It almost seems a foregone conclusion that the healthcare system in America is broken. We’ve all heard about the challenges: our aging population (the “silver tsunami”), the difficulties in delivering care to rural and underserved populations, the obesity and early onset diabetes epidemics—the list of challenges goes on. It can feel overwhelming and difficult to know where to begin and how to make a meaningful difference.
Peter Jones saw the same broken system and decided to do something about it. And to help others do something about it. In addition to all the great work he is doing in healthcare innovation research, Peter published a landmark book that is inspiring and informing a new way to think about, plan and design a better healthcare system. He brought his thinking and methodology to Delight 2015 for a full-day healthcare intensive.
Designers as professional caregivers
In Design for Care: Innovating Healthcare Experience, Peter presents a sweeping overview of the design issues facing healthcare and shows how designers can work with practice professionals, patients, caregivers, and other stakeholders to make a positive difference. We had the pleasure of engaging in some Q&A with Peter.
Steve: In your book, you describe an opportunity for designers to become members of an integrated care team. What kind of progress are you seeing in this area? How far out are we from designers being considered professional caregivers?
Peter: This is hard to say. A lot of my Master of Design students are interested in healthcare now, and are conducting design research in mental health, hospice and end of life journeys, patient-centered care, and other areas of service. Those working inside a hospital organization often have their work as design professionals constrained, as they face the problem of finding a role fit within a huge, 24/7 care facility that has never had anything like a “design department.” I don’t think it’s systemically effective to just conduct one-off studies or enhance patient experience in one or two services. But it does take time to learn the domain and the language, and to become recognized as valued in these risk-managed “guardian culture” environments.
Steve: Who are the stakeholders that define your work and the need for it inside the hospitals you work with? Is it the clinical group? Patient experience? Patient advocacy? Marketing? All of the above?
Peter: There are many possible stakeholders for the practices in Design for Care, as the book covers the consumer, patient experience, clinical, educational and healthcare system domains. Briefly for each, with one chapter in each domain. So the healthcare sector is vast and my design challenge—to interaction and service designers primarily—is to connect knowledge and practices across these domains so that we might understand better connective relationships between people, roles, providers and organizations.
In terms of my practice, with Redesign Network (and our Strategic Innovation Lab at OCAD University as well) we work with both insiders and outsiders. I’m a service system designer and have specialized in clinical reference, education, and point of care decisions for about 10 years. Hospitals and healthcare systems, health agencies, and clinical staff are my main focus, and we don’t touch many patients in research, but they are the ultimate beneficiaries of design for healthcare service providers. Clients include product/service vendors of information and educational resources, so much of my user research and prototyping is done with clinicians of many different levels and specialties.
Steve: If I’m at a hospital where there is no interest in design thinking, how can I start to get traction?
Peter: If you’re at a hospital already, what is your role? You don’t need a design revolution to change practices, improve patient care, and develop better IT experiences. You work from the position you’re in and locate functions and problems, whether infection control or electronic health records, that surface real pains for “users” of any kind that you have some control or responsibility for.
Design thinking is not the only way to socialize ideas and design value, and I’m not sure it’s the best way in healthcare, as it risks becoming a fad. As design thinking is not a natural integration into healthcare culture, in the hospital setting, it risks becoming a cost center function and then marginalized by Lean workstream analysis, which is a strong part of culture. These functions tend to compete, not complement one another. Since hospitals don’t produce products, their internal customer for design work is driven by clinical services and IT, which are used to running their own shops.
My second book, We Tried To Warn You, describes how user-centered design was pulled into a company to help recover from a huge product failure, and because no design culture existed, the roles for design, prototyping and research were shared between me as an advisor and a small internal team with complementary roles. We built competencies on the available skills and started a series of prototypes and disciplined customer research visits. Visible successes led to a horizontal embrace of the new skill base into product lines other than the one we started with. I call this a socialization process, and it can work in a large institution such as a hospital with no cultural handles for design thinking.
You have to remember that hospitals and medical practice have no design tradition and that our language doesn’t make sense to the majority of people in healthcare roles. This is one domain where cool design talk doesn’t work well. More and more medical centers are building innovation centers within the institution, but these are usually joined up with the quality or research disciplines, both of which are analytical and evidence-based.
Where design practice has made the most difference, in my view, has been in sociotechnical systems—think human factors and advanced UX in complex clinical work, the integration of clinical workflow and IT, in surgery, radiology, pediatrics, chronic disease.
Steve: Who are some of the lesser known providers or institutions on your radar for driving noteworthy innovation in this area in terms of effectively integrating design into the healthcare enterprise?
Peter: There are so many different niche sectors growing, which could all claim design advances yet in quite different applications. Some of the most effective applications are not widely known because they don’t make good “design stories,” but these include multidisciplinary design solutions for sociotechnical problems such as EMRs, nursing workflow, and care team communication and coordination. Mayo Clinic and Kaiser Permanente have innovation centers that are fairly well known, of course. My book covers some cases from Toronto’s Open Lab (innovation in complex care), which manages dozens of clinical design research projects, as well as Toronto’s Healthcare Human Factors group.
Healthcare IT remains hampered by poor design, especially the electronic medical records systems (EMRs) that have been rapidly installed over the last five years with Obama administration funding. EMRs are a tough problem to work with and it takes deep inside knowledge of practice and patient issues triggered by bad information representation. Children’s Hospital of Philadelphia has a well-regarded bioinformatics group that’s been a design leader for their massive EMR system, developing clinically usable interfaces for common yet complex pediatrics problems. Their Care Navigator is an interactive UX model for EMRs that all institutions should be looking at.
But these are very deliberate, expensive, and high-risk UX projects. We need more designers with the skills and aptitude to work on these (often) multi-year programs, and we need more sharing of knowledge (and code) across academic medical centers and these labs.
Steve: Do you see a parallel between the “health seeker” you discuss in Design for Care and today’s online information searcher? Can we learn from Google how to be better health seekers? If so, how?
Peter: I proposed health seeking as the individual’s response to their own biological process of returning their physical well-being to a near-normal state. It’s what we do when we take a nap after a long day of work, or simply need a sliver removed from a foot. It’s the irritations that make us get up and go to the doctor, and it’s how we as individuals can be self-healing participants in both the natural processes and clinical support for health. We search online when we’re puzzled or concerned about a symptom or unknown issue.
In the book I write about “infocare” and health information seeking, which is different than health seeking. It’s perhaps a subtask of the drive to heal or determine the scope of a concern. Google isn’t always the best first stop, because our non-clinical terms are going to hit the most common index, resulting in confirmation bias.
Actual health problems can be complex and not self-diagnosable, so browsing high-reliability sites like Mayo, Cleveland Clinic and Cancer.gov is better than searching consumer sites, but links to these sites may not display in the first 10 results.
Steve: Who is on your must-read list? Who would you miss most if they took a quarter off from publishing or speaking?
Peter: I love Atul Gawande, of course. I always pay attention to Don Berwick, founder of Institute for Healthcare Improvement, and Paul Plsek, who brought awareness of complexity theory to healthcare. I find Trisha Greenhalgh’s constant research and systematic reviews phenomenal resources, and I’ve followed social scientists like Marc Berg and Ross Koppel.
We don’t see enough designers speaking at healthcare conferences or even in design meetings. Our projects are too often privatized, inconclusive, or unreportable. This may make us seem rare or inaccessible to clinical practitioners, and it limits our access and credibility.
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About Peter Jones
Peter Jones’ healthcare innovation research develops the opportunities for connecting content and learning resources to professional practice and clinical education. He has led service design and field research for leading decision and educational services and interactive products for physicians, nurses, and medical students. He is author of Rosenfeld Media’s Design for Care: Innovating Healthcare Experience. He wrote Design for Care to help designers deliver systemically relevant solutions to the emerging problems of multidisciplinary healthcare services and the complexity of care: http://designforcare.com.
Peter is also associate professor at Toronto’s OCAD University, where he is a senior fellow of the Strategic Innovation Lab and teaches in the Strategic Foresight and Innovation MDes program. Peter previously published We Tried to Warn You (Nimble Books, 2008) and Team Design (McGraw-Hill, revised in 2002). He has authored recent peer-reviewed research articles and whitepapers, available online at his blog Design Dialogues.