Design can transform healthcare services and spaces

By Stacey Chang, Executive Director of the Design Institute for Health, a collaboration between the Dell Medical School and the College of Fine Arts at the University of Texas at Austin dedicated to applying design approaches to solving systemic health care challenges as an integrated part of medical education and training. Stacey is also a member of the TEDMED 2016 Editorial Advisory Board.

Stacey ChangRecent developments in medical research have focused significantly on individual health. From personal genome sequencing and microbiome analysis to the influence of a person’s specific environment and behaviors, it’s clear that – as we develop new therapies – there’s tremendous value to be derived from considering what makes each of us biologically unique. Yet, our collective health outcomes as a society inexorably worsen. Although our technological virtuosity shines, we still seem unable to address aspects of health that are broadly universal and shared across the collective of human society.

As we seek new approaches and creative problem solving, “design thinking” should continue to become an increasingly powerful tool for identifying and solving these complex health challenges. Most casual observers view “design” as an aesthetic discipline that gives rise to beautiful things – for instance, we are all familiar with the output of interior designers and graphic designers. Design thinking, however, is not about the output, but rather the perceptive, inspired methodology that leads to that output.

Specifically, design thinking begins with research that reveals the deeper needs of the humans in the system, needs that they are either unaware of or unable to describe. The research, qualitative in nature, is a savvy combination of psychology, sociology, and anthropology. It leads to insights that are the inspirational spark necessary to develop completely new solutions (not just incremental revisions of existing tools or constructs, an unfortunately common response in healthcare). Those solutions are then built and tested, but in quick, low-resolution iterations. The resulting failures are of low consequence, but rich with learning, and the rapid-cycle revision leads to large-scale interventions that have already had the major risks resolved.

Design thinking is a fundamentally different approach to problem solving, and particularly unique in health. After more than a decade practicing design thinking at the design firm IDEO and leading the health side of the business, I founded the Design Institute for Health last year. As a collaboration with the new Dell Medical School and the College of Fine Arts at the University of Texas at Austin, we are positioned to apply design thinking in Central Texas with the goal of developing a model for what the health system of the future looks like.

We’ve already begun to remake services, environments, infrastructure and incentives. For example, through our design research, an underlying insight we identified was that the more you give a patient (a person, really) increased control and ownership over their experience, their anxiety will lower, they’ll be more engaged, and they’ll feel more empowered to develop self-efficacy. Though obvious in hindsight, it turns out that this is applicable across the entirety of people’s experiences in health, and is also consistent across every demographic divide.

The Children's Medical Services, at Broward General Medical Center, in Ft. Lauderdale, Florida. Home Visits with Nurses and Social Workers, June 10, 2011. Inter Professional Nursing.
Home visits with nurses and social workers at the Broward General Medical Center in Ft. Lauderdale, Florida. Image courtesy of the Robert Wood Johnson Foundation.

As a result of this insight, we’re designing outpatient clinics with no waiting rooms (because isn’t waiting just actually a process failure?) where patients and their families are granted their own private room for the duration of their stay. It becomes their personal space, where they can control everything from lighting, to entertainment, to the layout of the space. In this environment, we also ask them to take a more active role in their own care and make decisions, enabling them with information and perspective along the way.

We have also found that care providers (doctors, nurses, and staff) want to be recognized as humans, as well. They hate the system that has turned them into robotic executors of process, instead of providers of human care. In pursuit of efficiency, many nursing functions are parsed into smaller and narrower bundles of tasks. Pre-operative nurses onboard patients, but rarely spend more than ten minutes with a single patient before they’re handed off, and the bed is turned. This assembly line scenario is akin to the automotive assembly line worker who puts the same four screws into the same plastic part over and over again for an entire 8-hour shift. To upend the model, we’re redesigning the roles, so the nurses cover pre-op, intra-op, and post-op; in doing so,the nurses see fewer patients in a day, but develop a meaningful relationship with them throughout the entire stay. While this demands more of them in breadth of skill, it turns out that giving staff more control and ownership over their experience also makes them more engaged and empowered, and delivers a better outcome.

A deeper understanding of human motivation can lead to meaningful impact. In the end, scientific advances are an important and necessary component of the advancement of our society’s health, but it only represents one edge of innovation. To achieve our collective wellbeing, we must ultimately engage everyone in pursuit of better outcomes. We need to redefine health in terms that people can embrace and influence, giving them the agency to act on their own behalf. We might, perhaps, call this a culture of health.