Saturday, April 29, 2006

The most successful immigrant?

link to original article.

American Heritage Magazine April/May 2006 Volume 57, Issue 2

American Pie

How a Neapolitan street food became the most successful immigrant of all
By Hanna Miller

Almost every American food—from egg foo yung to empanadas—is covered in the phone book under the generic heading “Restaurants.” Only pizza stands alone. Pizza, a Johnny-come-lately compared with such long-standing national favorites as the hamburger and hot dog, has secured a special place on the American table. Everybody likes pizza. Even those who claim to be immune to its charms must deign to have the occasional slice; a staggering 93 percent of Americans eat pizza at least once a month. According to one study, each man, woman, and child consumes an average of 23 pounds of pie every year.

But pizza wasn’t always so popular. Food writers in the 1940s who were worldly enough to take note of the traditional Italian treat struggled to explain the dish to their readers, who persisted in imagining oversized apple-pie crusts stuffed with tomatoes and coated with cheese. “The pizza could be as popular a snack as the hamburger if Americans only knew about it,” The New York Times lamented in 1947, illustrating its plaint with a photograph of a pie subdivided into dozens of canapé-sized slices.

That writer’s wistful tone was supplanted in a very few years by a weary one, as culinary chroniclers became jaded by the nation’s voracious appetite for pizza and the pie’s never-ending parade of variations. “The highly seasoned pizza with its tough crust and tomato topping is such a gastronomical craze that the open pie threatens the pre-eminence of the hot dog and hamburger,” the Times reported in a 1953 story about “what is perhaps inevitable—a packaged pizza mix.”

Pizza had wedged its way into the nation’s hearts and stomachs almost overnight, a phenomenon befitting a food that became synonymous with quick and easy. Americans seeking fun in the years after World War II found a good measure of it in pizza, a food that when eaten correctly (a matter of some debate among 1950s advice columnists) forced the diner’s lips into a broad smile. Pizza, like teenagedom and rock ’n’ roll, is a lasting relic of America’s mid-century embrace of good times.

Modern pizza originated in Italy, although the style favored by Americans is more a friend than a relative of the traditional Neapolitan pie. Residents of Naples took the idea of using bread as a blank slate for relishes from the Greeks, whose bakers had been dressing their wares with oils, herbs, and cheese since the time of Plato. The Romans refined the recipe, developing a delicacy known as placenta, a sheet of fine flour topped with cheese and honey and flavored with bay leaves. Neapolitans earned the right to claim pizza as their own by inserting a tomato into the equation. Europeans had long shied away from the New World fruit, fearing it was plump with poison. But the intrepid citizens of Naples discovered the tomato was not only harmless but delicious, particularly when paired with pizza.

Cheese, the crowning ingredient, was not added until 1889, when the Royal Palace commissioned the Neapolitan pizzaiolo Raffaele Esposito to create a pizza in honor of the visiting Queen Margherita. Of the three contenders he created, the Queen strongly preferred a pie swathed in the colors of the Italian flag: red (tomato), green (basil), and white (mozzarella).

Thus ends the story of pizza, according to most histories of the pie. It’s not a bad story, but it’s only the beginning; Esposito’s adventures in patriotic baking have little to do with why American pizza makers are taxed to exhaustion every Super Bowl Sunday.

Pizza crossed the Atlantic with the four million Italians who by the 1920s had sought a better life on American shores. Most Italians weren’t familiar with the many regional variations their fragmented homeland had produced, but a longing for pan-Italian unity inspired a widespread embrace of a simplified pizza as their “national” dish. Fraternal “pizza and sausage” clubs, formed to foster Italian pride, sprouted in cities across the Northeast. Women got in on it too, participating in communal pizza exchanges in which entrants competed with unique pies, some molded into unusual shapes, some with the family name baked into the dough.

Although non-Italians could partake of pizza as early as 1905, when the venerable Lombardi’s—the nation’s first licensed pizzeria—opened its doors in Lower Manhattan, most middle-class Americans stuck to boiled fish and toast. The pungent combination of garlic and oregano signaled pizza as “foreign food,” sure to upset native digestions. If pizza hoped to gain an American following beyond New York City and New Haven, it would have to become less like pizza. By the 1940s a few entrepreneurs had initiated the transformation, starting a craze that forever changed the American culinary landscape.

The modern pizza industry was born in the Midwest, not coincidentally a place of sparse Italian settlement. Although pizza had pushed into the suburbs as second-generation Italians relocated, most of the heartland was pizza-free. Its inhabitants had neither allegiance nor aversion to the traditional pie. The region also boasted an enviable supply of cheese.

Despite such advantages, Ike Sewell still wasn’t thinking pies when he partnered with Ric Riccardo to open a Chicago restaurant. Sewell, a native of Texas, planned on offering a menu of Mexican specialties. Riccardo willingly agreed, having never tried Mexican food. His first meal changed his mind so completely that, he liked to say later, he fled to Italy to recover from it. While there, he sampled classic Neapolitan pizza and found it much better than Sewell’s Mexican offerings. Sewell eventually agreed to forgo enchiladas for pizza, but not until he’d inflated the thin-crusted Neapolitan recipe to make it more palatable to Americans. “Ike tasted it and said nobody would eat it, it’s not enough,” Evelyne Slomon, author of The Pizza Book, said. “So he put gobs and gobs of stuff on it.”

Sewell’s lightly seasoned deep-dish pie, introduced in 1943, the signature item at Pizzeria Uno, was the first true American pizza. The pie was a uniquely Chicago institution, like a perennially losing major-league baseball team, that other cities showed no interest in adopting. Until Uno’s opened its first location outside Chicago in 1979, people had to go to East Ohio Street to sample anything like Sewell’s idea of a pie. But its success liberated pizzeria owners nationwide to tinker with their product, ultimately paving the way for the megafranchises.

Sewell was followed in the next two decades by scores of independent operators who deleted the traditional herbs and went easy on the garlic in hopes of gaining a bigger clientele. Pizza was no longer the province of firstand second-generation Italians. Americans of every ancestry wanted a slice of this pie. “I make any kinda pizza you want,” the New York pizzeria owner Patsy D’Amore told The Saturday Evening Post in 1957. “One day a man order a lox pizza with cream cheese. It turn my stomach, but I make it for him.” Professional pizza chefs like the unnamed Japanese-American woman who stumped the panel of the TV show “What’s My Line?” in 1956, and the Mexican-Americans who helped make pizza the second-best seller at the 1952 Texas State Fair (edged out only by the irresistible corn dog), and fledgling franchises like Pizza Hut, gradually shed all Italian imagery from their advertising campaigns.

But despite the best entrepreneurial efforts, most Americans remained unfamiliar with pizza well into the 1940s. “We had to give it away at first,” Eugenia DiCarlo told a McNeese State University interviewer of her husband’s attempt to establish a pizzeria in Lake Charles, Louisiana, in 1947. “They had never, never heard of it down here. And, boy, every time they’d take a piece of it, they liked it. And more and more liked it, told other people, and then got to the place where that was the biggest part of our business.”

The urge to tell other people about pizza was apparently a universal impulse that seized knowing literati like Ora Dodd —who in 1949 penned a two-page paean for the Atlantic Monthly: “It is piping hot; the brown crust holds a bubbling cheese-and-tomato filling. There is a wonderful savor of fresh bread, melted cheese and herbs. This is a pizza”—and World War II servicemen returning from Italy. Veterans ranging from the lowliest private to Dwight D. Eisenhower talked up pizza.

Led by the servicemen’s newfound cravings, Americans timidly sampled their first pies. Most weren’t crisp, bathed in olive oil, or sprinkled with mozzarella; if cooks followed the advice offered by Good Housekeeping in 1951, their pizzas were biscuit rounds or English muffins topped with processed Cheddar cheese, chili sauce, salt, pepper, and salad oil. Cooks could also opt to add deviled ham, stuffed olives, or canned tuna to the “cheese treatment.”

Americans who ate at any one of the country’s rapidly proliferating pizzerias (the number of parlors in the United States skyrocketed from 500 in 1934 to 20,000 in 1956) enjoyed a pie that cut a neat compromise between the traditional Italian pizza and Good Housekeeping’s “Yankee” variety. Pizzas at the Pennsylvania parlor where Andy Zangrilli got his first job were massive rectangles speckled with slithery pepperoni disks. “It was a hit,” said Zangrilli, who today owns a chain of pizzerias. “If you didn’t like the pepperoni, you’d take it off. It was the Model T of food.”

Unlike other ethnically derived foods that enjoyed faddish popularity in modern America, pizza never masqueraded as exotic. Its consumers didn’t aspire to be cosmopolitan or courageous. They were simply drawn in by the bewitching interplay of tomatoes, bread, and cheese—drawn in so strongly that by 1958 the novelty singer Lou Monte could issue an album called Songs for Pizza Lovers.

But it wasn’t just the taste that Americans liked. The social aspect of the pie appealed to a nation riding the postwar boom economy. It seemed uniquely suited to the fun that defined the 1950s, easy for “the gang” to share and informal enough to figure in slumber parties and sock hops. While the early New York pizzerias had been forced to sell by the slice to draw lunchtime business, most pies outside the five boroughs were sold whole, making it nearly impossible to eat pizza alone (although Jackie Gleason attributed his girth to having accomplished the feat many times, sometimes within the span of a single meal).

“I call it happy food,” Slomon said. “It’s a communal thing. You can have two people enjoying a pizza or you can have a group.” Sophia Loren in 1959 told the Los Angeles Times that having been raised in Italy to consider pizza the food of poverty, she pitied Americans when she saw how many pizza joints they had. “So I think America not so rich after all. Then I find eating pizza here is like eating hot dog—for fun.”

Eliminating cutlery made pizza eating seem raffish to more staid diners. Although Dear Abby urged her readers to respect the pizza as a pie and reach for a fork, the etiquette authority Amy Vanderbilt condoned eating slices “out of hand,” adding that “pizza tastes best as a finger food.” Look magazine in 1954 published an illustrated step-by-step guide, instructing readers to hold pizza from “the arc edge,” rather than the measly tip, and “roll it in a log.” Bob Hope still had reservations when his buddy Jerry Colonna prepared a pie. “It’s a tough baby to cut,” Hope complained. “I never cut it,” Colonna responded. “It’s hand food. Chew it down and have fun.”

Pizzeria owners accelerated the fun by hiring dough-tossing showmen to divert patrons by spinning pies skyward, sometimes sending the dough 12 feet into the air (and creating an overly dry pizza in the process). Tossers such as Aldo Formica, who demonstrated his talent on Tennessee Ernie Ford’s television show, became second-rung celebrities. “Then it started coming out that maybe the guy with the hairy arms in the dough wasn’t turning people on, and maybe he was turning people off,” the pizza consultant John Correll said of the tosser’s ultimate disappearance from the scene. “But pizza has stayed locked in to the image of fun and frolic.”

The image was polished in 1953 when Dean Martin swung his way through “That’s Amore!,” an Italian-flavored love song that famously compared the moon to “a big pizza pie” (a phrase that irritated exacting food writers, who insisted it was redundant).

By the mid-1950s pizza was everywhere. Although it would be another decade before baseball stadiums and zoos offered the snack, political parties, fundraising groups, and synagogue sisterhoods were plying their members with pizza. Fun and flavor aside, the price was right: Zangrilli sold two slices at his Pennsylvania State College parlor for a quarter. “Pizza fit students’ needs perfectly,” Zangrilli said. Sometimes too perfectly, as a 1950s Atlanta restaurateur discovered when he added pizza to his menu and immediately attracted hordes of Georgia Tech students who would congregate around a single pie and linger for hours. He dropped the pies.

An anonymous pizza baker in 1957 blamed James Dean for inducting teens into the pizza fraternity. “Jimmy loved pizza,” he complained to The Saturday Evening Post. “His fans knew that, so they loved it too.” Pizza was pitched as the ideal snack for hard-to-please high schoolers by companies such as General Mills, whose Betty Crocker character appeared in a 1960 comic strip to solve the “Problem of the Puzzled Parent,” who is perplexed by what to serve her daughters’ friends after a roller-skating outing. What do “most teenagers” like? she wonders. Refrigerated pizza dough, Betty Crocker assures her. Betty is proved right, as always. “Gee, Mrs. Steward, you sure know what’s good,” one handsome teen raves (although he disconcertingly appears to be eyeing her twin daughters rather than her pie). By 1963 pizza was a staple of the school lunch menu. The American School Foodservice Association that year announced it was bested only by hamburgers and hot dogs in the cafeteria popularity contest.

Adults weren’t ready to cede pizza to children, though. People of every age and income bracket went for it, as Lucille Ball, who met her second husband, Gary Morton, on a blind date in a pizza parlor, could attest. George Liberace was so enamored with pizza that in 1959 he contemplated abandoning the brothers Liberace to open a parlor, reconsidering only when brother Lee, the pianist of the duo, teased him ruthlessly.


Pizza’s mid-century journey from unknown to unparalleled was captured in a raucous 1956 skit aired on “Caesar’s Hour,” the show’s second gag that year grounded in pizza adoration. Pizza was to Sid Caesar’s writing team what domestic tranquillity was to the creative staff over at “The Adventures of Ozzie and Harriet”: a source of endless inspiration. In “The Commuters,” three couples are absorbed in a competitive Scrabble game. The word pizza is played, but nobody’s too sure how to spell the name of their new favorite food (the word routinely shows up on first-grade spelling lists today). So the couples consult a dictionary, taking care not to drool on the definition. The men, now rapturous at the thought of a pie, flee for the nearest pizzeria, promising to return with pizza for everyone. This being comedy, they hit a snag on the way home: Their car breaks down, and the pizzas are in danger of getting wet. One of the men decides to shield the pizzas beneath the hood, a bit of chivalry that manages to jump-start the engine. Powered by pizza, the men arrive home to find their wives asleep, to be awoken only by having fragrant slices of pizza dragged beneath their noses. Pizza was a dream come true.

The premise of Caesar’s skit quickly became dated as Tom Monaghan institutionalized the innovation that transformed America’s infatuation with pizza into a lasting relationship: home delivery. In 1960 Monaghan and his brother James bought an Ypsilanti, Michigan, pizza joint called Dominick’s (James traded his share to Tom one year later in exchange for a Volkswagen Beetle). According to Correll, Monaghan was forced to rechristen the store as Domino’s when Dominick complained he was “besmirching his name” with a lousy product. But Monaghan wasn’t fixated on quality: He decided to best the competition by offering free delivery, a service that every major chain later added to its repertoire. Pizza purveyors tested lots of new concepts in the 1970s and ’80s: There were restaurants that explicitly wedded pizza to entertainment, such as Chuck E. Cheese’s, where a life-sized rat boogied through the arcade, and restaurants that emphasized fresh and novel ingredients, such as California Pizza Kitchen, home to the caramelized pear and gorgonzola pie. Nothing, however, has yet supplanted the large pepperoni pie delivered hot within the hour as the quintessential American pizza experience.

Pizza’s firm hold on the American appetite is unlikely to slip anytime soon. With very little nudging from pizza marketers, Americans have made pizza the traditional food of the emerging national holiday Super Bowl Sunday; almost 70 percent of viewers eat pizza while watching the game. Both spontaneous and economical, ordering pizza remains a signifier of carefree camaraderie; pizza seems to automatically make any event a little more fun. “We will have pizza(!),” the Carleton College history department announced last year in a memo meant to lure students to a meeting. It’s hard to imagine fried chicken or tofu having the same drawing power. “Pizza is more popular than ever,” Slomon said. Not bad for a food that most Americans had to have explained to them just 50 years ago.

Hanna Miller, a food historian, leads culinary tours in Asheville, North Carolina.

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Want to Have the Best?
A coast-to-coast guide to America’s 10 (well, actually 11) greatest pizzas
By John Mariani

I know of no Supreme Court decisions on what constitutes a pizza in America, but if the Justices ever need guidance, they might well turn to the rubrics drawn up by the august Associazione Vera Pizza Napoletana that stipulates exactly what does and does not constitute a true Neapolitan pizza, including ingredients, size, cooking method, oven temperature, and the height of the crust’s edges. Here are some in the United States that I think would handily pass the test; they have certainly passed my own personal taste test.


Lombardi’s

32 Spring Street, New York, N.Y., 212-941-7994.
You gotta hand it to them: Lombardi’s was apparently the first to sell pizza in America, and it was clearly the standard the pizzerias that followed had to meet or beat. It is still a great pizza— misshapen, steaming, slightly puffy, with a yeasty crust and wonderful gooeyness to the creamy, full-flavored cheese. The pizza bianca (white pizza), with three cheeses, garlic, and olive oil, is pretty terrific too.


John’s Pizzeria
278 Bleecker Street, New York, N.Y., 212-243-1680.
There’s almost always a line out the door for John’s impeccable pies, which have a good chewy crust and nice balance of sauce to mozzarella. Practice makes perfect, and they go through thousands of pies each week here, at the original Greenwich Village location and at two others uptown that are just as good, if not so evocative.


Mario’s
2342 Arthur Avenue, Bronx, N.Y., 718-584-1188.
If a business has been around since 1919 and is into its fourth generation of family members keeping things the old way (in this case the Miglucci family), and if every “New Yawk” sports figure and plenty of politicians wanting the Bronx vote come here, you know something good is cooking. The pizza at Mario’s, prepared by Joe Miglucci, is paramount for its flavors, the bubbly crust, and the good vibes of this cordial family eatery.


Naples 45
200 Park Avenue, New York, N.Y., 212-972-7001.
To look at this sprawling, sleek trattoria adjacent to Grand Central Terminal, you’d think it is just too slick to be good. But Restaurant Associates put its clout, money, and resources into every aspect of creating a great pizza, including locating water with the same mineral content as in Naples and special-ordering the flour. The result is a superb pizza, and the wood-burning ovens turn them out every two or three minutes, with a good layering of cheese in counterpoint to the tomatoes.


Totonno’s Pizzeria Napolitano
1524 Neptune Avenue, Brooklyn, N.Y., 718-372-8606.
Certainly the best of the Brooklyn pizzerias, Totonno’s (now with branches in Manhattan and Yonkers, New York) is as much a part of going to Coney Island as grabbing a hot dog at Nathan’s Famous. Once known for its screaming, eccentric owner (now retired), Totonno’s is a far easier place to like these days, as much for its ambience as for its perfect pizzas.


Frank Pepe Pizzeria Napoletana
157 Wooster Street, New Haven, Conn., 203-865-5762


Sally’s Apizza
237 Wooster Street, 203-624-5271.
These are the two famous pizzerias on Wooster Street that give New Haven its reputation for great pies, and, frankly, I give even odds on who makes the better pizza. Pepe’s has garnered more national attention, and the pies can be fabulous, but the wait is long, the waitresses are brusque, and the pizza guys take their time getting your pie out. Sally’s, here since 1938 and very proud of its pizzas, is a bit more lovable. Both make the New Haven specialty, a clam pizza, which I’ve yet to learn to love.


Al Forno
577 Main Street, Providence, R.I., 401-273-9767.
Providence has a number of good pizzerias, and Al Forno is really a full-scale restaurant that got famous for Johanne Killen and George Germon’s grilled pizzas, made from dough stretched and placed on a blazing wood-fired grill, then turned and topped with ingredients. The smokiness is a great part of these pizzas’ appeal, but the crust attains a hot, bubbly charring that is as delicious as the toppings themselves.


Spago
176 North Canon Drive, Beverly Hills, Calif., 310-385-0880.
Swankier than this restaurants do not get—Wolfgang Puck’s wildly successful glam palace in Beverly Hills. But the original Spago (now closed) was set up as a pizzeria and grill, and the young Puck pioneered great pizza in California, even as he came up with marvelous new ideas for them, like a “Jewish pizza” topped with smoked salmon, sour cream, and caviar. Avoid his frozen pizza line in the supermarkets but go for the original Puck pizza at Spago.


Pizzeria Bianco
623 East Adams Street, Phoenix, Ariz., 602-258-8300.
Phoenix is not a town where you expect to find great pizza, but Bronx-born Chris Bianco has become a legend for his commitment to perfecting this single item of gastronomy. Many believe he has, with house-made mozzarella, luscious tomatoes, and fresh herbs, along with some other items like sausage and a few sandwiches thrown in for good measure.


Chez Panisse Cafe
1517 Shattuck Avenue, Berkeley, Calif., 510-548-5049.
Alice Waters’s great distinction as a chef and restaurateur is that she started out asking, “Why can’t everything in America taste the way it does in Europe?” Thus was born the great Chez Panisse and upstairs a café that serves salads and pizzas any Neapolitan would be proud of, even if Waters gets a little Californian with her toppings.

John Mariani, food critic and historian (and author of many books, including The Encyclopedia of American Food & Drink, which contains 500 classic recipes—among them an unsurpassable one for chicken pot pie) publishes a “Virtual Gourmet Newsletter” available at www.johnmariani.com.

Three Web sites should please the pizza-insatiable: Pepe’s famous New Haven pizza has a wonderfully appealing fan site (www.jour.unr.edu/goldbaum/travelblogs/pizza/home); www.pizzatherapy.com will tell you everything from how to start a business to where to get the best pie in Alabama; and www.sliceny.com has daily updates on pizza-related news, a glossary, recipes, and the piPod, a map you can download for your iPod to find the best pizzeria within walking distance (so far, only in New York). Two books also carry on the story. In American Pie: My Search for the Perfect Pizza (Ten Speed Press, $27.95) Peter Reinhart, a celebrated baker and baking instructor, scours the Western World, from Genoa to Los Angeles in his quest, offering recipes along the way. Another pizza pilgrim, Ed Levine, has recently chronicled his travels and discoveries in Pizza: A Slice of Heaven (Universe, $24.95). If John Mariani’s 10 picks of great pizzerias aren’t enough for you, Levine offers dozens more, ranging from the green-chile pies of New Mexico to the kimchi toppings of Korean-American establishments and the expanding empire of Nick Angelis, who, starting in Queens, New York, produced a pie with enough savory authority to colonize Manhattan, where he has opened a handsome new pizza restaurant called Adrienne’s Pizza Bar in the financial district.

Friday, April 28, 2006

Trying to whip up a miracle.

Unfortunately most physicians chose to become physicians because they either didn't want to or couldn't think like designers.

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A Prescription for Innovation

The Mayo Clinic's new SPARC lab is driving experimentation at the frontier of health care. How? By getting physicians to think more like designers.

From: Issue 104 | April 2006 | Page 83 | By: Chuck Salter

The first kiosk looked like a grade-school project or a prank. It didn't have a screen. Didn't even plug in. Patients stared at a piece of paper and tried to imagine the real thing, a terminal that would allow self-service check-in for a doctor's appointment. The next iteration was less primitive, a laptop with an apparent touch screen, except that it didn't work; someone sitting beside it, using a separate keyboard, typed in the system's response like a high-tech ventriloquist. The model after that had a responsive touch screen, but the functionality was sparse. No matter. The kiosk was getting there.

And that was the idea: Put the earliest version, the rough sketch, in front of patients to see what they thought. Then use the feedback to tweak and retest. Then do the whole thing over again.

The Mayo Clinic in Rochester, Minnesota, is no stranger to innovation. W.W. Mayo and his sons--still known here as Dr. Charlie and Dr. Will--founded their rural group practice in the late 1800s around a new concept at the time: integrated medical care, which involved various specialists working together in the same building, performing comprehensive evaluations, and administering coordinated treatment. Ever since, innovation has been a vital part of the clinic's DNA, traditionally in the research lab.

But the approach with the kiosk--rolling out unfinished ideas to patients--is something new. Last summer, Mayo opened SPARC, a clinical innovation lab that operates like a design shop and that specializes in the "patient experience." Doctors, nurses, and other staffers do what designers do: They interview, shadow, and observe customers (in this case, patients) to uncover their needs, brainstorm with abandon, and engage in rapid prototyping--hence, the paper kiosk.

Despite its status as one of the best known and most respected medical facilities in the world, Mayo is wrestling with the same issues that designers routinely tackle: In an increasingly competitive field, how do you differentiate yourself? How do you generate fresh ideas and implement them in a timely fashion? And how do you make sure those ideas actually benefit customers?

Mayo's program is "definitely unique, and it has enormous implications," says Dr. Samantha Collier, vice president of medical affairs at HealthGrades, which rates the quality of the nation's hospitals. "Medicine has long been embedded in tradition. But just because this is what we've done since the days of Marcus Welby doesn't mean it's still the best way. [Mayo] could find disruptive ways of practicing medicine better. This isn't just about customer service but about quality."

SPARC is not simply a research lab or a medical clinic. It's both. Real patients see real doctors and, in doing so, participate in experiments (they're briefed and asked for permission). Instead of being shunted off-site, the program is based in the Mayo Building like any other clinic; it occupies a corridor that used to house urology. The acronym, which stands for "see, plan, act, refine, and communicate," is meant to remind participants of the design-oriented methodology so they'll continue to employ it when they return to their departments.

The idea grew out of the realization that outpatient care is overdue for fresh ideas. "Medicine has changed, people have changed, technology has changed, but the exam room isn't so different than it was in the 1800s," says Dr. Michael Brennan, an associate chair in the department of medicine, where the program originated. Mayo wants its doctors to apply the same experimental approach to clinical innovation that they apply to scientific innovation.

Ryan Armbruster, SPARC's director of operations and design, researched how other organizations, such as Procter & Gamble and Hewlett-Packard, foster innovation, and was struck by the prominent role of design. Dr. Alan Duncan, SPARC's medical director, had always thought of design as merely about aesthetics, but he quickly recognized the parallels to health care. "Look at how physicians generate a diagnosis," he says. "You do a history, listen, and think about all possibilities. It's purposefully broad to avoid locking into an early diagnosis, just as a designer wants to avoid locking into an early solution."

The inclusion of actual patients is critical. Understanding user needs, after all, is a tenet of smart design, says Armbruster. There are three types of needs: those that are explicit and tacit and can be identified by surveying and interviewing people; those that can't be articulated but become apparent through observation; and latent needs, the hardest to root out. "The only way to identify them is to make something and have people experience it," Armbruster says.

"Just because this is what we've done since the days of Marcus Welby doesn't mean it's still the best way. Mayo could find disruptive ways of practicing medicine better."
Dr. Victor Montori, an endocrinologist, brought doctors and patients to SPARC to experiment with a new way of discussing statins, drugs that lower high cholesterol. Too often, he says, patients get overwhelmed with information and let the doctor choose the treatment. Because they didn't decide for themselves, patients tend to abandon the therapy, which puts them back in the doctor's office.

Montori tested a one-page guide that gives an individual's risk of a heart attack, shows how statins affect those odds, and outlines possible side effects. He's still reviewing the data, which suggests better adherence to medication, but he already knows that the personalized guide got patients' attention. "After the fifth or sixth prototype, we started seeing an emotional and physical response," Montori says. "They were moved." He knows this because SPARC's exam rooms are equipped with small cameras that provide rare glimpses into doctor-patient interactions. "We hear all the time about a clinician being empathetic," Montori says. "Now we're watching empathy at work. The eye contact. The listening. We see the whole dance."

In fact, most everyone can see. With the help of office furniture maker Steelcase, Mayo created a highly transparent environment. The glass walls reveal SPARC's inner offices and show support staff working at the front desk; researchers reviewing project videos; and the SPARC team leading workshops in a central space that functions as an informal lounge and meeting room. SPARC removes the mystery found in a typical closed-off clinic.

The space is also highly flexible. Much of the corridor, including the exam rooms, can be reconfigured to accommodate a variety of experiments. Walls, furniture, and computers can be moved like puzzle pieces. "People come expecting to see the finished product," says Armbruster. "But they experience the opposite. They see prototypes in different stages of evolution."

Mayo's physicians both embrace design principles and integrate them with traditional medical research--in effect slipping the doctor's white coat over all-black designer duds. Doctors or managers propose a problem or a question they want to explore, and the SPARC staff assembles a cross-functional team, which gets a crash course on design methodology. By "the second hour, we were out with cameras, notepads, and tape recorders," says Becky Smith, a manager in patient education. Her team discovered that Mayo's main education center was confusing. It was intended for patients and family members to learn more about diagnoses or treatments. But because the space was open--no walls or doors--patients weren't sure if the computers were for them or the Mayo staff. When they did venture online, it was mainly to check email.

"We hear all the time about a clinician being empathetic. Now we're watching empathy at work. The eye contact. The listening. We see the whole dance."
After researching user needs on the Mayo campus, study groups typically reconvene in the SPARC lounge to share observations, ideally in the form of stories: how patients checked in, how they learned about treatment options, and so on. The goal is to explain how and why people behave the way that they do, to uncover the short cuts around a problem. Then the brainstorming begins. Whiteboard walls get papered with sticky notes and possible solutions. Finally, it's on to prototypes.

Smith's patient education group generated a host of ideas: an enticing name for the area--"The Discover Center"; an entrance modeled after an artery of the heart; more interactive computer programs; anatomical models that encourage hands-on learning; and a snack bar devoted to learning about and making healthy food. Management approved one of the upgrades right away, removing a pillar to improve visibility. In the next two months, visits increased 15% over the same period a year earlier.

The innovation program is still finding its feet, but Armbruster can tell it's having an impact. In one sense, it's subtle; he hears from workshop participants who are applying what they learned in SPARC in their day-to-day problem solving. But SPARC experiments are also beginning to have tangible effects on Mayo's patient experience. Take the long lines at check-in. The last thing people want when they're feeling sick or anxious is to stand around waiting. According to the SPARC team's research, 87% of patients using a kiosk would use it again to speed things along. In fact, the latest kiosk prototype actually plugs in and has a fully functioning touch screen. Based on that work, a top-level committee is weighing the addition of kiosks across the Rochester campus.

Already, SPARC's reach is expanding. What began a couple of years ago as an intriguing but modest concept was named one of the Mayo Clinic's top priorities last year. SPARC's full-time staff has grown from two to six. There are a half-dozen projects going on, and the number of workshop participants is 500 and counting. SPARC is catching on, winning traction--and, hopefully, sparking Mayo's next whirl of innovation.

Chuck Salter (csalter@fastcompany.com) is a Fast Company senior writer based in Chicago.

Thursday, April 27, 2006

Real grief, virtual mourning.

April 27, 2006

Rituals of Grief Go Online

By WARREN ST. JOHN

Like many other 23-year-olds, Deborah Lee Walker loved the beach, discovering bands, making new friends and keeping up with old ones, often through the social networking site MySpace.com, where she listed her heroes as "my family, and anyone serving in the military — thank you!"

So only hours after she died in an automobile accident near Valdosta, Ga., early on the morning of Feb. 27, her father, John Walker, logged onto her MySpace page with the intention of alerting her many friends to the news. To his surprise, there were already 20 to 30 comments on the page lamenting his daughter's death. Eight weeks later, the comments are still coming.

"Hey Lee! It's been a LONG time," a friend named Stacey wrote recently. "I know that you will be able to read this from Heaven, where I'm sure you are in charge of the parties. Please rest in peace and know that it will never be the same here without you!"

Just as the Web has changed long-established rituals of romance and socializing, personal Web pages on social networking sites that include MySpace, Xanga.com and Facebook.com are altering the rituals of mourning. Such sites have enrolled millions of users in recent years, especially the young, who use them to expand their personal connections and to tell the wider world about their lives.

Inevitably, some of these young people have died — prematurely, in accidents, suicides, murders and from medical problems — and as a result, many of their personal Web pages have suddenly changed from lighthearted daily dairies about bands or last night's parties into online shrines where grief is shared in real time.

The pages offer often wrenching views of young lives interrupted, and in the process have created a dilemma for bereaved parents, who find themselves torn between the comfort derived from having access to their children's private lives and staying in contact with their friends, and the unease of grieving in a public forum witnessed by anyone, including the ill-intentioned.

"The upside is definitely that we still have some connection with her and her friends," said Bob Shorkey, a graphic artist in North Carolina whose 24-year-old stepdaughter, Katie Knudson, was killed on Feb. 23 in a drive-by shooting in Fort Myers, Fla. "But because it's public, your life is opened up to everyone out there, and that's definitely the downside."

It's impossible to know how many people with pages on social networking sites have died; 74 million people have registered with MySpace alone, according to the company, which said it does not delete pages for inactivity. But a glib and sometimes macabre site called MyDeathSpace.com has documented at least 116 people with profiles on MySpace who have died. There are additions to the list nearly every day.

Last Thursday, for example, a 17-year-old from Vancouver, Wash., named Anna Svidersky was stabbed to death while working at a McDonald's there. As word of the crime spread among her extended network of friends on MySpace, her page was filled with posts from distraught friends and affected strangers. A separate page set up by Ms. Svidersky's friends after her death received about 1,200 comments in its first three days.

"Anna, you were a great girl and someone very special," one person wrote. "I enjoyed having you at our shows and running into you at the mall. You will be missed greatly ... rest in peace."

Tom Anderson, the president of MySpace, said in an e-mail message that out of concern for privacy, the company did not allow people to assume control of the MySpace accounts of users after their deaths.

"MySpace handles each incident on a case-by-case basis when notified, and will work with families to respect their wishes," Mr. Anderson wrote, adding that at the request of survivors the company would take down pages of deceased users.

Friends of MySpace users who have died said they had been comforted by the messages left by others and by the belief or hope that their dead friends might somehow be reading from another realm. And indeed many of the posts are written as though the recipient were still alive.

"I still believe that even though she's not the one on her MySpace page, that's a way I can reach out to her," said Jenna Finke, 23, a close friend of Ms. Walker, the young woman who died in Georgia. "Her really close friends go on there every day. It means a lot to know people aren't forgetting about her."

More formal online obituary services have been available for a number of years. An Illinois company called Legacy.com has deals with many newspapers, including The New York Times, to create online guest books for obituaries the papers publish on the Web, and offers multimedia memorials called Living Tributes starting at $29. But Web pages on social networking sites are more personal, the online equivalent of someone's room, and maintaining them has its complications. Some are frustratingly mundane.

Amanda Presswood, whose 23-year-old friend Michael Olsen was killed in a fire in Galesburg, Ill., on Jan. 23, said none of his friends or family members knew or could guess the password to his MySpace account, which he signed onto the day before he died. That made it impossible to accept some new messages.

"There's a lot of pictures on there that people haven't seen," Ms. Presswood said. "His parents have been coming to me for help because they know I know about the Internet. They even asked if I could hack it so I could keep the page going."

The Walkers correctly guessed the password to their daughter's page, and used it to alert her friends to details of her memorial service. They also used it to access photographs and stories about their daughter they had missed out on.

"It's a little weird to say as a parent, but the site has been a source for us to get to know her better," Mr. Walker said. "We didn't understand the breadth and scope of the network she had built as an individual, and we got to see that through MySpace. It helped us to understand the impact she's had on other people."

At the same time, Ms. Walker's mother, Julie, wrote in an e-mail message, the family was overwhelmed by unsolicited e-mail messages from strangers offering platitudes and seeking to advise them on how to handle their grief. The family found such offerings unwelcome, however well intentioned.

"The grief of our own friends and family is almost more than we can bear on top of our own, and we don't need anyone else's on our shoulders," Mrs. Walker wrote.

Mr. Shorkey said he and his wife remained in touch with their daughter's friends through MySpace. And they visit her Web page daily.

"Some days it makes me feel she's still there," he said. "And some days it reminds me I can never have that contact again."

Copyright 2006 The New York Times Company

guide to generating great stories.

How to tell a great story
Seth Godin

This article appeared in Ode issue: 32

Great stories succeed because they are able to capture the imagination of large or important audiences.

A great story is true. Not necessarily because it’s factual, but because it’s consistent and authentic. Consumers are too good at sniffing out inconsistencies for a marketer to get away with a story that’s just slapped on.

Great stories make a promise. They promise fun, safety or a shortcut. The promise needs to be bold and audacious. It’s either exceptional or it’s not worth listening to.

Great stories are trusted. Trust is the scarcest resource we’ve got left. No one trusts anyone. People don’t trust the beautiful women ordering vodka at the corner bar (they’re getting paid by the liquor company). People don’t trust the spokespeople on commercials (who exactly is Rula Lenska?). And they certainly don’t trust the companies that make pharmaceuticals (Vioxx, apparently, can kill you). As a result, no marketer succeeds in telling a story unless he has earned the credibility to tell that story.

Great stories are subtle. Surprisingly, the fewer details a marketer spells out, the more powerful the story becomes. Talented marketers understand that allowing people to draw their own conclusions is far more effective than announcing the punch line.

Great stories happen fast. First impressions are far more powerful than we give them credit for. Great stories don’t always need eight-page colour brochures or a face-to-face meeting. Either you are ready to listen or you aren’t.

Great stories don’t appeal to logic, but they often appeal to our senses. Pheromones aren’t a myth. People decide if they like someone after just a sniff.

Great stories are rarely aimed at everyone. Average people are good at ignoring you. Average people have too many different
points of view about life and average people are by and large satisfied. If you need to water down your story to appeal to everyone, it will appeal to no one. The most effective stories match the world view of a tiny audience—and then that tiny audience spreads the story.

Great stories don’t contradict themselves. If your restaurant is in the right location but had the wrong menu, you lose. If your art gallery carries the right artists but your staff is made up of rejects from a used car lot, you lose. Consumers are clever and they’ll see through your deceit at once.

Most of all, great stories agree with our world view. The best stories don’t teach people anything new. Instead, the best stories agree with what the audience already believes and makes the members of the audience feel smart and secure when reminded how right they were in the first place.

A labor of longevity.

Palais Ideal, Hauterives, France.
Created by Ferdinand Cheval, a.k.a. le facteur Cheval
Born 1836, Charmes-sur-l’herbasse, France
Died 1924, Hauterives, France

A four-sided castle made from concrete, lime and wire, located in Hauterives, France. Architectural styles from various time periods and countries–Algiers, China, Northern Europe–are visible in the facade. Work on the Palais Ideál began in 1888, when Cheval retired from the postal service. It took Cheval 34 years to complete. Today the site is visited by over 120,000 people annually.

“Whatever your age, whatever you wish to
achieve, if you are courageous, persistent and
hard-working, you are sure to succeed.”
—Ferdinand Cheval

On a day in 1879, Ferdinand Cheval, a rural postman, made his rounds through the town of Hauterives. The area of Hauterives once lay beneath the sea. The landscape, as a result, is rich in fossils and porous limestone. Much of this rock has been sculpted by time and the elements. For Cheval to trip over a stone as he walked across the steep and rocky terrain was hardly an unusual incident. However, this "everyday" occurrence would come to change the course of his life.

Cheval stopped to examine what he called his “stumbling block.” He found its shape so bizarre that he decided to take it home. The next day he returned to this same spot and found more beautiful stones which he gathered up enthusiastically and carried off. This event he took as a divine sign. “Since Nature provided me with sculptures I shall become an architect and a mason (besides who isn’t a bit of a mason?). While tramping I thought of Napoleon who said the word ‘impossible’ does not or should not exist. Since then I agree with him. The word impossible no longer exists.” With these rocks of varied and fantastic shape Cheval would create his “fairy-like palace beyond imagination,” the Palais Ideál.

Delivering Mail, Collecting Stones

From this day forward, Cheval embarked on a 27-year period of collecting stones. During this time he would add an extra ten kilometers to his already lengthy 32-kilometer daily route. At first, Cheval carried the stones home in his pants pockets. When his wife tired of mending his trousers, Cheval looked into new modes of transport. For a while he used baskets, but as the stones grew in number and in weight, even baskets became impractical. Cheval needed something sturdy, sure-footed and dependable. He sought a partner capable of back-breaking work who would bear the burden without complaint. Cheval acquired a wheelbarrow and the two began a long-term and fruitful partnership.

For 30 years, Cheval’s wheelbarrow was his trusty companion, transporting rocks and materials to the garden known today as Palais Ideál. The two had a regular routine. Cheval would deliver the mail, marking stones along the way for later pick up. After his rounds, Cheval returned with his wheelbarrow and together they would see the selected stones back to his collection garden.

Humble Beginnings Lead to ‘Ideal’ End

This country postman was an unlikely fit for such an inspired task. His life until this point had been unremarkable. Born in 1836 at Charmes, Cheval had received minimal formal education. It is unlikely he had had any experience in architectural construction. Perhaps his early years in Hauterives working as a baker gave rise to the possibility of magical creation. Or perhaps it was a dream he had in 1864.

In this dream, Cheval built a rock palace: a chateau of grottoes. It was a fantastical creation, something from a foreign and faraway land. After this vision, Cheval disappeared from Hauterives for a few years. Some believe he traveled to Algiers, an experience which may explain the North African elements (the Arabian Mosque and the Algerian Maison Carrée) in his Palais Ideál. Foreign travel may instead have been purely vicarious. Cheval taught himself about the world outside through the pages and pictures in Le Magazin Pittoresque.

Putting Hauterives on the Map

Hauterives itself was a small, small world and before long everyone knew about Cheval’s little project: “The tongues started to wag in my home town and surrounding area. They quickly made their minds up. ‘He’s an old fool who fills his garden with stones.’” Accusations of Cheval’s madness would eventually shift to growing admiration. Word spread and people flocked to see the Palais Ideál for themselves. Before long Cheval’s tourist attraction had put Hauterives on the map. “I was laughed at, blamed, criticized,” he said, “but this kind of mental attention was neither contagious nor dangerous and as a result they did not find it useful to fetch some doctor of the mind. I was then free to devote myself to my passion in spite of everything.”

Cheval was incredibly proud of his architectural accomplishment. He wanted to ensure that the Palais and its creator would not fade from local memory when he was no longer around to promote them. Within the palace’s foundation, Cheval dug deep pits in which he placed two stone coffins. He intended these as tombs for himself and his wife. This idea was eventually abandoned, possibly due to city regulations or possibly because such a macabre inclusion would detract from the whimsical nature of the building itself. Cheval altered his plan and instead constructed his "Tomb of Silence and Eternal Rest" in the local cemetery, using his traditional building materials: lime, cement and wire.

The Final Words of Facteur Cheval

Cheval also wrote an autobiography. In it, he described the events leading up to the creation of his masterpiece. The title itself lauded his effort, breaking building time into years (34), days (9,000) and hours (65,000). He began his autobiography in 1922. Two days after its completion, in 1924, Ferdinand Cheval died in Hauterives at the age of 88.

Since his death, others have sought to memorialize the postmaster-architect of Hauterives. A special town meeting was called in honor of Cheval. A unanimous vote was taken to commemorate him through a bronze bust. Today, this monument stands outside the Hauterives post office, a tribute to this local legend and master of the Palais Ideál.

The Palais Ideál is maintained and open for tours daily from 9:30AM to 12:30PM and 1:30 to 4:30PM in winter and during longer hours in other seasons. It is closed December 25, January 1 and January 15–31. Times subject to change.

The Palais Ideál is located in the small French town of Hauterives, in the Drôme, about thirty miles south of Lyon, at the crossing of D51 and D538. Be sure to visit Cheval’s tomb a mile up the road and his bronze likeness outside the Hauterives post office.

For more information, visit: http://www.aricie.fr/facteur-cheval/