When we discuss “design,” we often imagine the eccentric artist creating an evening dress, a modern home interior, or even a smartphone of singular beauty and/or utility. But design can, should, and sometimes does go far beyond individual objects, environments, and organizations to create complex systems that achieve large-scale impact.
Design has always been about understanding underlying human needs, and then taking an iterative approach to creating new solutions for those needs by manipulating and adapting what surrounds us. Design, at a systemic scale, creates individual solutions that are more powerful when combined and serve as a platform for ongoing progress.
Here is one classic example from Kaiser Permanente. A new mother, as she recovers from the birth of her child in the hospital, is often anxious about her path to discharge. Simultaneously, the nurses who care for her need an efficient way to communicate the progress of both mother and baby to one another, especially between shift changes. Kaiser has designed a low-tech solution to both issues. In each recovery room is a simple bulletin board, titled “Your Journey Home,” that has a dozen hooks on which cards are hung. The cards describe tasks that need to be completed before mother and child can leave the hospital: for example, immunizations, hearing screening, birth certificate, follow-up appointments, and discharge medications. As each task is addressed, the task card is turned over on its hook. The mother can see clearly what lies ahead. At shift changes, the handoff conversation between nurses happens in front of the board, which allows the mother to participate as well, and creates a common understanding about next steps. The success of this idea has made it the foundation of a program that extends past discharge with an electronic platform that allows follow-up and shared decision-making after the hospital stay.
The dysfunction of our modern health care system isn’t about failure of intention, but rather pursuit of siloed and sometimes conflicting priorities. The needs of clinicians haven’t always aligned with the needs of patients, and both are subject to the demands of payers and regulators, and the financial limitations and business strategy of the provider organization. When each party manipulates and adapts to meet its own needs without regard to the needs of the others, it creates the incoherent mess we call our health care “system.” Medical professionals are trapped in the episode-driven fee-for-service revenue machine that defines value by productivity rather than impact on the patient’s health. Patients are trapped in the 10-minute office visit, the formularies and preauthorizations that second-guess their physicians, and arbitrary limits on visits for physical therapy or psychotherapy that ignore their needs and their rate of progress. Patients bypass their doctor for the drugstore clinic, or just don’t bother until they’re really sick. Both clinicians and patients get lost regularly in the systems that surround them, be it EHRs that prioritize accounting or hospital campuses that haphazardly add spaces to accommodate new services or capabilities.
Fortunately, payment reform at the national level is a catalyst for health care to redesign itself. Providers will be rewarded for their outcomes, given some measure of flexibility in what they do to arrive at those outcomes, and allowed to explore more meaningful venues of care outside the clinic, where people spend most of their lives — at home, at work, and in their communities.
To capitalize on this new paradigm, the Design Institute for Health was founded in 2015 at the University of Texas at Austin, as a collaboration between its Dell Medical School and its College of Fine Arts. Dell is the first new medical school in nearly 50 years at a top-tier U.S. research university, and the Design Institute is led by two senior leaders formerly from IDEO, an international design firm that applies design approaches to solving systemic challenges. The Institute includes the participation of payers as well. By touching every aspect of an operating health system, as well as medical education and training, the Institute creates human-centered solutions in both clinical and community environments in a way that evolves the typical role of design.
Much has been made about the impact of design in domains as diverse as education, the developing world, and, of course, consumer electronics. In those arenas, design has managed to wholly reorient systems in order to create new value.
Design interventions in health care have tended to be piecemeal. They address specific aspects of the ecosystem — more friendly clinic experiences, easier-to-use medical devices, improved medication adherence, more effective care protocols — but don’t achieve the large-scale transformation that design has activated in other industries. The Design Institute for Health aspires to establish ways to achieve such transformation through a new type of collaboration.