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Design Thinking in Healthcare

Article · May 2015

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Design Thinking
in Healthcare
Design for the 21st Century
Teacher: Mark Jenkins
University of Sussex
Student: Margarita Cox
Product Design, 2015
Index

1. Introduction
3. Design thinking
4. Design thinking process
5. Design thinking in healthcare
6. Case study
12. Conclusions
13. References
Introduction
Design for Healthcare

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? –Sparing the technology part,
obviously-

Cristina Osorio, from the NHS, talked to us about how

the UK’s government is now investing more and more
in design for healthcare.
From her talk, I found very interesting how the design
briefs were set, and how the Design Council –NHS’s
partner in this crusade- gave effective answers to the
healthcare problems.
From the briefs that the NHS set, two called my
attention, ‘Design Bugs Out’ and ‘Patient Privacy and
Logos of the NHS, Department of Health
Dignity’ and Design Council, the three main
partners in the health system redesign.

Design Bugs Out

Brief: Redesign healthcare equipment and furniture in order to facilitate its cleaning and
this way eliminate hospital infections.

The designers approached this by

eliminating and redesigning all the
surfaces that were hard to clean,
such as joins, crevices, rough
surfaces. They also made the
dissemblance of the parts easier,
so the equipment could be
separated before cleaning, making
it easier.

Redesigned Commode
Design Council

1.
Patient Privacy and Dignity

Brief: Design products that safeguard privacy and dignity in hospitals.

The designers approached this from different areas; they redesigned the classic hospital
gown so patients could feel they had at least some of their privacy intact. They invested
in special separating screens; to be used in large common rooms were patients of every
kind are put together.

Redesigned Gown.
It has straps and special closures that allow the body to be fully enclosed when wanted.
Design Council

Kwick Screen New signage

Its design enhances privacy inside big rooms in hospitals. It also has an Signage had to be redesigned as well, since it was
innovative material that allows folding it to form angles that give more very confusing and men kept going inside women’s
privacy when needed. bathrooms, and viceversa.
Design Council

I found very interesting how design in the specific context of healthcare can help people
in a tangible way, this products actually help patients, even if it is by covering their bodies
or allowing them to have cleaner furniture.
I realized that it was not only the designing of products that could help in healthcare, but
the design ‘way of thinking’.
2.
Design Thinking
What is Design Thinking?
“Design thinking is a human-centred
approach to innovation that draws from the
designer's toolkit to integrate the needs of
people, the possibilities of technology, and the
requirements for business success.”
Tim Brown, IDEO
CEO and President

Looking at the definition, some parts of it stand out, such as ‘human-centred’, ‘innova-
tion’ and ‘designer’s toolkit’.

Human- centred We never design for nothing, we design for users, so it’s only
logical if our design is ‘human-centred’.

Innovation Every time we make a new design we create, we innovate, and we

become innovators.

Designer’s toolkit Quoting Tim Brown again, designers usually have the
“ability to be intuitive, to recognize patterns, to construct
ideas that are emotionally meaningful as well as functional,
and to express ourselves through means beyond words or
symbols.”

3.
The Design Thinking Process
Since design thinking it’s a relatively new concept, and a very flexible one, there are
many variations of how this process can be approached.

According to Stanford University’s way of seeing it, design thinking is 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
2. Define: Defining a problem statement from your conversations with the customer
3. Ideate: Brainstorming, creation of a lot of ideas that might solve the problem
4. Prototype: build models to test these ideas
5. Test: try your prototypes with the users

Empathize Ideate

Define Prototype

Test

Steps of Design Thinking

Stanford University

In Tim Brown’s book, ‘Change by Design’, he talks about the design thinking process
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 implementa-
tion. 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 get the product to people’s lives. We will look at
these spaces further on while analysing a case study.

4.
Design Thinking in Healthcare
We have now seen how the design thinking process works, but now:
How can this process help in healthcare?

In the United States, Design Thinking has been applied by healthcare providers for a long
time now. Two of its main exposers are the Mayo Clinic -one of US’s best clinics- and
Kaiser Permanente -one of US’s largest healthcare providers-.
In both places they founded Innovation centres, where they apply the design thinking
process and teach it to their staff.
In the UK, the Royal College of Art has been applying design thinking for over 20 years
now, and joining the Design Council, it has been part of the redesigning for the NHS as
well.

Ed Matthews, Senior Research Fellow, said, 'Our early work, tended to address patient
safety issues through the design of products, packaging or labelling systems. But current
challenges, such as the ageing demographic or 'time bombs' such as dementia, obesity,
diabetes and respiratory disease, mean that in order to deliver sustainable healthcare, we
must do all we can to prevent so that we are less obliged to cure. This means designing
to promote behaviour change rather than simply designing widgets.'

In the last few years, changes have been happening since design entered the healthcare
system, causing a race for innovation that is generating competition between healthcare
providers. This competition makes healthcare better and better.

On the other hand, design can complement the scientific method, helping to translate
ideas into real possibilities, and give solutions that other disciplines can’t.

In the next section, we will look at the experience that Kaiser Permanente had when
using the design thinking process to improve the information exchange between nurses
at shift changes in its hospitals.

5.
Case Study: Kaiser Permanente’s NKE

Nurses exchanging information next to a patient’s bed after the program was finalized.
Picture taken from IDEO’s web page.

At Kaiser Permanente’s hospitals they had a problem; the nurses were loosing a lot of
time while exchanging shifts, because they had to pass on to the next nurse all the
information regarding patients from their own shift to the next one, and this process had
many failures. To help solving this issue, Kaiser Permanente (KP) went to IDEO, so they
could help them with a designer’s approach.
This is how the Nurse Knowledge Exchange programme was born.

The Team

To make this programm successfull, IDEO set up a team that was multidisciplinary,
conformed by members of IDEO and people from KP’s hospitals.

Main Team:
- Strategist (former nurse)
- Organizational-development specialist
- Technology expert
- Process designer
- Union representative
- Designers from IDEO

Innovation teams of nurses were also set in each hospital. This programme was iniciated
with 4 hospitals, and then expanded to the whole KP’s network.

6.
Space 1_inspiration

We will analyse this process from IDEO’s three design thinking spaces, since it was IDEO
who leaded the programme.

During the first space, observations were made at shift changes around the clock, nurses
were encouraged to share experiences, and the team took pictures and notes to
registrate the process. They also observed other factors that could affect the shift
change, such as staffing, lab, bed management, transport and nursing roles.

Nurses and the team in this stage.

Pictures taken from a video that explains the process in KP’s web page.

7.
During this stage, the team found out that the the techniques used by nurses were very
different in each case; some of them made voice records of each patient and then gave
them to the new nurse, others had face to face conversations with the next nurse after
their shift. Some of the nurses had very precariate ways of compiling information, such
as writing notes in the back of old labs, or even scribbling them on their scrubs. This
caused a huge amount of lost information, that generated a significant waste of time for
the new nurse, and made the patient feel he was not being well taken care of.

The main problem they found was that for every shift change, 45 minutes were lost
because of this information exchange. Also, many times the nurses failed to give all
information, sometimes missing very important facts, that went from exams that had
already been taken, to how the patient was feeling that day. Patients felt that in every
shift change the hospital turned into a ‘ghost town’, because all the nurses were
exchanging their information, and couldn’t be reached. They also felt there was a ‘hole’ in
their care, since with every new nurse they had to repeat information they had already
given to a previous nurse.

Opportunities

From these findings, the team created a framework that highlighted the issues that
needed to be redesigned, such as schedules, software, information hand-offs and the
interaction with patients.

8.
Space 2_ideation

During this space, the team took all their learning from the previous stage and did
brainstorming sessions together with nurses. From this sessions they developed
prototypes and tested them for three weeks. During the testing these ideas evolved
based on the feedback that nurses gave.
Many of these solutions were not phyisical, but involved the relation between nurses and
patients, a reformed schedule and better interaction with the patient.
One of the solutions they came up with was the instalation of a ‘CareBoard’, that was a
board installed inside each patient’s room with all their information, so the nurse could
fill it during her whole shift, avoiding the waste of time at the end of it. With this board,
patients could also interact, and complement if any information was missing.
Testing this board, the team found that the time nurses used for information exchange
was more than halved, and patients felt more taken care of.

Brainstorming sessions of the team.

Pictures taken from a video that explains the process in KP’s web page.

9.
 Care Board inside a patient’s room.
Picture taken from a a presentation of the programme by KP.

10.
Space 3_implementation

After the programme, testing revealed that a higher quality knowledge transfer was
being made, also, preparation times between shifts were reduced. This produced a much
earlier and better informed contact with patients.

This programme has been implemented now in every ward of Kaiser Permanente’s
hospitals, with huge success.
After this process, Kaiser created an Innovation Center, to continue applying design
thinking in its hospitals and teach their staff.

11.
References
http://www.ijdesign.org/ojs/index.php/IJDesign/article/view/928/348
https://hbr.org/2010/09/kaiser-permanentes-innovation-on-the-front-lines
https://hbr.org/2008/06/design-thinking
http://www.ideo.com/by-ideo/change-by-design/
http://www.ideo.com/about/
https://xnet.kp.org/innovationconsultancy/nkeplus.html
https://xnet.kp.org/innovationconsultancy/projects.html
http://share.kaiserpermanente.org/article/kaiser-permanen-
tes-innovation-consultancy-featured-in-harvard-business-review/
http://www.mayo.edu/center-for-innovation/what-we-do/design-thinking
http://www.mayo.edu/center-for-innovation/what-we-do/why-design-in-health-care
http://www.tedmed.com/talks/show?id=7134
http://www.forbes.com/sites/henrydoss/2014/05/23/design-thin-
king-in-healthcare-one-step-at-a-time/
http://www.ideo.com/work/nurse-knowledge-exchange
http://arcadenw.org/article/radical-collaborations

13.
 Conclusions
From this investigation I realized that design thinking can be taken into any field, and
anyone can do it. You just need to learn how and have an open mind to implement it
and take it to your own area of work.
I also realize that the richness of the process is in its multidisciplinary nature, because
only this way you can design a solution that fully responds to the problem. A multidisci-
plinary team can solve problems from every point of view by complementing one
thoughts with different perspectives.
Another fact that is very important is co-designing, because this way you can ensure
that your solution will be taken in consideration, if they design it with you, they will
follow it.

To finalize, I will quote a girl that worked with Mayo Clinic’s Innovation Centre:
‘design isn’t just part of the solution. Design changes how we see the problem’

12.

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