Making the Case for a Design-Led Transformation

Review of Design for Care

When you hear about problems in the healthcare space, the list can be long enough to require a prescription of its own.

They can be concerns that we as individuals face.

  • Coping with a disease or condition and understanding your care choices
  • Figuring out how to make decisions to improve your health and maintain a healthier life
  • Determining which insurance plan is best
  • Determining which hospital to go to for a particular surgery

From a healthcare delivery perspective, the issues can be frightening.

  • Thousands of medical errors made annually
  • Increasing rates of hospital-acquired infections
  • Complicated data displays in electronic medical records that can cause medication errors
  • Wrong site surgery
  • Information hand-offs at shift change and unit transfers
  • Dysfunctional cultures within clinical care teams where people are afraid to speak up if they think something is about to go wrong for fear of retaliation

Given all the local and systemic challenges in healthcare, designers have the opportunity to make an impact in a high-risk environment that can one day be linked directly to the improvement of patient outcomes.

Design for Care, by Peter Jones, makes the case for a design-led transformation across the entire spectrum of healthcare to help solve these various problems. To read a little more about why we should be listening to Jones, particularly in the context of designing in the healthcare space, check out his credentials.

Jones describes various types of problems in healthcare:

  • Simple problems, such as fixing a broken bone
  • Complicated problems, such as surgical operations due to many moving parts and many ways to fail
  • Complex problems, like chronic diseases such as asthma, cancers, and autoimmune diseases
  • Wicked problems, those complex problems with uncertain interventions as well as uncertain outcomes such as come with aging populations with multiple chronic diseases

Jones offers a lens in which to tackle these problems. He cites design strategists Garry VanPatter and Elizabeth Pastor from Humantific with the four stages of design evolution:

Design 1.0: Traditional Design (traditional craft design processes)

Design 2.0: Product/Service Design (industrial and interactive product design)

Design 3.0: Organizational Transformation Design (organizational level transformation design)

Design 4.0: Social Transformation Design (transformation across a large healthcare institution)

When building a product/service/application in healthcare, a significant shift in design practices and methods is required as the relative scale of problem solving increases from Design 1.0 to Design 4.0.

Throughout the book, Jones gives real-world examples of Design 1.0 through Design 4.0 and illustrates the methods used by practicing healthcare researchers and designers. Each section of Design for Care offers a look at specific areas throughout the system of healthcare, and almost every chapter ends with a case-study that concludes with “tips on techniques” and lessons learned.

To further illustrate the problems in healthcare, Jones begins each chapter with a persona (“Elena”) and her journey across the continuum of care. An Elena vignette  introduces each chapter and brings to life a journey that we can all relate to.

Another way to look at the problems in healthcare (particularly when designing and building a product/service/application) is through the lens of the “sociotechnical” system. Jones writes, “Information and interfaces are integral parts of a sociotechnical system–the social system that organizes work and tools into a meaningful function in an organization. When technological systems are merely ‘installed’ into complex operations, social practices change to adapt. If the systems are not integrated well, entire system installations can be rejected at great administrative cost.”

Through several chapters, Jones hones in on electronic medical record (EMR) design and the unfortunate effects he feels EMR implementations have had on clinical settings. This was probably the most frustrating section of the book for me, not because of Jones but because of the impact (or lack thereof) that EMRs have had in the clinical setting. According to research by Jones, “Major EMRs reveal critical interface design and clinical workflow challenges… and can trigger potentially hazardous situations at every level of function.” Other organizations such as the Institute for Healthcare Improvement and the National Patient Safety Foundation have found similar issues.

It is maddening to me that the creators of these EMRs didn’t take into account this “sociotechnical” system. In my training as a user experience designer, this is one of the first things that I learned: When designing a system that helps people do their job, the design of the system must integrate into their workflow. You must take into account the people, their context and their activities.

In the clinical setting, user experience designers should’ve been employed from the beginning (classic story right?) to ensure that EMRs support the needs of clinicians to make clinical work more safe and efficient.  Jones goes into great detail on why EMRs are the way they are today and how to eventually innovate the EMR design.

As a user experience designer in healthcare, Design for Care has given me new ways to look at the problems that I’m trying to solve. Jones has illustrated different forms of user research methods–such as empathic design research and cognitive engineering–that I’ve yet to use and brainstorming techniques–such as bodystorming– that I can start applying on certain projects.

To me, Design for Care is a call to all designers out there to join in on the quest to “do no harm” by  “designing no harm.” One thing Jones makes very clear though in this book: Working in this space will require a long-term commitment. He says that to be effective, we have to acquire a much deeper level of domain knowledge than in other industries/service areas. Jones explicitly states, “The complexity of healthcare IT applications requires that designers make a personal and usually long-term commitment to the domain, involving years of learning, practice, and patience with slow progress.”

You will need to shift your thinking from your standard problem solving to “design thinking” and to “systems thinking.” The problems are “complex and wicked” and the standard user-centered design methods aren’t enough. The standard user-centered design methods are fine for traditional design and product/service design. However, when you get into organizational transformation design and social transformation design, new design strategies and methods are needed.

According to Jones, the presence of designers in healthcare organizations is quite new. Some of the best examples, he says, are in-house designers who learn the field from within. He says that the typical digital agency model is not recommended for this type of design because of the significant requirement to understand actual patient care.

I agree with Jones here. In my experience in healthcare, I’ve made the most impact by being “in-house,” where I’m directly connected to healthcare domain experts and share in the responsibility/accountability of creating a product and service that is geared toward keeping patients safe while in the hospital.

Healthcare needs design. Badly. After a dozen years working in various industries doing user experience design, I realized I was at a crossroads in my career and I wanted to do something that was more meaningful to me personally. I wanted to find those wicked problems that I could help solve and work with the people that were solving them. I found healthcare, specifically the clinical setting. The problems can be daunting since lives are actually at stake. Design for Care has reminded me of why I work in this industry and the vast opportunities for design to make an impact and improve patient outcomes.

Posted in Book Reviews | 1 Comment »

1 Comment

  • Ashraf Ali

    June 17, 2014 at 9:51 pm

    Thank you for sharing this article. It’s an important topic that needs to be discussed and brought to public attention. Poor design has rippling effects that can cascade. In the field of health, it can become a situation between life and death. It’s extremely important to build a holistic viewpoint and attack the problem methodically.

    I don’t agree on the comment of a “typical digital agency model.”

    First, this comment discounts the specialized agencies in the health and pharmaceutical space. Many companies from big agencies like Havvas and DraftFCB Healthcare to smaller ones like Juice and Flashpoint have significant expertise in the health space. Second, many new health care start-ups are behaving like consulting firms with digital agency experience. They work from the outside in order to tackle problems in the healthcare space.

    Most importantly, this is an education issue. Design has often been considered a last minute attachment. It is a band-aid that needs quick fixes. Educating senior level management in the healthcare sector about the importance of design and process and structure to build a better healthcare system is the greater challenge. I believe it’s a three fold process of government recommendations and regulation (to some extent), private sector consultancy (i.e. agencies), and public awareness campaigns to generate interests (i.e. PSAs that appeal to patients and medical staff).

    I believe this article (and Design for Care) is the first baby steps in understanding each company’s role in shaping healthcare.

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