Care Redesign

Care Redesign Survey: How Design Thinking Can Transform Health Care

Insights Report · June 7, 2018

Analysis of the NEJM Catalyst Insights Council Survey on Care Redesign: How Design Thinking Can Transform Health Care. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.

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Advisor Analysis

By Amy Compton-Phillips and Namita Seth Mohta

Health care in the United States has evolved to be a complex and disconnected system. We are unable to deliver the excellent care that our patients deserve, that is fiscally responsible to citizens, and that clinicians sought to provide when they took on this work.

If we could start over, how would we redesign health care delivery?

A recent survey of NEJM Catalyst Insights Council members shows them ready to embrace design thinking to transform care. They view design thinking as valuable for a range of health care issues — yet its application has been impeded by limited organizational buy-in and limited understanding of the concept.

Health Care Organizations Only Occassionally Apply Design Thinking

From the Care Redesign Insights Report: How Design Thinking Can Transform Health Care. Click To Enlarge.

Design thinking is defined as a discipline that uses designers’ sensibility and methods, such as collective idea generation, rapid prototyping, and continuous testing, to match people’s needs with what is technologically feasible, provides customer value, and is a viable organizational strategy.

The great majority of Insights Council members — who are clinical leaders, clinicians, and executives directly involved in health care delivery — believe design thinking can be extremely useful, very useful, or useful in the health care industry (say 95% of respondents) and their own organizations (91%).

The survey identifies a wide range of issues that would benefit from design thinking: staff and provider flow collaboration, patient scheduling, care coordination, and social determinants of health, to name a few. In a written comment, an executive respondent highlights the need to overhaul office and clinic checkout processes: “A patient has to go to a checkout desk, wait for assistance, wait for scheduling, have their information overheard, be uncomfortable, etc.” Stacey Chang, MS, Executive Director at the Design Institute for Health at the University of Texas at Austin, puts it well: “The dysfunction of our modern health care system isn’t about failure of intention, but rather pursuit of siloed and sometimes conflicting priorities.”

Design for Patients

Patient input is often the best ingredient for true transformation. Take, for instance, the dialysis clinic in Jönköping, Sweden, which redesigned its facility to enable self-dialysis. While health care leaders on the project thought state-of-the-art beds and beautiful artwork would promote healing, patients encouraged them to forgo all that, buy cheap dialysis chairs, and allocate resources to exercise equipment so they could work out while they underwent their treatment. No health care professional thought of that — the patients did.

The family of one of the authors (ACP) recently experienced the need for patient-centric design firsthand. My brother, who is deaf, was diagnosed with tongue cancer by his dentist. He spent six months suffering from not only his condition, but also a lack of coordinated care. Nothing seamlessly connected his extended care team, which comprised the dentist; an ear, nose, and throat specialist; a medical oncologist; a radiation oncologist; and others. The knowledge transfer between these providers was abhorrent, and it left him with intense anxiety.

Design thinking would enable that health system to reimagine these handoffs in a more elegant and productive manner. The care team members would be encouraged to walk in the patient’s shoes, really observe and experience the system from his perspective, and develop practical solutions.

With so many health care professionals considering design thinking a useful endeavor, one would expect it to be widely utilized. Yet two-thirds of survey respondents say their organization employs design thinking occasionally, seldom, or never.

So how can health care professionals progress from merely understanding the value of design thinking to putting it into everyday practice? The burden, and opportunity, lies at the feet of the survey respondents, the NEJM Insights Council. Clinical leaders (45%), executives (37%), and clinicians (33%) are ranked as the three most appropriate stakeholders to champion the application of design thinking. What is a bit surprising in this result is that patients fall closer to the bottom of the list, at 14%.

As health care leaders and frontline clinicians begin to implement design thinking to accelerate needed changes, they should expect to encounter significant barriers, including these top three from the survey: limited buy-in from decision makers (chosen by 52% of respondents), limited understanding of design (47%), and insufficient training in design (32%). To us, the fourth barrier, return on investment (28%), is somewhat more interesting. Good design tends to be efficient and therefore cost-effective.

In this new era of patient-driven care delivery, it’s not enough to adapt existing systems; we need to create something better. Design thinking can get us there.

VERBATIM COMMENTS FROM SURVEY RESPONDENTS

An example of a well-designed health care delivery process at your organization.

“Screening all aspects of patient factors (physical, psychological, financial, social, cultural) and building it to a support system. Assign experts as a care team to work with all issues and communicate well. Build a system for appropriate referrals to utilize resources.”
— Clinician at a large nonprofit community hospital in the South

“Electronic tracking systems (home grown) to identify, track, and communicate to patients with incidental lung nodules on CT scan who need to return for follow up scans. Similar system is in place for patients in the lung cancer screening program. The systems are driven by the radiologists, who systematically apply the Fleischner guidelines (or L-RADs for cancer screens) for follow up imaging based on nodule size and quality.”
— Department chief at a midsized nonprofit teaching hospital in the West

“Color coded system in computer for nurses and physicians so we both can see where the patient is regarding the visit. In room, needs labs, needs vaccines, awaiting paperwork, signing out, etc…”
— Director of a large nonprofit health system in the Midwest

“Following 3 inpatient patient deaths involving root causes of poor communication, silo’d cultures of practice and accountability, a formal patient safety program was designed that delineated responsibility and chain of command. A great deal [of] systems level thinking occurred by hospital leadership and frontline clinical/ operational staff to link departments, develop processes to empower personnel and reward successful improvements.”
— Clinician at a small nonprofit teaching hospital in the Northeast

Download the full report for additional verbatim comments from Insights Council members.

Charts and Commentary

by NEJM Catalyst

In February 2018, we surveyed members of the NEJM Catalyst Insights Council, who comprise U.S.-based clinical leaders, clinicians, and health care executives, about the potential of design thinking to transform care. The survey covers the organizational issues and health care industry issues that would benefit most from design thinking; the usefulness of design thinking within health care delivery; the frequency of employing principles and techniques of design thinking; stakeholders most appropriate to champion design thinking; and barriers to applying design thinking to health care problems. Completed surveys from 625 respondents are included in the analysis.

Workflow and Patient Activities Are the Organizational Issues That Would Benefit Most from Design Thinking

From the Care Redesign Insights Report: How Design Thinking Can Transform Health Care. Click To Enlarge.

NEJM Catalyst Insights Council members say the top organizational issues that would benefit most from design thinking are workflow, for staff and patients alike, and patient-facing activities such as scheduling appointments. In written responses, survey respondents single out scheduling as a poorly designed aspect of care delivery, citing issues with skills of centralized schedulers, the need for provider input on scheduling, and an abundance of inefficiency. More executives (41%) and clinicians (39%) than clinical leaders (29%) rank patient adherence/compliance with therapy among the issues that would benefit most from design thinking approaches.

Download the full report to see the complete set of charts and commentary, data segmentation, the respondent profile, and survey methodology.

Download Full Report

NEJM Catalyst wishes to thank Stacey Chang, MS, Executive Director, Design Institute for Health, The University of Texas at Austin, for assistance in constructing this survey. Check NEJM Catalyst for monthly Insights Reports not only on Care Redesign, but also on Patient Engagement, Leadership, and the New Marketplace.

Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.

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