The health care path

Generally (over the last 20 years): inpatient health care (pdf) utilization has been flat, outpatient care steadily increasing, and home health treatments rising.

What emerges is a trend toward treatment options that have become more convenient for patients (the cost usually declines, too; but not necessarily):

Inpatient Care —> Outpatient Care —> Home Health Care

That’s good and the path is getting longer.  Home health care services have been provided to the most needy patients.  The next logical step, which is already being taken, is to provide health care in the home to patients who are not as needy; for example, the home monitoring of cardiac patients.  And home monitoring toes the line on the next logical step: personal care for diagnoses previously needing professional assistance (personal care could/should, definitionally speaking, include personal responsibility for healthy eating/living/exercising as well).

Health care services will continue to be pushed down this path:

Inpatient Care —> Outpatient Care —> Home Health Care —> Personal Care

Applicable design example: hospitals!

Because MRSA and C. diff are increasingly problematic in hospitals (and hospital equipment has been said to be badly designed):

British designers have come together to give the grim and functional hospital ward a much-needed revamp, and in doing so, they have thrown out the clunky old bedside cabinets, the tired mattresses and dubious-looking commodes and replaced them with more futuristic versions.

The makeover has been prompted not by aesthetic shame, but by medical prudence.

Design! The Guardian report continues:

“There are huge issues with superbugs in hospitals, but it’s likely that if we can make the environment easier to clean, we will go a long way to improving the situation. A lot of hospital furniture has nooks and crannies that are repositories for bugs, so the challenge was to design those out,” said David Kester, head of the Design Council.

How the glorious people at the Design Council did it:

Design teams were despatched to hospitals to look over wards and talk to doctors and nurses about how curtains, bedside cabinets, commodes and other ward furniture were used. The Council then called on designers to come up with smooth, cheap and simple alternatives.

Finding the opportunity.

I reckon the crux of our problem is that our thinking was/is too short-term:

Thinking about the future is fundamentally important to dealing with the challenges of today. In order to confront these problems successfully, we have to think carefully about the implications and results of the steps we might take, not just in the immediate moment, but as conditions continue to evolve. As we’ve seen time and again, it’s all too easy for actions that seem reflexively correct to lead to far greater crises down the road. (Fast Company)

Swine flu/Media coverage

This swine flu stuff is serious business.  However, in consideration of recent media coverage, a little perspective can be a good thing:

The Daily Show With Jon Stewart M – Th 11p / 10c
Snoutbreak ’09 – The Last 100 Days
Daily Show
Full Episodes
Economic Crisis Political Humor

Medical Utopia: Designing cities to protect against diseases like swine flu

No doubt that if you have consumed any amount of media in the last 48 hours you are aware of the swine flu.  It is, as well it should be, a growing concern.  And something to think about seriously (the smart people/people who work on things like this for a living have been doing so for a while now re: avian flu).

Snarkmarket points to a thought provoking post at BLDGBLOG that combines a cadre of interests on this blog: medicine/public health/urban planning/design/the future.  Number 10 from This Diseased Utopia: 10 Thoughts on Swine Flu and the City:

In the end, then, what spatial form might a medical utopia take, and how could it be architecturally realized?
In 50 years will you be walking around the edges of the city with your grandkids when one of them asks: Why are these buildings out here, so far away from the rest?

And you’ll say: They’re here because of swine flu: we redesigned the city and our diseases went away.

Is it possible to have fun in a health care workplace?

Two things leading to this: 1) a class discussion this week about whether or not it’s possible to have “fun” in the health care workplace (like Southwest Airlines or Zappos); 2) a presentation the following day proving that it is, in fact (and in the correct context), possible:

Here’s an explanation on why they were enjoying themselves so vociferously.

In: Apologies

I’m sorry:

For example, with a new policy on apologies, Toro, the lawn mower folks, reduced the average cost of a claim from $115,000 in 1991 to $35,000 in 2008—and the company hasn’t been to trial since 1994. The VA hospital in Lexington, Massachusetts, developed an astonishing approach to apologizing for errors (forthcoming—even when no patient request or claim was made). In 2000, the overall mean VA system malpractice settlement was $413,000. The Lexington VA hospital settlement # was $36,000—and there were far fewer per patient claims to begin with.

Praising diversity

In praise of diversity, the Scott E. Page type of diversity!!; from a story in the The Salt Lake Tribune on research by Katie Liljenquist:

new workers with different backgrounds and perspectives help existing teams of employees make better decisions by prompting more discussion and analysis.

(aside: hopefully that extra discussion and analysis is fruitful.)

Hire weird.  Or just someone different than you.

via: Creative Class

In: Experiments, Doing

This is fantastic (Financial Times):

What’s so strange to an economist who walks into a business is that economists have a set of models that describe how businesses should optimally respond. But that’s not how businesses make decisions.

That’s not to say the economists’ models are necessarily right. The business model can be sensible. It’s usually pretty seat-of-the-pants, built round a set of rules of thumb, but that makes sense because the world is so complex and they have to make so many decisions that they can’t optimise every one. But there are some decisions that are too important to make guesses on – and, in those cases, you either need to find data to help you or to generate your own data through experiments.

This is better; always in favor of “doing;” experimenting in business/+health care:

If you can figure out the answer without having to design and conduct an experiment, that’s wonderful. But a lot of everyday activities that businesses undertake could be transformed into experiments with almost no effort and almost no cost. The way businesses operate more and more lends itself to being able to run these real-world experiments. The lessons are enormous and the costs are often trivial.