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.

TEDMED 2016: Calling all artists

2016-02-11
Artwork by previous TEDMED artists.

At TEDMED, design is a core component of our brand. Every aspect of our event – both on-stage and off – is carefully crafted and designed to capture the imagination. To us, art is a powerful storyteller; we use it as a vehicle to share compelling stories from the fields of public health, medicine, science, and technology. Our stage program has featured a wide array of artists, such as anatomical illustrator Vanessa Ruiz, creative arts therapist Melissa Walker, fine art photographer Kitra Cahana, and bacteria artist Zachary Copfer. Committed to diversity and multidisciplinary thinking, we also integrate art into our social experiences at TEDMED. At our 2015 event, we featured “The Art of Saving a Life”, an incredible virtual and live artistic exhibit about the importance of immunizations, commissioned by the Bill and Melinda Gates Foundation.

It doesn’t stop there. Each year, TEDMED selects an artist to create portraits of our speakers. In the past, we’ve had the honor of working internationally acclaimed combat artist Victor Juhasz, faculty and students from the Rhode Island School of Design, and internationally acclaimed Israeli author and illustrator Hanoch Piven. Each has brought personal vision and flair to the work, resulting in wildly different yet captivating illustrations. Their exceptional work was featured in TEDMED event and promotional materials, and was also incorporated into various elements of the event design to foster a creative, collaborative setting.

In 2015, we took a slightly different route in finding an artist. We love to experiment with new ideas and approaches, and decided to crowdsource nominations for artists from our own backyard – the TEDMED community. Our call for artists led us to the talented illustrator and designer Lauren Hess. This year, we’re doing it again. As we gear up for TEDMED 2016, we’re excited to recommence our search for an artist who can help us bring our speaker portraits to life. Our chosen artist will receive recognition on our website and in printed materials, and will be invited to attend TEDMED 2016 as our guest (travel and accommodations included).

If you’re interested, or know someone who might be, read on:

ABOUT THE PROJECT
The artist will need to produce roughly 50+ portraits in a 6-8 week timeframe. Illustrations will be based on reference photos that will be provided. Final portraits will need to be delivered as high res digital files based on our specifications.

ELIGIBILITY AND TIME FRAME
This call is open to amateur and professional artists, and all art mediums will be considered. While not required, the artist would ideally have a close tie to health and medicine. This could take form in the following ways:

  • Experience in the medical community
  • Experience working with patients
  • A personal story connecting the artist to health and medicine

The work will take place between May – July 2016.

HOW TO APPLY
To apply (or nominate an artist), please send an email to art@tedmed.com. Be sure to include a work sample, a brief bio, any relevant links, and details about the best way to get in touch (email, cell, etc.). If the artist is a good fit, someone from our team will reach out.

Application deadline: Midnight, April 15, 2016.

It’s smart to design simple: Q&A with Josh Stein

On the TEDMED stage, serial entrepreneur and CEO & Co-founder of AdhereTech Josh Stein shared what he’s learned about designing ‘smart’ devices and the internet of things as they relate to positively influencing patient behavior. We caught up with Josh to learn more.

The Internet of Medical Things
Connected Medical Devices Will Revolutionize Healthcare… If Patients Actually Use Them. Josh Stein at TEDMED2014. (Photo: Sandy Huffaker for TEDMED)

Why does the talk matter now? What impact do you hope the talk will have?

The Internet of Medical Things is going through a period of incredible growth, which is absolutely fantastic for patients! However, there’s an enormous design hurdle in regard to user adoption, and this hurdle is largely ignored. In short, there is too great a focus on what these devices can do, and not enough focus on how these devices will actually do it.

The Internet of Things, (IoT), or ‘smart’ devices, can be separated into two distinct categories: devices that users purchase and devices they don’t purchase.

Most IoT devices fall into the former category. Users will pay a lot of their own money for a gorgeous new smart phone, TV, or fitness tracker because these gadgets provide an immediate benefit to the user (they are awesome and fun to use). In these instances, consumers are willing to go through a reasonable set up and learning process for these devices.

In contrast, a large percentage of smart IoT medical devices actually fall into the latter category: users don’t buy these devices, and they are provided to users by a third party. This occurs because: 1) other parties subsidize these tools in order to improve patient outcomes and thereby decreasing overall costs or increasing revenue, 2) consumers typically don’t like to pay for medical devices, and 3) consumers typically don’t see a tangible immediate benefit from these devices.

The reason why this distinction is so important is that most smart medical devices are designed as if they fall into the former category, at least from a user-experience perspective, when they actually fall into the latter category. Thus, these smart med devices are designed as if patients will go through a long and complicated set up process to use said devices, when in reality the patient will not perform such tasks. Patients are simply expected to do way too much in order to use most smart med devices.

I shared this thought at TEDMED 2014 with the hope that this notion will resonate with other smart medical device creators. This could potentially lead to improved devices and better patient health.

What kind of meaningful or surprising connections did you make at TEDMED?

I met Jim Madara, the CEO of AMA; he and his team spoke about the innovative ways in which they are revolutionizing how medicine is taught. I met Marc Koska; his syringe is one of the most ingenious medical devices that I have ever seen. It solves a huge problem through simplicity and understanding its user. I built a relationship with an individual who is innovating clinical trials at one of the most innovative companies in healthcare. I don’t want to mention this person’s name because, though this introduction, my company is now planning an engagement with his incredible organization. Stay tuned for updates on this collaboration – we’ll keep TEDMED in the loop!

I also met one of my favorite stand-up comedians, Tig Notaro. Her TEDMED talk was awe-inspiring, and it was amazing to see a whole other side to her. I can’t say enough great things about her and her work!

I had the pleasure of speaking with Jay Walker. His wisdom and advice has directly impacted product and vision of my company. I genuinely attribute a great deal of our success to the conversations I’ve had with him.

What is the legacy you want to leave?

I want to be known as someone who has a net positive benefit on the world. Professionally, I believe I’m on the right track with the innovative work that my team and I are doing –  our product has been improving the adherence and outcomes of patients since 2013. We work long hours, but seeing improved patient health and traction continues to motivate us.