user: *Question*
A prospective client sent me a link to this in-depth article on IBM's design thinking revolution, where Phil Gilbert, IBM's General Manager of Design, has hired over 1000 designers into the firm, and pushed for over 8000 of its managers and staff to get 'trained' in design thinking. They have even created specific design centres across the firm, with design offices in most of its key locations, such as the one above. The goal is nothing short of beginning IBM's next phase of transformation, one of many in its 100+ year history. However, all is not rosy. Despite achieving a monumental success relative to the status quo, 8000 'recognised' design thinkers in a corporation of over 370,000 souls is barely a dent in terms of changing practice. If NoTosh were to effect change in only 2% of the teachers with whom we work, we'd have packed up our bags long ago. I'm not sure hiring 1000 designers in and of itself is the answer to any organisation trying to instil a different way of viewing the world. Here's why. Since design thinking really began to be a thing, back in the early 60s, the designer him or herself has consistently been at the centre of the design process. Even though we talk of 'user-centred design', the actual ideation and production of a solution, and in many cases the synthesis and definition of the problem to be solve, too, are all tasks undertaken by skilled 'designers', rather than the people in the organisation who have the scope, brand, or 'permission' to play in that space. Once the designers leave the project, so does the design thinking. There is a reason d.school sees its executive courses filled with repeat customers and firms like IDEO continue to thrive - they are resolving challenges in specific examples of services or products, but not necessarily transforming the firms and organisations who had the budget and desire to solve a problem in that specific area. Solving a problem costs money. Solving a problem and teaching the client how to do it again and again costs more than just money.... After the end of this story, Gilbert probably realizes that:  A. The budget is sufficient  B. The task is easier said than done as costs are usually higher than planed for recurring training sessions.  C. The goal challenge is easily attainable  D. not enough information
**Answer**
B

*Question*
I had the joy, absolute joy, of observing an ER nurse just about lose it and the poor pompous MD (who had left the room) was still clueless. I was in the ER with my dad and my sister. It was late. Dad had taken a tumble, hit his head and because he was on a blood thinner, he had to be checked out at the ER. This ER was in the same hospital we always went to. As we completed the history etc. I noted “stroke effecting speech.” They had a complete synopsis of dad’s history which I gave them as we checked in. Dad is getting tired and his speech was getting more slurred. My Dad was in work clothes. I was in something pretty casual and my sister was in the same clothes (business attire) that she had put on at 6 a.m. I am sure we looked pretty ragged. In waltzes Dr. Hotshot. He looks around and asks my sister and I who we are. My sister introduced us making sure to introduce me as “Dr. Lea (I think that was the first, last, and only time she called me ‘Dr.”). He then turns to my dad and asked what happened. Knowing how difficult it is to understand Dad, I start to answer. My bad. The doctor abruptly stops me and says, “I didn’t ask you. I want him to tell me.” In hindsight, I realize he wanted to hear dad’s speech as a part of his assessment. Dad begins. His speech is slow and very very slurred. Dr. Hotshot looks totally befuddled. Dad had gotten out about 3 sentences out when Dr. Hotshot stops him and abruptly asks, “Does he always talk like that?” My sister, without missing a beat, replies, “No, sometimes he speaks French.” As I am trying to not swallow my head to keep from laughing, I notice the nurse in the room has buried her mouth in her shoulder. Dr. Hotshot exits. A scan shows no damage. And, for the record, Dad never did learn to speak French. Dr Hotshot probably thinks that  A. The Dad is dead  B. The narrator is friendly  C. The sister is mean  D. not enough information
**Answer**
C

*Question*
Both gross and tragic. The 1980 Bank Robbery in Central Nyack that was medically managed at the Nyack Hospital where I responded to the ONLY Code 66 of my career. That “66”indicated for us an external disaster about to unload in our emergency room. The two policemen who were mortally injured and died on our stretchers were personal friends and one the boyfriend of one of the nurses. Their injuries were from machine guns where the flesh is riddled with explosive elements as opposed to a gunshot wounds where there is both an entry and exit site. In our Trauma and Triage Course we never learned about machine gun injuries. Additionally there were the criminals who were also injured and of course we needed to treat them as any other patient regardless of their behavior. The friends of the injured policemen were trying to get to these villains and it was just the most awful evening of my life. To this day I remember feeling nauseous in a way I had never felt before. We had debriefing sessions for weeks and of course were very upset for months. The wounds we had to address, the insertion of chest tubes and everything else all in such a rapid manner was indeed a more than gross situation. There was even open heart massage. Private doctors reported to help; many are not trained or current in emergency medicine; much is left to critical care nurses in a community hospital that is not a teaching institution with residents and interns on staff. Recently one of the women involved in this crime came up for parole. Of course there was great opposition from the community relative to her release. She was young and that was 38 years ago. I believe people deserve a second chance, but of course this is a very controversial matter. What did the nurse perceive this episode as?  A. A debriefing session  B. The ONLY Code 66 of my career  C. A Trauma and Triage Course  D. not enough information
**Answer**


assistant: B