Design: Engage the patients!

A pair of British innovation consultancies are putting design to work improving health care—both involve asking (potential) patients for their input.

The Engine Group asked individuals in a number of vulnerable populations what kind of health care services they would use and then co-designed those services:

The findings showed that all the groups shared simple needs, mainly concerned with emotional, social and low level mental health issues. The findings also indicated a lack of trust towards the NHS in general, although the stakeholders were able to identify an individual with whom they had a productive relationship. The resulting service suggestion ‘Open Door’ emerged from this work. It was built around a place of safety – somewhere warm, safe and non-judgemental – where a variety of services are designed to address peoples needs. Different touchpoints were developed to increase access, so that the user groups could begin to better manage their health.

Live|Work comments on a recent report by the National Health System outlining the need for a new approach: High quality care for all.  Its gist: health care gets personal.  Live|Work says:

The move from quantity of services to quality of services involves switching attention from the productive capability of the NHS machine (how many cancer patients can we treat with these resources?) to the ability of NHS services to meet the needs of patients and the public (how can we support the health needs of each and every person in Britain in a timely manner?).

What is needed is a new way of thinking about services that starts with the individual not the organisation. We call this Service Thinking.

…

Service Thinking presents a major challenge. It requires a new type of engagement with patients and the public. And it means NHS staff handing over some of the control to patients.

Our experience at live/work, working with NHS trusts and the NHS Institute for Innovation and Improvement, is that engaging patients in the design of services is particularly challenging because of the past focus on increasing the quantity of services.

Engage thy patients!  Their input propels design.

d2009: Green Predictions

Inhabitat asked a host of experts their predictions for green design in 2009.  Some interesting quotes applicable to the coming melding of the design and health care delivery worlds:

Allan Chochinov:

In 2009 I think we’re going to see an explosion of Service Design around the world. Many firms are already practicing it, but it will take on a new urgency as more and more people recognize service as the new product.

Sarah Rich:

This means that designers will be working with new ideas around the relationships between people and their stuff, placing greater focus on longevity and durability, take-back programs and renewability, and hopefully on ways to place community at the center, using social networks and human relationships to be sure people have what they need.

Piers Fawkes:

In our new book Good Ideas for 2009 we talk about the concept of ‘Design For Change’ which argues that we should design for our changing world. Staying flexible, accepting new ideas and plans, and acknowledging that things never stay the same allow us the space to work with interesting new possibilities instead of fighting them. If we can see events unfolding on the horizon, we can be ready to take full advantage of them rather than blindly reacting when they come pounding on our door.

d2009: RED’s Open Health

For whatever reason (it must be government provided health care) the United Kingdom has taken the lead in injecting design thinking into health care delivery.

Waaaaaayy back in 2004 the Design Council in the United Kingdom started a project called RED to address social and economic problems through innovation led by design.  Open Health is RED’s solution to modernizing the National Health Service and aligning its service offerings with the patient needs:

By 2010, one in ten of us will have diabetes. By 2030, the incidence of chronic disease in over 65s will more than double. Current NHS spending on diabetes alone stands at £10 million every day. And yet about 90% of healthcare takes place in the home.

Chronic disease and conditions related to an unhealthy lifestyle have reached epidemic proportions and are rising still. This presents a momentous challenge for our current healthcare system.

Improving existing services is not the answer. Preventative approaches to health mean radical changes in our individual lifestyles – eating well, exercising more, self-managing chronic conditions. These changes can’t be delivered through hospitals and GPs surgeries alone. We need to design new types of services that tap into people’s motivations and relate to their daily lives.

Read the entire RED pdf report for the specifics.

2009: Design!

Bill Hollins:

Many senior managers involved in the service sector are still unaware of the benefits that design can bring to their offerings and, as a result, many organisations are operating at a sub-optimum level.

Mounting economic pressures combined with a gloomy 2009 outlook make innovative design investments for health care organizations seem silly.  Au contraire.  Mr. Hollins writes:

Only recently have managers in organisations involved in the service sector realised that a conscious effort in applying design techniques to services can result in greater customer satisfaction, greater control over their offerings and greater profits.

From the International Herald Tribune:

The economic crisis has also squashed any lingering doubts about the urgency of finding new ways to address acute social problems more efficiently – from caring for the expanding elderly population, to improving the management of over-stretched health care services. This newfound realism is already benefiting the emerging breed of “social designers.” (bold and italics mine)

Your job in 2009 (if you truly consider yourself a health care transformer) is to fully comprehend the concept of design and the power it holds for improving our health care system.  By no means am I a design expert in the traditional sense; but design excites the heck out of me.  New thinking (ideas…solutions…execution…) is required in a time (this year…next year…the year following…) of significant transition through a difficult operating environment.

That said, we all need tools to help expand our thinking and diversify our perspectives.  Throughout the entirety of 2009 (upon occasion) our own system will supply design-minded information focused upon aiding this quest.  Thoughtful debate is always welcomed.

Here is the start: a couple of definitions worth more exploration.

Service Design (from Wikipedia) “is the activity of planning and organizing people, infrastructure, communication and material components of a service, in order to improve its quality, the interaction between service provider and customers and the customer’s experience.”

Social Design (from Wikipedia) is “a design process that contributes to improving human well-being and livelihood.”

Here’s to a designfull 2009!

Design will conquer health care

When was the last time your hospital hired a designer that wasn’t dedicated to interiors?

No, seriously.  To catch you up, design is emerging as a solution to a wide variety of problems.

We all know about IDEO (at least you should) and what they’ve done for care delivery, but what about the increasing role health care will play in community health?  Insert Participle:

We believe there needs to be a new settlement between individuals, communities and government – new ways for people to get involved in determining their lives in a meaningful way, new approaches that mean some people do not get stuck at the bottom of the heap for generations and new bonds that mean people can flourish and bring their dreams alive.

We also think that what matters is not just ideas, but real change on the ground, in our communities.

On an everyday level this means public service reform – this is where the opportunities lie, to build something different.

At Participle, we do two things: Firstly, bring together the widespread community level ideas and creative activity, and mix it with world-leading experts in any given field; Secondly, drive forward thoughts and actions around developing a new social settlement which can deal with the big social issues of our time.

Fast Company explains:

[Hilary] Cottam is one of a new wave of design evangelists who are trying to change the world for the better. They believe that many of the institutions and systems set up in the 20th century are failing and that design can help us to build new ones better suited to the demands of this century. Some of these innovators are helping poor people to help themselves by fostering design in developing economies. Others see design as a tool to stave off ecological catastrophe. Then there are the box-breaking thinkers like Cottam, who disregard design’s traditional bounds and apply it to social and political problems. Her mission, she says, is “to crack the intractable social issues of our time.”

The application to the health care industry, again from Fast Company:

Earlier this decade, while working for the Design Council, Cottam turned to health care. Originally she planned to rethink hospital design but became more interested in community-based services for sufferers of chronic diseases such as obesity and diabetes. “One in four people in Britain now has a chronic disease that’s treated at home,” she says. “So why are we investing in hospitals rather than community-based solutions?”

One problem the Design Council team identified is that diabetes sufferers often forget to raise important issues with doctors and caregivers. The solution was a pack of diabetes cards, each printed with a question to be used as a prompt. Superficially it looks like a health-care project but, as Cottam points out, design techniques were critical in identifying patients’ problems and producing an efficient graphic solution. “It’s amazing how new the simple design concept of understanding users is to many in the health-care field,” says Tim Brown, CEO of the design firm Ideo, which works in U.S. health care, among other industries. “Hilary’s work has shown that you can take rigorous design methodology and apply it successfully in social systems.”

This all goes back to getting out of health care.  Hire from outside the industry, too.  Never be afraid to hire those creative types, either.  Then let them attack the most challenging problems your organization encounters (i.e., financial constraints, throughput issues, etc.).  The solutions created may astound you.

Health Care Innovation Center!

Kaiser Permanente’s Sidney R. Garfield Innovation Center “is a living laboratory where ideas are tested and solutions are developed in a hands-on, mocked-up clinical environment. Many aspects of delivering healthcare can be innovated and examined at the Center using real-world scenarios and activities, such as simulations, technology testing, prototyping, product evaluations, and training.”

From an ADVANCE article:

“The center’s focus is to get front-line staff — the people who are delivering care — to come together and work with designers, architects and technologists to innovate or improve a physical space, a new technology or some type of work process,” explained Jennifer Ruzek, director of the center. “It’s really important that all the disciplines work together, because if you want to improve a complex process such as medication administration, nursing, pharmacy and physicians all need to come together.”

This is cool on multiple accounts—an organization has taken health care delivery innovation so seriously that they have created a center to facilitate continuous improvement.  The benefits:

“You can get large groups of people from different disciplines together, speaking the same language experientially, to reach consensus on what is the best design that meets their needs and the patients’ needs,” Ruzek said. “We’ve found that when you take people out of their day-to-day environment, a few things happen: First, they’re not distracted by what’s going on in a live facility. People begin to step back and think about the big picture. Nurses, as you know, are great at working around challenges. But here, you’re asking them to think differently — they come up with ideas that solve challenges, rather than just working around them.

“Second, we’ve found the experimental prototyping process at the Garfield Center speeds up decision-making. We rule out ideas that don’t work quickly and arrive at solutions faster.

“And third, it’s much easier to try out ideas in a mock environment rather than disrupting a real hospital unit or clinic.”

This makes so much sense, why are there not more organization sponsored dedicated environments to explore delivery innovations?

The Emergency Department Experience

An emergency department visit is often a highly stressful situation.  That stress makes long waits longer, feelings of being ignored more prevalent, bad service worse.

Not often do people speak about a good experience at the E.D.  Considering the circumstances, great service in the E.D. isn’t going to make anyone enjoy the visit by any means.

Bad service makes the experience awful—and worth sharing with others.

This Letter to the Editor outlines two bad experiences separated by several months.  During the second visit “after about an hour of this unacceptable and potentially dangerous behavior” the party decided to leave the E.D. for another (read: a competitor) 25 miles away.

Admittedly, there are challenges when trying to improve E.D. experience.

However, improving patient experience is a must in the E.D.  For many it is the introduction to a hospital.  The environment is always hectic and always stressful.  Improving that experience means managing patient expectations.  It means making a concerted effort to sympathize with very ill patients (most do).  Patient loyalty should not be taken for granted.  A bad experience could mean potential patients avoid your organization—for all services.

(links h/t: Kevin MD)

Hospital Design

Health Care Fine Art comments on a new look hospital in London.  There’s also a link to a post from last summer asking the question “Why No Cool Looking Hospitals?”  Read the post and the comments—there are some interesting thoughts.

One thought on why the newest of hospitals continue to utilize traditional architectural themes is the opportunity for expansion.  The boxy buildings make it easier to add floors or corridors without upsetting the design.  Medicine changes often and sometime those changes require new construction.

Anyway, hospital design is getting better.  The biggest challenge will come as we continue to update the Hill-Burton hospitals to allow, among other things (including functionality), natural light into buildings.