Innovation in Care
Dr Harvinder Popli 
Dr Geeta Aggarwal
We can improve patient experience, deliver sustainable healthcare and achieve better clinical outcomes by taking recourse to Design Thinking, a creative and human-centered approach that addresses a broader spectrum of patient challenges.
By Dr Harvinder Popli / Dr Geeta Aggarwal
An innovation in healthcare or in any area is at the intersection point between feasibility, viability and desirability. Ideas must be assessed in regard to all three aspects and only when all three aspects are taken into consideration can an idea become a genuine innovation.
It is possible to approach the subject of innovation from several directions. Design Thinking is a structured approach, through its focus on human desirability creates better products and services that are located at the intersection point of the factors related to innovations.
Since mankind was created, the human race has always had one main goal: survival. In the beginning of times, this involved trying not to be eaten by lions, but now in civilized societies, this has evolved into healthcare. Everyone has gone to a hospital at least once in his or her lives, we even begin our lives inside a hospital, from the moment we are born. So, how can it be that hospitals are exactly the same as they were hundreds of years ago?
So, there is need to invest more and more in design for healthcare. It can be from redesigning healthcare equipment and furniture in order to facilitate its cleaning and eliminate hospital infections to design products that safeguard privacy and dignity in hospitals.ng
Design Thinking is generally considered as a creative and human-centered approach to problem-solving. Even that’s true, but actually it’s not just about problem-solving but problem-identification. This distinction is important because, in the past 25 years, healthcare has got into a primarily evidence-based mindset where there’s a strong reliance on quantitative measures to ascertain what problems are and how effective solutions are.
So, Design Thinking is a truly human-centered way of putting people first — understanding their lives and challenges — in order to identify needs and put in solutions. It’s also more useful for identifying systems-level challenges, too.
Over the past few years, Design Thinking has gained popularity for driving innovation for the world’s leading businesses. The beauty of this methodology is that it’s empathy-driven and intentionally cross-functional — tenets that are crucial to the healthcare industry.
Design Thinking places people at the forefront of innovation work: on one hand as user, on the other as part of a creative and wherever possible, interdisciplinary team.
Yet, healthcare is one of the last frontiers to embrace this human-centered approach to defining and solving problems. This approach aspires to generate fresh systemic approaches and large-scale transformation in healthcare through design.
Since Design Thinking is a relatively new concept, and a very flexible one, there are many variations of how this process can be approached.
Basic elements of Design Thinking
Design Thinking creates space where innovations can come into being and grow. Here, the flexibility of the physical working environment plays a role, as does a team culture that is characterized by mutual respect and trust, the courage to fail, and an open and constructive feedback culture.
Design Thinking uses methods and experiences from various disciplines and encourages innovativeness mainly through:
• The energy of a non-hierarchical, interdisciplinary team
• The creation of a flexible environment and the nurturing of a respectful and error tolerant work culture.
Design Thinking process
Even before the start of a Design Thinking project, it is important to discuss, together with the project partner, the original problem statement and the nature of Design Thinking project and also to ensure that theses aspects are compatible.
A Design Thinking project starts with the definition of the design challenge, careful project planning, and a phase of understanding. Design Thinking is generally formed by five different steps, which can be used in a linear or non-linear way.
These steps are:
1. Empathize: (Talking to your customers directly) At the beginning of a Design Thinking process, the main aim is to learn as much as possible about the actual problem. Interviewing and observing potential users or those on the receiving end of the problem are an essential part of each research phase in addition to performing Web research or trying it out yourself.
2. Define and synthesize: (Defining a problem statement from your conversations with the customer) The synthesis phase serves to extract from the large amount of collected information those items that the team wants to concentrate on in the following steps. The result will be a ‘point of view’ describing a concrete user and his or her needs. This point of view will now serve as the starting point for the subsequent brainstorming phase.
3. Ideate: (Brainstorming, creation of a lot of ideas that might solve the problem) During brainstorming, quantity is more important than quality. Ideas are allowed to be crazy and instead of being discussed, ideas are quickly and simply turned into real prototype.
4. Prototype: build models to test these ideas
5. Test: (Try your prototypes with the users) In order to come as close as possible to reaching your target of a user-centric solution, it is imperative that you test possible solutions with potential users from the very outset and that you integrate their feedback into the further development of solution. It doesn’t matter how unfinished the prototype for a solution is at the beginning.
Design Thinking process may be seen as a system that has three different spaces which can overlap, rather than steps that follow one another. These three spaces are inspiration, ideation and implementation. In the inspiration space, we find the problem or opportunity that we look forward to address. In the ideation space, we generate, develop and test ideas. And in the implementation space is where we apply the product to people’s lives.
Prototyping is an integral aspect of Design Thinking
While prototyping, it can be done in a very specific way, so that we can learn from it quickly, cheaply, and early on. It is far more preferable to mess up at this stage of the game. To do so requires a different mindset, but if you can master that mindset, your team is going to make bolder decisions because the cost of failure drastically decreases.
Clinics can be designed as prototype, everyone will have assumptions about the room, whether they’re architects, facilities planners, interior designers, or nurses. So mock the room up out of foam core, build the walls, put in furniture, bring the physicians in, and run a code scenario. This is a great way to get feedback from physicians and then communicate with architects. It allows us to make mistakes and figure out friction points early on, which is a huge time and money saver. Prototyping lets you take risks that you ordinarily wouldn’t because the cost of failure is too high.
When you’re thinking about doing things at scale at the outset that naturally leads to a lot of regression to the mean and mediocrity. It’s next to impossible to innovate without taking risks; the secret is to reduce the cost of those risks to allow you to make bold moves early on and make divesting from what doesn’t work less painful.
Applications of Design Thinking in healthcare:
With the help of Design Thinking, healthcare excellence in things like patient experience, systems thinking, and health entrepreneurship can be thought of.
There is need to focus on tackling the acute needs of the community e.g. reducing the wait time for appointments of physicians and surgeons. This can improve not only someone’s quality of life but can alleviate downstream expenditures. The patients need not to work in chronic pain because they have no choice.
Design Thinking plays an important role in primary care, mental health, and some interesting intersections between health and other areas. Data shows that 80-90% of your health is dictated by things outside the four walls of a healthcare clinic. So, there is need to strengthen and reinforce the connection between people’s day-to-day activities and their overall well-being. This means the creation of new offerings, as well as both design and behaviour change work to improve existing offerings.
People understand the importance of good experience. Sometimes we forget that healthcare is a hospitality industry; they get wrapped up in the clinical delivery aspect of it. But it’s helpful to look at what hotels do, not just in terms of the physical space, but the services.
In healthcare, people are becoming savvier about the experience they want to have and it’s driving them toward these different business models, like concierge medicine. That’s going to be increasingly challenging for the entrenched players…they’re going to have to adapt to changing consumer expectations and behaviours.
Design Thinking in patient care:
Patient care is not just about exchanging pleasantries and moving ahead with the treatment. When you apply Design Thinking to this process, you will uncover ways in which care goes beyond the treatment.
A customer empathy map will help you understand your patient’s pain, concerns, fears and go beyond the clinical treatment. For instance, simply by listening to the concerns of expectant mothers, you can help them ease their anxiety. After quality research & brainstorming viable solutions, you can arrive at a proposed solution to help them be better informed about the labour process.
Design Thinking in Clinical Experience
Memorize the last time you were sitting in the emergency-room and recollect your waiting experience. Wait times are difficult to pass. You are in a troubled state of mind. Patients and their families spend a considerable amount of time in waiting rooms, sometimes waiting to be treated and other times waiting to see the doctor.
Design Thinking may bring forth innovative ways of helping patients feel comfortable and make their experience bearable.
Design Thinking to improve patient experiences:
Missing appointments is a very common issue of patients, which leads to relapse of disease and burdens the healthcare system. The thorough understanding of patients (for example, those who regularly miss appointments) is what guides the rest of the process. Design Thinking involves continuously testing and refining ideas, feedback is sought early and often, especially from patients.
Design Thinking has already taken hold in healthcare, leading to the development of new products and the improved design of spaces. Yet it remains underused in addressing other important challenges, such as patient transportation, communication issues between clinicians and patients, and differential treatment of patients due to implicit bias, to name just a few. If more leaders embrace Design Thinking, they can leverage a deeper understanding of patients to solve such problems, achieving better clinical outcomes, improved patient experience, and lower costs along the way.
Healthcare design evolving in the next decade
Design has not fully expressed its potential in healthcare. In fact, there is lot of work to do. Most of the places where design has made some headway in the industry are through architecture and interior design –and that’s great, but those are two very traditional businesses that have a familiar way of doing things.
What’s going to be increasingly common and get really interesting is the other verticals in which design starts to get involved. Service design is a big one; blueprinting of services, creating service standards, training and onboarding your employees, etc.
It’s easy to have these big ideas, but until someone experiences what you’re designing in a tangible way, it’s just as easy for them to say, “Nope, it’s not going to work.” That’s why there is need to try as quickly as possible to turn the corner and make stuff.
The way we deliver healthcare today is not sustainable, either financially or from a customer experience perspective. The absolute best way to change that is by training a new generation of physicians. The problem is, the existing system isn’t ready for them to deliver care the way they want to. By arming them with the methodologies of Design Thinking, they can start provoking the system and driving the kind of change that is needed for a really human-centered, value-based healthcare system. This approach is helpful in designing a patient-centered experience and addressing a broader spectrum of patient challenges.
There is need to consider the areas of prenatal care and pain of injections in healthcare applications. Diabetic patients go through this painful experience, every day. Sometimes they have to administer these injections themselves, and sometimes they have to deal with a less skilled, less empathetic nurse.
Don’t you think we need a better solution to this? Can’t we develop something which makes this experience less scary? Can we go that extra mile and feel the pain of these patients? Can we somehow make them suffer less than they are already suffering?
Innovation has a lot of space in healthcare by Design Thinking. Thus the change management aspect of innovation can’t be underestimated in healthcare. Service design is going to have an outsized impact on healthcare.
(The authors are from Delhi Pharmaceutical Sciences & Research University, New Delhi)