At Navicent Health’s Family Health Center in Macon, Georgia, health care leaders have started to use design thinking to find opportunities for improvement. This past April, they debuted an overhaul to the standard preoperative process, complete with new steps to target patients most at risk of complications.
“We’ve been looking at ways to change the traditional health system responses,” says Harry S. Strothers III, MD, MMM, Chief of Family Medicine at the Family Health Center. “While I would prefer to start from scratch to figure out the best result and design the system to get that result, in most situations you can’t do that.”
For guidance on preoperative optimization, Strothers’ team turned to a nearby hospital, Gwinnett Medical Center, whose preoperative process was resulting in fewer cancellation rates in surgery and fewer holds on the schedule. Strothers has since applied their work to Navicent’s preoperative process in hopes of seeing decreased length of stay, decreased surgical infections, lower 30-day rehospitalizations, and improved patient satisfaction — and they have, indeed, started to see results. “We haven’t been doing it long enough to have statistically significant results yet, however, we are closely watching the trends and will make adjustments as needed per the design-thinking model,” Strothers says.
Stothers adds that their research also showed that the best results came from implementations designed for the local situation; there were no best practices in implementations. Thus, most of the design thinking revolved around explaining the risks of surgery to patients with complexities such as smoking and out-of-control blood sugars, and then helping them with interventions.
“Instead of try[ing] to do PDSA cycles of improvement, we decided to try to design processes that would optimize the patients’ experience and fitness for surgery,” Strothers says. “You can’t convince people to do things — such as stopping smoking — unless they understand the risks and are then given techniques to change their behavior,” he says.
Family Health Center, and Navicent Health System overall, are in the minority of putting design thinking into practice, according to our recent NEJM Catalyst Insights Council Report on the power of design to transform care. Only 24% of respondents say they always or mostly employ the principles and techniques of design thinking at their organization. However, 91% of Insights Council respondents say design thinking would be useful for their organization.
Strothers credits Navicent’s Center for Disruption and Innovation for bringing design thinking to the hospital level. “The CEO understands that it’s important and there are different people within the system trying to use it,” he says. Like nearly half of respondents, Strothers says a limited understanding of design is a barrier, as well as insufficient training in design. “There are only a certain number of people who feel they are good at it, and only a limited number of resources who can help you do it,” he says.
LifePoint Health’s Memorial Medical Center in Las Cruces, New Mexico, also uses design thinking, with the goal of boosting staff member communication to impact quality. Anthony W. Baird, DSc, MHA, CPHQ, CPPS, Executive Administrative Director for Medical Staff and Clinical Quality at the 300-bed facility, and CEO John Harris, helped create the Advancing to Quality Committee to bring leaders together, workshop problems, and affect change.
“Within an hour meeting, we empower employees to put their plan into action,” he says. As part of this effort, each “task” is worked through a color chart of red, yellow, and green to denote that it’s a challenge, is being worked on, or is a success. Participants are given 30 days to resolve each item. Some who resolve their tasks are rewarded with a gold set of wings to wear on their nametag or a silver set presented at a department meeting by the CEO.
One such challenge revolved around fall-risk patients. Initially, the hospital focused on providing different color socks to denote fall risk, but staff complained the socks were not kept in a convenient place. The task force recommended signs be placed in patient eyesight (ground, ceiling, and wall) to remind them or family to call a direct line for help getting up.
“We made a dramatic change in our falls with injuries; the rate is now imperceptible,” Baird says. They also placed inexpensive RFID chips on bed monitors so that those wouldn’t accidentally go home with patients, saving $50 per monitor and ensuring each patient would always have one.
Harris and Baird now have their sights on patient flow, aiming to provide patients with a single badge they’d receive at check-in, which would easily guide them through complex visits that require an exam, an MRI, labs, and more. “The card/badge would contain a unique HIPPA-compliant identifier on the magnetic strip or bar code that would link the registration or scheduling system, [so that when] the patient presents, personal identification would confirm identity. At every turn, their next appointment would know they were coming and would be ready,” he says, eliminating long wait times and redundant paperwork.
“Design thinking starts at leadership but requires empowerment and trust in the people around you,” Baird says.