven Wright joke of, I have a map of the United States, its actual size. It's huge and scary and terrifying, but you offer a way forward, which is for individuals to work and within their niche and design that way, but then be designing with that ecosystem mindset.
Chris McCarthy: For sure. And again, the ultimate purpose is to find what is the most leverageable point in the system that I can take my finite resources and innovation, bandwidth, or improvement bandwidth and apply that to that leverage point to have an outsized impact on the entire system. So, it's a very strategic approach. Instead of just guessing that me solving problem X is the right thing to do. It's a more thoughtful approach to say, actually problem Z is where if I put my limited time and resources, I am going to have a much bigger bang for my buck than if I do in this other area.
Dr. Jerome Pagani: I love that we've walked the journey from optimizing business processes all the way through to designing a health ecosystem. Because I feel like, you know, that, that just really spans the entire gamut right there.
Dr. Craig Joseph: So, Chris, we've heard your whole life story, your toddler time of wanting to do design. I think you had said potty trained first, then design.
Chris McCarthy: Yep. Yeah.
Dr. Craig Joseph: Where are you now? What's going on now?
Chris McCarthy: Yeah. So, I am in a very exciting juncture in my life where I am attempting to take my three loves, so, human-centered design from Kaiser Permanente, systems building and ecosystem building and coopetition from the Innovation Learning Network, and take systems thinking and academic rigor from Hopelab and bring them into my own consulting practice. So, I am in the early days of that startup phase of angst and joy of having launched my own thing.
Chris McCarthy: It's ILN Coaching and Consulting. If all goes well, I will be working at the intersection of systems thinking and design thinking in service of the greater good, and specifically, you know, my love is healthcare and well-being. That's what got me started in the early days, and that continues to be my journey.
Dr. Jerome Pagani: Chris, at the end of every podcast, we like to ask folks about three things or experiences that are so well designed, and they could be outside of healthcare, but they're so well designed that they bring you joy to interact with.
Chris McCarthy: Yeah, one is a new app that I'm using, and I can't believe I'm referring to an app, but that's just the way it goes. Even in 2023, there are still new apps to be found. It's called Tandem, and it solves a major problem for anybody that has roommates or a significant other that they're trying to split expenses with. A lot of older systems, you have to like enter in all the information, the prices, and for what they're for. And it's a lot of work. So Tandem is this app that streamlines all of that. It basically pulls your credit card statements into the app, and it takes what many people know how to use very well, a dating app, swiping left and right, and you swipe left to get rid of a charge that is maybe not for the couple or for the family. It's just for you personally, and you swipe right for a charge that is for the family, and it automatically splits it into whatever ratio your family has decided to split it up. And I've been using it for about three months, and it has saved me so much time compared to the way I used to split expenses. So that's one that I love. And the second and third are similar. So, I live in San Francisco. I live in a very urban area, so I have a small apartment, and I really try to optimize space and at the start of the pandemic, couldn’t go to the gym anymore. And I had to figure out, how am I going to work out. So, I bought this home gym called PRX. It's featured on Shark Tank, and it's incredible. Like it's basically a full gym that's on pistons. And when you're not using it, it lies flat against the wall and only sticks out like four inches. And so, when you're using it, you just pull it. It's on pistons, it lowers. And it’s a squat rack, and it's a pull-up bar, and it's a bench and has everything. And even though we're able to now go back to the gym, I don't think I ever will. I love my home system. And then just recently, which is very similar to this system, I've gone down a rabbit hole on Murphy Beds, and there are some really awesome new designs that are out there. I'm looking at this bed that converts into this amazing bookcase and desk, so that'll be my home office. But then you pull it down, and everything is on levers. So even the desk rotates underneath the bed and is just sitting there, all your paperwork, all your books, just hang underneath while the bed is down. And as you lift the bed up, everything just cantilevers back into place. So, I haven't bought that yet, but I'm in the rabbit hole of Murphy Beds, and it is a fun rabbit hole.
Dr. Jerome Pagani: Sounds amazing.
Dr. Craig Joseph: I was just picturing all those books all over the floor every night. And then every morning you had to put all the books back. So, you kind of burst my bubble there with the guestroom.
Chris McCarthy: It's not for every night.
Dr. Jerome Pagani: Well, Chris, this has been an absolute pleasure. Thank you for joining us on the podcast.
Chris McCarthy: Super awesome to be here. It was a lot of fun. Thanks.