The Designer Will See You Next
I’m a doctor in a busy London hospital, and until recently the last person I would have expected as a co-worker is a designer. However, increasingly healthcare professionals are turning to designers for insights to help improve the services we deliver. In the UK we provide care free at the point of delivery, the NHS is an internationally respected healthcare system and the pride of a nation. However, doctors, managers, policy makers and most importantly patients are still asking for more. How can designers help?
In truth designers, in some format, have been integral in healthcare for a long time. Working for private sector companies, they have helped to engineer better joint replacements, make user-friendly software products, improve hospital environments and develop more effective business processes. Increasingly, healthcare systems in the developed world are struggling to cope with the rising demands placed upon them by aging populations, chronic illnesses and the spiralling costs of healthcare delivery. Furthermore, despite budgetary constraint, patients and their relatives expect the quality of care to be maintained or improved, and all with better accessibility. This has prompted an enhanced role for designers on the frontline of hospitals, developing patient-centred solutions for healthcare’s biggest challenges.
Delivering innovative change, much like providing good clinical care requires listening to the patient; for designers this means listening and understanding the issues of all stakeholders, especially patients and their families, a process known as people-centred design. With these insights the product or process under review can be designed specifically for the users’ needs and not just the systems’ needs.
Embedding designers into hospitals is not without challenges. The aim of this article is twofold: First, it is to advise doctors on how to engage with a designer and why it’s worth doing so. Second, it is to help designers understand how healthcare professionals evaluate new solutions
For healthcare professionals – what problems is a designer interested in?
Designers are interested in healthcare problems of all types, products and/or processes. They want to work with healthcare professionals and prefer to get the problem at the earliest stage possible. For example, when our team was given the brief of improving how an eyedropper works for delivering glaucoma medication, the initial response was not let’s make a “better dropper” but let’s try and understand the whole process. Why is the patient on the medication? What is the objective of the medication? And why don’t they like using the eyedropper?
It turns out this is a wider problem of communication. The patients just didn’t understand why the doctor was putting them on an uncomfortable to administer medication, for a condition, which once under control, didn’t cause them any problems. Our team noticed that, for doctors, time was critical, because the increasing pressure to see more patients in a given day made the successful communication of long-term treatment benefits very difficult. In this case, the benefit of the designer was to consider the service as a whole and identify the key targets for change.
Before you all rush to provide your local hospital designer with a list of service or product gripes, remember that, currently designers are a finite resource, and so there must be criteria for how problems are selected so the maximum benefit can be achieved. Consider 3 dimensions. First is scale; re-designing the layout of a waiting room does not necessarily produce a high level of impact. However, re-designing the whole outpatient process such that it occurs on a digital platform could. Second is cost; in these times of austerity we want to achieve “more with less”, increasing adherence to medication via simple interventions could have dramatic cost-benefits. Third is potential to deliver; try to avoid pet projects with no perceivable end-point, the goal should be system transformation and this can’t happen without implementation.
If you are interested in applying design thinking to some of the challenges your organisation faces there is a host of useful information out there. Specifically, the NHS Institute of Innovation and Improvement provides literature to help support an experience based design approach within healthcare.
For designers – how will a healthcare professional evaluate your work?
The goal of a designer in healthcare should not be to just produce ideas, but to consider how they can be widely diffused throughout healthcare to create transformative change. Five key qualities have been shown to encourage widespread diffusion; relative advantage, compatibility with existing values or practise, simplicity and ease of use, trial-ability and observable results1.
Translational research in healthcare can be split into creating a product or process followed by converting this research concept into practice. Both phases are associated with significant barriers that contribute to the overall delay. It is said, in the healthcare sector, it takes 17 years from having an idea to widespread diffusion2. Therefore, it is of paramount importance that the benefits of an innovation are evaluated and presented in an industry accepted way to prevent delays.
Common barriers include; securing funds, ethical approval, prooving concepts via research and publishing or presenting positive findings. This doesn’t even consider idea generation, the iterative design process or applications for intellectual property rights (IPR). Unfortunately, to design for healthcare all these hurdles must be considered.
Got an idea you want funded: Best to start looking for money early! Healthcare research funding is extremely competitive and generally involves a lot of paperwork. Furthermore, with our current period of financial austerity budgets are even tighter.
Created your concept: Now you have to test it! You will need to design a study to test your idea, this is harder than it sounds, my advice is get some help. The best way to find this is through a relationship with an academic clinician or researcher who works in the area you are designing for. There are many ways a researcher can evaluate an intervention; this can be through qualitative or quantitative research strategies. The key part of this is to have a very defined research question and the research stategy will follow.
Ready to test your idea: Hang on you need approval! Your wooden/glass concept knee replacement may look great but it’s probably not going to pass ethics. There are various different approval bodies but in general consider your host institution compliance officer, the hospital clinical governance or research ethics committee and sometimes (with a device) larger national bodies. Your friendly clinical research colleague can help point you in the right direction. Have a spare pen because this will be a lot of paperwork.
I’m funded and approved: now the hard work gathering and analyzing data begins! More reasons to form a good relationship with an academic because this is what they do. (They also normally have ready access to junior healthcare professionals and/or students who can collect data for you).
I’ve done it, tell the world: stand down soldier publishing research takes time and a lot of re-writing! For the best journals your work will go through a peer-review process, which means review by two independent experts. Scientific journals are assigned an impact factor, which is frequently used as a proxy for relative importance. The higher the impact factor the greater the audience and the bigger the potential impact; my advice is aim high.
I’ve created a transformative-novel-innovation, established the intellectual property rights, designed and conducted an approved study, analyzed and published the data in the best journal ever published: all you have to do now is convince people to use it! (That is another entire article)
Fortunately, if you were diligent with phase one then you will be able to confidently demonstrate the relative advantage; the compatibility with existing values or practice; the simplicity and ease of use; the trial-ability and you will have observable results.
Designers in healthcare are nothing new; what is new is embedding them right on the frontline where, it is hoped, they can have the biggest impact. The health sector is a formidable industry to work in, and one with significant institutional constraints. Designers will have to become adept at navigating these restraining forces if they are to be successful.
Healthcare professionals want to do the best for their patients. Often this is through establishing best practises, creating sensible regulation and adhering to strict patient safety standards. Fundamentally, this conservative behaviour could be seen to be at odds with the creative design process. However, it must be remembered that in healthcare regulations and processes have built up over time to protect patients and improve quality.
Fundamentally, healthcare professionals and designers are both problem solvers looking to improve patient care. They have complementary skill-sets, which when applied together; have the potential to create transformative solutions for some of health care’s biggest challenges.
- Diffusion of Innovations, 5th Edition by Everett M. Rogers (2003)
- Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: understanding time lags in translational research. JRSM, 104(12), 510–520. doi:10.1258/jrsm.2011.110180
Dr. Matthew Prime is an Orthopaedic Surgeon at St Mary’s Hospital in London
and a Clinical Research Fellow at HELIX Centre,
the Institute of Global Health Innovation, Imperial College London.