In my role as the patient safety innovation coordinator for the Armstrong Institute, I spend a lot of time helping clinicians improve processes in health care delivery. Oftentimes I've found that when faced with a challenge we all have a tendency to go right to solutions we're comfortable with. Especially in health care, we’re used to working within so many constraints that we sometimes miss the opportunity to look at not just what's viable and technically feasible, but also what's desirable for everyone involved.
To help people think beyond the obvious to what we call wild ideas, I use a process called design thinking — a human-centered design approach that was popularized by IDEO. And within these wild ideas, we often find elements that are very useful not only in solving problems, but also in increasing the satisfaction of all the people involved in a process.
So how does it work? Here are five steps to design thinking that I've adapted from the IDEO methodology:
Step 1: Learn. The traditional way of learning in health care is to read all the literature about a topic and talk to a few people. But what we think we know from that research might not be what we need to know. The learning step in design thinking is based on empathy. It involves talking to end users of an entire system to understand their needs. For example, at Johns Hopkins we're working on improving the way emergency code teams are deployed in the hospital. The goal of this project is to ensure that all patients are responded to in an efficient, reliable, effective way. So we're interviewing patients, families, nurses, doctors, pastoral care, security personnel and others to get input from everyone involved in the process.
Step 2: Define. This is where the team comes together to share insights from step 1. For our emergency code team deployment challenge, we stuck Post-it notes on a huge wall identifying themes that included technology, workflow and communication needs. We realized that some larger, long-term system fixes were required. And we identified opportunities for improvement that we could tackle right away.
Step 3: Ideate. In this step, you get people together through focus groups or brainstorming workshops, and come up with ideas for the ideal state of the situation you’re working on — letting ideas flow without any limitations. What could you do if you had no constraints, financial or otherwise?
Step 4: Prototype. After coming up with a bunch of ideas, you pick one or two and create prototypes. A prototype, for example, might be a physical representation of a solution. Sometimes we use cardboard, colored tape, markers, pipe cleaners and any other supplies that may be immediately available to make our idea tangible. Or, a prototype could be a sketch with role-playing to demonstrate a proposed communication process. In other words, the prototypes can be low fidelity so they don't use up much time and money. It's really about getting the concept across in the simplest, most cost-effective way to keep the process moving forward.
Step 5: Test. You then take each prototype to the end users you got input from in step 1 and let them react to it. Does it address their unmet needs and solve the problem they’re facing? Based on their feedback, you may need to revise the prototype and test it again.
At any point, repeat steps as needed. Just continue working the process until you come up with a solution that works — and that people will embrace.
Design thinking is rather new to health care, but we're seeing great value in it. It's really getting people to think in new ways and come up with innovative solutions. Plus, by creating low-fidelity prototypes, you can try things out with very low risk but potentially high impact.
So rather than waiting for a big grant to come through, try moving forward on human-centered design to see if you can create innovative solutions right away.
This post first appeared in the Microsoft in Health blog.
This post was updated after readers pointed out an inadvertent omission — the role of patients and family members in this work.
Thank you for your great article. I agree with everything you said. I wounder it would be important also to stress that the planned intervention should be as simple as possible. I imagine that in your work this is already happening, but I do wounder this should be one key objective of every new intervention to be implemented: to be as simple as possible. For example, by eliminating unnecessarily forms; simplifying forms language etc. Dr. Pronovost (from your hospital) talks about that in "Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out", when he describes the steps involved in implementing protocol to reduce central catheter infection in ICUs. Besides the great team work needed to improve the safety culture (that he lead amazingly, as known by all involved in patient safety), we learned about his effort to make all the necessary equipment accessible to the ICU team. I know this is not news for you. Just want to highlight that.
Alex -- Thanks for your comments. You are absolutely correct. We encourage teams who are problem-solving to consider the criteria below when developing their solutions: Is the solution:
2) easy to test?
4) compatible with existing workflows whenever possible?
In some cases we try to disrupt the current process or system when needed, as in our current project highlighted in the blog.
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I applaud your efforts and use of IDEO. However, even here I see you doing what you are comfortable with and what you know best. For me, there are two things that I would address. First, is interviewing patients and what they feel they need. The benefit of this is not only the patient perspective but the expertise the patients may have which they can bring into the process which is outside the insular ways of the healthcare system. Engineers, managers, teachers and many others that you wouldn't even suspect have insights that would open up the thinking. This could be a good use of your Patient Family Advisory Board members who are mostly relegated to helpful improve the scores on the HCAHPS rather than more meaningful work of helping the hospital learn how to communicate with each other and save lives. The second point is seeing a long term perspective in the context of not only acute care but in the long-term wellness of the patients. How does the team get feedback beyond the acute care boundary. Thank you...
Cathy -- Thanks for your comments on the blog. You are spot on. It was my oversight in the blog to not highlight our “North Star” as we are learning about the problem. Patients and families are almost always involved in the process (since they are users of our entire system) as we are gaining insights and deep empathy for the problem. The patient and their family as you and others will agree are at the very sharp end of all that we do, and designing solutions WITH them rather than FOR them is an imperative. Thank you for pointing out this oversight.
I absolutely agree with the above comment. When reading Step 1 in your blog, I had to reread it because I thought I overlooked the word patient. Designing a team and receiving feedback without the most important member of that team would be a monumental error. Interviewing patients and their families is essential. Perhaps not in the same setting with other health care professionals where the language and concerns may be a bit confusing for the average person, but certainly in another venue. Why not find out what is important to patients and their families? Their answers may surprise you.
Linda -- Agree completely, can’t believe I left out the most important person in the work.. the patient. That was a complete oversight. I want to ensure you that we almost always start with patient and their families, and include them throughout the process including in our prototyping. They add such an incredibly important layer of insight that we would not discover without them. So glad to hear that you value their insights as well.
Rhonda- incredible post! It's clear that healthcare is in desperate need of "divergent" thinking (courtesy of the IDEO philosophy on human centered design), and so glad to hear about your work at the Armstrong Institute. Here at Brown Medical School, we've started up an initiative called Design Plus Health where we work on healthcare problems with a design institute, starting from the beginning of the educational process of medical students and designers (designplushealth.org).
Much work that needs to be done. Agree with the comments above that the first step, Empathy, nearly always involves the Patient as that human in "human centered design"!
Thanks for your message. Love what you are doing at Brown http://www.designplushealth.org/#intro-2 thanks for sharing. I agree, reaching out to work with design students who have objective and unbiased views (except for their personal experiences) is an innovative approach to tackle many of the wicked problems in healthcare. We have been fortunate to collaborate here at Hopkins in Baltimore with MICA (Maryland Institute College of Art), and their MASD students take part in design challenges around healthcare where their identified solutions are often at the true center of viable, feasible, and desirable.
Would love to see how we could find synergy in some of the work that we are both doing.