Design learning and journey maps are all the rage here at Stanford University and in Silicon Valley. So why not apply it to health systems to reduce diagnostic errors?

That’s what Stanford Health Policy’s Kathryn M. McDonald is trying to do: Map the journey of worrisome scenarios that keep clinicians up at night, and then plant design seeds that might just help those clinicians get back to sleep.

One of those real-world scenarios involves a preventable diagnostic error made as a high-risk condition unfolds across multiple visits to the doctor. Missed cancer diagnoses, for example, are the leading cause for paid medical malpractice claims in the ambulatory setting, with one in 20 patients experiencing potentially preventable diagnostic errors each year.

“For example, a patient who has a positive fecal blood test, but no follow-up colonoscopy within a reasonable period may experience a missed opportunity to detect and successfully treat colon cancer,” McDonald said.

McDonald and her team worked with San Francisco public health clinics that cater to low-income patients to investigate this key problem — missed diagnosis and prevention activities during outpatient care — then came up with design seeds to plant possible solutions.

She and her co-authors published their research in the journal Implementation Science. The project was conducted at the Ambulatory Safety Center for Innovation (ASCENT), a patient safety learning laboratory led by Dr. Urmimala Sarkar at University of California San Francisco, and funded by the federal Agency for Healthcare Research and Quality.

The team used a research design approach called “journey mapping,” a tool that tells the story of a customer’s experience through his own viewpoint. They constructed maps for each pathway used by doctors to monitor patients with sinister findings, starting with the initial diagnostic assessment during an initial clinic visit and continuing through ongoing follow-up visits.

“Whenever participants in the study verbalized elements of the pathway that were particularly vulnerable to error or poor monitoring, we marked the activity with a bullseye target, also referred to by clinicians as a ‘pain point,’” the authors wrote. “To our knowledge, this technique has seldom been applied to the ambulatory setting, and has not been targeted to clinic workflow efficiency or patient safety intervention development.”

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“A design seed gives the specs for what a solution needs to do,” said McDonald, who is the executive director of Stanford Health Policy’s Center for Health Policy and Center for Primary Care and Outcomes Research. “Once you know the vulnerabilities through journey mapping, you create all the design seeds that are tied to the problem, then the implementation stage becomes much more straightforward and more likely to assure that all the key goals are met.”

To test out this theory, McDonald’s team spent the last two years working with doctors, residents, nurse practitioners and registered nurses with the San Francisco Health Network. The publicly funded integrated health network operates under the auspices of the San Francisco Department of Public Health and includes 14 primary care clinics, as well as urgent and specialty care at Zuckerberg San Francisco General hospital.

“The health system serves many of the most medically and socially vulnerable patients in San Francisco,” the authors wrote in their research paper. “Like many safety-net systems and ambulatory practices, the health system does not have a comprehensive electronic health record system and struggles with information transfer as well as fragmentation of health information across over 50 electronic platforms.”

The health system had more than half a million outpatient visits last year by people who could not afford care. Patients at the network’s main clinics and hospital are diverse: 35 percent are Latino, 21 percent are white, another 21 percent are Asians, and 17 percent are African-American.

Only 1 percent of the network population has commercial insurance; 10 percent were uninsured; 57 percent were on Medi-Cal — California’s Medicaid program — 21 percent were on Medicare and the remaining 11 percent were covered by other, mostly public sources.

This type of ambulatory health care is complex, requiring constant tracking and reconciliation of individual patient activities, patient data, and the unique evolution of each clinical case.

"Human factors and industrial design methodologies have tremendous potential to help unravel these complexities and provide fundamental insights that can drive the development of novel solutions," said co-author George Su of the University of California San Francisco School of Medicine.

McDonald said that journey mapping helped frontline clinic members see their workflow for a specific task, which in this case was monitoring this diverse population for follow-up visits after a potentially sinister finding. The system challenge is population management of an ill-defined problem.

“Lots of ambulatory care work is done one patient interaction at a time, but robust monitoring requires a view from a higher plane,” she said in an interview. “Journey mapping makes the aerial view more tangible and realistic for clinic team input.”

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McDonald’s team selected high-risk cancer situations: incidentally discovered pulmonary nodules; monitoring for breast, colorectal and prostate cancers; and ear, nose and throat cancers. These high-risk cancers require recurring and timely follow-up care to assure intervention whenever the disease takes hold.

The team interviewed clinicians from each of five specialty clinics responsible for these high-risk patients in pulmonary medicine, breast cancer, gastroenterology, urology, and otolaryngology. They asked the frontline clinicians: “What keeps you up and night? And what are your clinical hunches about who might fall through the cracks?”

While the providers talked about the types of patients who become lost to follow-up visits, the researchers found, none of the clinics had a standardized and efficient method of quantifying how many patients were lost to follow-up care and, perhaps more importantly, why.

“Many other health networks share similar struggles with incomplete documentation and measuring the real-time scope of patient safety problems,” wrote McDonald and co-authors Sarkar, Su and Sarah Lisker of the University of California San Francisco School of Medicine; and Emily S. Patterson of Ohio State University College of Medicine.

“When a patient has a warning signal for a serious condition that has yet to materialize but may in the future, the ability of a clinical team to watch the patient closely over time hinges on incredible vigilance on the part of individual clinicians — hardly an ideal solution,” McDonald said.

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This is the crux of the problem, she said, and where so-called “design seeds” are planted.

“The design seeds lay the groundwork in a very specific fashion. Journey mapping and process tracing figure out the problem, in our case, vulnerabilities, and then the design seeds are the first-stage of the solution,” McDonald said. “It’s very user-focused, learning directly from those who are on the frontlines of the work, and making sure that the problem is specified in a way that allows for the developments of solutions that can scale more flexibly during implementation.”

The team identified 45 vulnerabilities within San Francisco’s publicly funded health clinics.

“Repeatedly, we heard that clinicians worry about properly tracking these patients, and are troubled by the significant personnel time required in carrying out patient-level monitoring activities without tools and organization approaches for population-level monitoring,” they wrote.

But even then, the team did not jump straight to solutions. That’s the next step.

The team will launch a pilot project to test possible solutions that will grow from the design seeds, such as whether new digital technology, workflow arrangements, and structured data collection could help find those patients lost in the cracks of an overloaded system.

“Such focused and potentially scalable work is particularly needed for patients who may be lost to follow-up in systems that are stretched for dollars and time,” the authors concluded. “Providers will often create informal workarounds in response to the lack of comprehensive and coordinated record-keeping systems, which can result in errors as well as redundant efforts.”

The ASCENT team is already implementing a monitoring solution informed by the journey mapping activities, in subspecialty care clinics at Zuckerberg San Francisco General, by testing technical and workflow models.

“We determined the need for a registry for high-risk patients in the otolaryngology clinic to help us monitor the entire process,” said Sarkar, a primary care physician and head of the ASCENT lab at UCSF. “This means the final diagnosis, workup and treatment planning, the actual treatment itself and then surveillance and follow-up.”

Siegfried S. Hecker wrote the following essay for Politico Magazine on the subject of the Trump administration's approach to North Korea:

Now that the nuclear crisis on the Korean Peninsula has been at least temporarily defused thanks to Kim Jong Un’s announcement that he would wait and see before launching missiles toward Guam—despite ominous North Korean propaganda as the U.S. and South Korea launch their latest joint military exercises—it’s time to step back and ask ourselves the big questions about just how useful our approach to North Korea’s nuclear program has been so far. 

My answer: Not very useful at all. During the past 15 years, North Korea first built the bomb and then expanded it to a nuclear arsenal that threatens the region, while Washington has continued to deny reality with its call for complete denuclearization. Which is why it’s time to take a long and serious look at the next option: talking with North Korea.

Although a Wall Street Journal op-ed by Secretaries Jim Mattis and Rex Tillerson earlier this month served to lower tensions by stating that the United States was still pursuing peaceful denuclearization, it does not introduce any new elements that could bring the two sides closer to ending the nuclear crisis. The op-ed, which reassured Kim that “the U.S. has no interest in regime change or accelerated reunification of Korea,” is a welcome relief from Mr. Trump’s “fire and fury” warning to Kim. But this approach is likely to fare no better in compelling Pyongyang give up its nuclear weapons than the Obama administration’s “strategic patience.”

So—how can we make real progress?

Washington should drop its preoccupation with North Korea’s intercontinental ballistic missile (ICBM) threat. It is misplaced and dangerous. Instead, Trump administration officials should talk with Pyongyang, face to face, without any preconditions, to avert what I consider the greatest North Korean nuclear threat—that of stumbling into an inadvertent nuclear war on the Korean Peninsula, which may lead to hundreds of thousands deaths including thousands of American citizens.

It’s important to understand why Kim is so obsessed with these weapons: to deter the United States from attacking North Korea and what Pyongyang calls “hostile policies.” Striking the U.S. with a nuclear-tipped missile would be suicide, and there’s no evidence that Kim is suicidal.

What’s more, there’s a lot to indicate that North Korea isn’t close enough to developing ICBM-capable missiles to strike the United States even if it wanted to. The panic over North Korea’s missiles was elevated recently when leaked classified U.S. intelligence estimates were reported to indicate that Pyongyang has already achieved such capabilities, in addition to possessing as many as 60 nuclear weapons in its arsenal. But I don’t concur with those estimates.

Based on my 50 years of experience with nuclear technologies and nuclear weapons, combined with what I saw and learned during my seven visits to North Korea beginning in 2004, I don’t believe Pyongyang has yet mastered the key elements of delivering a nuclear-tipped ICBM to the continental United States. Although North Korea demonstrated significant progress in the missile field with two launches in July, experts have raised serious questions about whether it has demonstrated all the missile and re-entry vehicle technologies that will protect the nuclear warheads during the fiery plunge into the Earth’s atmosphere.

Moreover, the nuclear warhead that must be mounted on the missile is the least developed and least tested part of North Korea’s nuclear ICBM ambitions. It must survive the extreme temperatures and mechanical stresses involved during launch, flight and re-entry into the atmosphere. It must detonate above the target by design, not accidentally explode on launch or burn up during reentry. More missile tests are needed that mirror real ICBM conditions to permit measurements that more accurately define the extreme conditions that the delicate materials such as plutonium, highly enriched uranium and chemical high explosives experience inside the warheads. It is much simpler to detonate a nuclear device in an underground tunnel under controlled conditions than to simulate all of the conditions a warhead experiences on the way to its target. 

What makes matters even more challenging for Pyongyang is that it has very little plutonium and highly enriched uranium. I have estimated that North Korea has 20 to 40 kilograms plutonium and 200 to 450 kilograms highly enriched uranium. My analysis is based on what I saw during my visits to the Yongbyon nuclear complex and on extensive discussions with their nuclear experts. These stocks have to serve multiple uses: They must be shared between experiments required to understand the world’s most complex elements, nuclear tests to certify the design of the weapons and stock for the arsenal. My best estimate, albeit with considerable uncertainty, is that the North’s combined inventories of plutonium and highly enriched uranium suffice for perhaps 20 to 25 nuclear weapons, not the 60 reported in the leaked intelligence estimate.

North Korea will need a few more nuclear tests because its experience with either material, plutonium or highly enriched uranium, for warheads is too limited for ICBM use. Nuclear test site preparations appear complete, but Pyongyang is most likely weighing the technical benefits against the political risks of conducting such tests. Whereas I believe North Korea has insufficient test data for ICBM warheads, we must assume it has already learned enough to mount a warhead on its shorter-range missiles that can reach all of South Korea and Japan because these missiles are able to accommodate bigger nuclear warheads and these would experience less stringent operational conditions.

In other words, the North still has a ways to go to pose a serious ICBM threat, but it is clearly working in that direction. The danger is that in his drive to achieve a greater balance with the United States by perfecting a missile capable of delivering a nuclear weapon to the continental U.S., Kim could miscalculate where Trump’s red line actually is, triggering a retaliatory action by Trump that could escalate to a nuclear war on the Korean Peninsula. Our problem is that we know nothing about Kim and the military leaders who control his nuclear arsenal and drive the missile and nuclear development programs. It’s time to talk and find out.

And we have to talk now, without demanding that North Korea agree to any preconditions, such as those suggested by Mattis and Tillerson – namely, an immediate cessation of its provocative threats, nuclear tests, missile launches and other weapons tests. Pyongyang is not about to make unilateral concessions before talks. One should read Kim’s announcement that he will wait with the missile launches as a positive signal, although he added that the U.S. must stop its “arrogant provocations.”

The diplomatic opening created last week on both sides makes such talks possible. President Trump should send a small team of senior military and diplomatic leaders to talk to Pyongyang. These talks would not be negotiations—not yet. Importantly, these talks would not be a reward or a concession to Pyongyang and should not be construed as signaling acceptance of a nuclear-armed North Korea. Talking would, however, be a necessary step toward re-establishing critical links of communication to avoid a nuclear catastrophe. The dialogue should stress the need for mechanisms to avoid misunderstanding, miscalculation or misinterpretation of actions that could quickly bring us over the cliff into a nuclear war.

The talks would provide an opportunity to convey Secretary Tillerson’s message that Washington does not seek regime change face to face in Pyongyang. In simplest terms, the team could underline the message that Washington is deterred from attacking the North, but not from defending the United States and its allies. It should reiterate that any attack on South Korea or Japan, be it with conventional, chemical or nuclear weapons, would bring a devastating retaliatory response upon North Korea.

The team can also impress upon Pyongyang that ensuring the safety and security of nuclear weapons is an awesome responsibility. These two issues are becoming more challenging as North Korea strives to make its nuclear arsenal more combat-ready. A nuclear-weapon accident in the North would be disastrous, as would a struggle to control the North’s nuclear weapons in the case of attempted regime change from within or without. All indications are that such talks would be strongly supported by the North’s two most important neighbors, South Korea and China, particularly if Washington consults them before.

For too long, America’s policy toward North Korea has been based on impractical goals. Complete, verifiable and irreversible denuclearization was a hallmark of the George W. Bush administration’s approach to North Korea and was also pursued by the Obama administration. Whereas complete and verifiable denuclearization might be realistic long-term goals, irreversible is impossible short of the total loss of human memory. The U.S. Manhattan Project produced the bomb in 27 months more than 70 years ago, and that was without knowing with certainty at the outset that it was even possible.

It was under Bush that North Korea first built the bomb and under Obama that it expanded to a threatening nuclear arsenal. Both presidents failed to address the root cause of Pyongyang’s determined effort to build a nuclear weapons arsenal—assuring the Kim regime’s security. Now, Trump faces a North Korea with the ability to inflict unacceptable damage to U.S. allies and U.S. assets in the region, while it also continues its drive to threaten the continental U.S. Perhaps, much as Dwight Eisenhower talked to Nikita Khrushchev, Richard Nixon to China’s Mao Zedong, and Ronald Reagan to Mikhail Gorbachev, Trump can take the next step with North Korea, and talk now to avert a nuclear catastrophe.

Rod Ewing will serve as co-director of the sciences for Stanford’s Center for International Security and Cooperation.

Ewing, a mineralogist and materials scientist, is the Frank Stanton Professor in Nuclear Security at CISAC and senior fellow at the Freeman Spogli Institute for International Studies. He begins his new position on Sept. 1, following David Relman, the previous co-director for the sciences. Amy Zegart is the CISAC co-director for the social sciences.

Ewing, whose research is focused on the properties of nuclear materials, leads the Reset Nuclear Waste Policy program at CISAC. He describes the center as a unique organization that “explicitly acknowledges” the role of science and the social sciences in formulating policy. 

“CISAC is a rare opportunity for political and social scientists, historians and scientists and engineers to work together on solving pressing problems. The fact that we have two co-directors reflects a serious intent to integrate knowledge from the widest range of perspectives in order to find policy solutions to important problems,” he said.

Scholarship, research

Ewing is the author or co-author of more than 750 research publications and the editor or co-editor of 18 monographs, proceedings volumes or special issues of journals. He has published widely in mineralogy, geochemistry, materials science, nuclear materials, physics and chemistry in more than 100 different journals. Ewing was granted a patent for the development of a highly durable material for the immobilization of excess weapons plutonium. He is also a founding editor of the magazine, Elements. In 2015, he won the Roebling Medal, the highest award of the Mineralogical Society of America for scientific eminence.

“My work on nuclear waste started out with a focus on technical issues, but over several decades, I realized that technical solutions were not enough.  I now focus on trying to understand why institutions – universities, national laboratories and federal agencies – fail to arrive at the technical solutions. I have been surprised to learn how little science has been applied to the nuclear waste problem – and how social issues have dominated the outcome,” Ewing said.

Expertise, policy

In particular, Ewing seeks to understand why so little information from experts rise through an organization and change accepted ‘truths.’

“I first saw this when I was a soldier in Vietnam and continue to see the same problem in many other areas, that a disconnect exists between the on-the-ground reality and policy,” said Ewing who served in the U.S. Army as an interpreter of Vietnamese attached to the 25th Infantry Division from 1969 to 1970.

“At the very highest levels, policies seem to be based on a hunch or a bias rather than an analysis of the problem. I have always wondered why this is so common – as it often leads a country or organization down a wrong and often dangerous path,” he added.

Born in Abilene, Texas, Ewing attended Texas Christian University (B.S., 1968, summa cum laude) and graduate school at Stanford University (M.S., 1972; Ph.D., 1974). He began his academic career as an assistant professor at the University of New Mexico (1974) rising to the rank of Regents’ Professor of Earth & Planetary Sciences in 1993.

From 1997 to 2013, Ewing was a professor at the University of Michigan, and in 2014, he joined Stanford.

MEDIA CONTACTS:

Rod Ewing, Center for International Security and Cooperation: (650) 725-8641, rewing1@stanford.edu

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu

"New laws in democratic countries that force social media platforms to remove disinformation will encourage autocratic countries to do the same, with devastating effects on human rights," writes Global Digital Policy Incubator Director Eileen Donahoe in her op-ed "Protecting Democracy from Online Disinformation Requires Better Algorithms, Not Censorship." Read here. 

When it comes to cybersecurity, Stanford is the hot spot, especially if you work in national security.

On Aug. 18, officials from the U.S. military, National Security Agency, U.S. Cyber Command, Joint Chiefs of Staff, and from countries known as the “Five Eyes,” attended cybersecurity discussions on campus. Most attendees were chief information officers. John Zangardi, the principal deputy chief information officer for the U.S. Department of Defense, led the group.

The "Five Eyes" refers to an alliance comprising the U.S., Australia, Canada, New Zealand, and the United Kingdom. These countries abide by an agreement for joint cooperation in signals intelligence, military intelligence, and human intelligence.

The event was held at the Hoover Institution, a co-sponsor along with Stanford’s Center for International Security and Cooperation, a center in the Freeman Spogli Institute for International Relations. Participants took part in two roundtables – the first one, “Geopolitical Perspectives,” provided a strategic overview of international security with Stanford’s William J. Perry (CISAC and the Hoover Institution), Michael McFaul (FSI and the Hoover Institution), Toomas Henrik Ilves (Hoover Institution), and Francis Fukuyama (the Hoover Institution and FSI's Center on Democracy, Development, and the Rule of Law).

The second discussion, the “Cyber Information Warfare Panel,” focused on cyber challenges with Amy Zegart (CISAC and the Hoover Institution), Herb Lin (CISAC and the Hoover Institution), John Villasenor (CISAC and the Hoover Institution), and Jay Healey (CISAC).

As cyber attacks escalate in magnitude – reflected in the 2016 Russian meddling in the U.S. election and the 2014 Sony Pictures hacking – the red alert has gone out to Washington D.C. to confront the issue.

At Stanford, Capitol Hill staffers are doing just that, thanks to the Congressional Cyber Boot Camp that takes place Aug. 14-16. The third installment of its kind since 2014, the workshop offered panel discussions, role-playing exercises, informational sessions, and networking opportunities -- all aimed at getting Congress on top of a fast-accelerating issue that has ramifications throughout the American domain.

This year’s event involved almost three dozen staffers hailing from U.S. Senate and House member offices and committees such as the U.S. Senate Select Committee on Intelligence, Homeland Security, Appropriations, Judiciary, Energy and Commerce. Top cyber and policy experts addressed them about some of the thorniest issues emerging in cyber realms -- and what it means for this country's political leadership and citizenry.

The boot camp was held at the Hoover Institution, a co-sponsor along with Stanford’s Center for International Security and Cooperation, the Freeman Spogli Institute for International Relations, the Stanford Cyber Initiative, and the Stuart Family Congressional Fellowship Program.

CISAC co-director Amy Zegart said, "The Congressional Cyber Boot Camp is our signature event because we’re connecting the worlds of public policy and cybersecurity in ways that help advance national security." Zegart, also the Davies Family Senior Fellow at Hoover, was a co-convener of the boot camp along with Herbert Lin, a CISAC  and Hoover senior fellow, and widely-known cybersecurity expert.

Zegart said the boot camp has grown so popular that a waiting list now exists. And, she points to policy impacts after just three years. For example, a legal counsel to U.S. Sen. John McCain, the chair of the Senate Armed Services Committee, attended a prior boot camp, which resulted in McCain visiting and reaching out to CISAC and the Hoover on cybersecurity issues over the past few years. A lot of those discussions are confidential, but that input had its roots in the boot camp and Stanford experts gather there.

“We created the cyber boot camp precisely because many Congressional staffers had told us this was the type of help they needed,” Zegart said.

In her introductory remarks to the group, Zegart said, “If we can help you, you can help our country.” The boot camp would be focused on, she said, encouraging “new knowledge” and building “new networks of people” in the field of cybersecurity.

Sean Kanuck, an affiliate with CISAC who served as the U.S.’ first national intelligence officer for cyber issues from 2011 to 2016, talked about reframing cybersecurity problems in his keynote address to the Stanford Congressional Cyber Boot Camp.

Exercises, networking

As Zegart said, cybersecurity is an urgent issue for policy makers like those at the boot camp, and last year’s presidential election and major hacking of corporations and security organizations attest to the increasing importance that Washington D.C. now places on it. Preparation is considered critical.

And so, this year’s camp included a simulation exercise with Congressional staffers assuming the roles of executives at a large, fictitious company (“Frizzle”) that is under a major cyberattack.

Each boot camp gets a new round of fresh Congressional faces. Last year, the Los Angeles Times published a story on the boot camp and all of the questions and issues that arose in such a scenario. For example, when should customers or authorities be informed, and what about retaliation? For most, cyber is a brave new world – and expert advice is appreciated – something that Stanford’s boot camp offers.

Evolving security threat

Cyber experts point out that nations are increasingly dependent on information and information technology for societal functions. This makes ensuring the security of information and information technology — against a broad spectrum of hackers, criminals, terrorists, and state actors – a top priority for any country. And it seems like every day, something new is introduced.

“Cybersecurity challenges are evolving at a rapid pace, and the cyber threat the nation faces today will be different from the one it faces tomorrow,” Zegart and Lin wrote in the workshop’s agenda.

Cybersecurity is not merely a technical matter, but a “multi-faceted enterprise” that requires drawing on computer science, economics, law, political science, psychology, and other disciplines, they noted.

The idea behind the boot camp is to help congressional staffers – those writing the nation’s policies on cybersecurity – use “multiple perspectives and disciplines” as they analyze and act on cybersecurity issues.

“The Stanford Cyber Boot Camp endeavors to give congressional staffers a conceptual framework to understand the threat environment of today and how it might evolve so that they are better able to anticipate and manage the problems of tomorrow,” Zegart and Lin said.

That seems to be happening on Capitol Hill, where staffers now know who to call for cyber advice.

Lin said he routinely receives calls from Congressional staffers who are alumni of the boot camp – they are seeking his feedback and guidance on cyber policy or legislation. Of course, those discussions are not for public disclosure, given the sensitivity. Lin was also asked to testify twice before Congress on cyber issues, and he was chosen by the Obama Administration to serve on the President’s Commission on Enhancing National Cybersecurity. He attests that the boot camp opened up the door for him being invited to that commission.

In December 2016, the White House cyber commission, with the help of experts like Lin, issued strong recommendations to upgrade the nation’s cybersecurity systems.

That’s the kind of policy impact the cyber boot camp seeks.

Topics and speakers

Themes covered at this week’s cyber camp:

• the role of offensive operations in cyberspace for improving the nation’s cybersecurity;

• why cyber defense is more difficult than offense;

• the role of market forces in enhancing or weakening cybersecurity;

• automotive cyber security; problems in applying existing law to accelerating technology;

• the economic, psychological, and organizational factors involved in cybersecurity;

• and the fundamental principles of cybersecurity.

Scheduled speakers included:

• Condoleezza Rice, senior fellow at the Hoover Institution and former U.S. Secretary of State and National Security Advisor.

• Michael McFaul, director and senior fellow at both FSI and the Hoover Institution.

• Marc Andreessen, co-founder and general partner of Andreessen Horowitz.

• Toomas Hendrik Ilves, the former president of Estonia; and distinguished visiting fellow this past year at CISAC, Hoover, and FSI.

• Andy Grotto, CISAC fellow, Hoover research fellow, and former senior director for cybersecurity policy at the National Security Council.

• Joel Peterson, chairman of JetBlue Airways; professor at Stanford Graduate School of Business; and chairman at the Hoover Institution Board of Overseers.

The group also will take a walking tour of the Hoover Institution’s Library and Archives and a trip to the Tesla factory in Fremont.

Prior coverage of boot camps:

Stanford News story on 2014 event

CISAC story on 2014 event

CISAC video of 2014 event

Stanford News story on 2015 event

Hoover story on 2016 media boot camp

MEDIA CONTACT:

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu