Design Thinking Guides Patient Improvement Efforts

For a day and a half, 22 Stanford Health Care managers left their day jobs and went back to school. They traveled across the medical center campus to the Paul Brest Hall at Stanford University to take a crash course in design thinking.

David Janka, MD, a Stanford medical school graduate turned design thinking coach, led participants through three hours of training on empathy interviewing, understanding needs and defining problems. He then sent them to Stanford Hospital to put their newly learned techniques to work on an actual design challenge: to improve the going-home process. Working in pairs, the students dispersed through inpatient units, and conducted interviews with patients and family members. Design thinking students start in the field, so they can develop empathy for the people they design for, and uncover the real human needs they want to address. By late afternoon, the group was back at Brest Hall, brainstorming possible solutions and creating rough prototypes.

This was the eighth such Design Thinking Boot Camp sponsored this year by the Product & Service Integration Department, a design group within Patient Experience. In all, 160 members of SHC’s leadership and management teams have been trained in the basics of design thinking. “We do a lot of teaching and training across the system,” said Alpa Vyas, vice president, Patient Experience. “We are looking for ways to complement the other improvement efforts we are making through the Stanford Operating System.” These mini sessions, she said, help build a design-thinking skill set within the organization, to give participants a new lens from which to view their work, or to inspire further study.

“Design thinking helps us better understand and not assume what our patients and families are really being challenged with as they navigate the system,” said Vyas. “It helps us dig deeper, go beyond the surface and connect back to what’s important to our patients and families.”

Putting design thinking to work

While these Boot Camps introduce participants to design thinking, other experienced individuals are leading teams who are putting these principles to work throughout SHC.

In 2015, Helen Waters, administrative director of Product & Service Integration, led a multidisciplinary team in applying design thinking to remap the layout and design of Pavilions D, E and F in 300 Pasteur, which will be renovated and activated for inpatient cancer care. Her team has now turned their attention and efforts to 500 Pasteur, where they are reimagining how inpatients receive and use information about their hospital care.

Waters began looking at how patients interact with and ingest all of the information they receive before, during and after a planned inpatient hospital stay. She worked in partnership with a multidisciplinary Patient Flow team, focusing initially on orthopedic patients and families preparing for major joint replacement. Before and during their hospital stays, she interviewed them about education materials, and observed their interactions with the information in their rooms. What she learned guided her problem solving. Patients don’t read the dense material packed into a three-inch binder by their bedside. They don’t watch the 57-minute video. What they want, she said, is a simple checklist of what to expect each day, and a compassionate and expert guide to nudge them through their preparations. What time is lunch? When am I going to CT? When is physical therapy coming? What time is my ride coming to take me home?  

“In designing systems, we haven’t always factored non-clinical needs, the responsibilities and task execution of patients and their caregivers, in equal measure to the needs of the delivery system itself,” said Waters. She used the insight from patient interviews to begin prototyping what she calls the Patient Plan. “The design thinking process helps lessen our biases and provides more clarity about the choices we make and the tradeoffs we select.” 

After testing mocked-up information templates, actual binders and hand-sketched screen shots with patients and families, her team is currently working on a simplified daily checklist concept. Waters is also working with Digital Solutions and Health Education to test a mobile device product to support the Patient Plan.

Designing the future state

Kash Kapadia believes design thinking is needed to uncover the unmet needs of patients and families. “In health care, we have extensive use of traditional methods such as surveys that often get you answers that are anchored in the current state,” said Kapadia, vice president and general manager of Digital Health. “But when you are looking to define a digital future, those methods are necessary, but not sufficient on their own.” Digital Health employs both methods, design thinking and traditional measurements of people’s attitudes, needs and desires, “to uncover the unheard and unmeasured, and as a result, the unmet needs of patients.”

In the past year, Digital Health has deployed design thinking to enhance the cancer patient’s digital experience, to understand the needs of physicians who refer to Stanford and to learn what health care consumers want from on-demand health. In a design thinking study of virtual visits, Kapadia’s team learned that patients find SHC difficult to access in their moment of need. With that new knowledge, Digital Health met with clinicians and operational staff, designed and tested a variety of solutions, and is currently working on operationalizing a new offering.

The Patient Safety Department is leveraging design thinking as one of multiple scientific disciplines being applied to safety redesign, according to Mitesh Rao, MD, director of the Center for Advanced Patient Safety. “Anytime we want to implement clinical redesign to create a safer and more resilient system, it requires a true understanding of the needs of all the users,” he said. “Without design thinking, that’s a piece that might not get captured completely.” Partnering with human factors, system engineering and simulation, the Center aims to leverage design thinking to proactively address concerns and implement innovation within Quality and Patient Safety.

Design thinking has become one more tool in a growing arsenal of strategies to improve the patient experience at Stanford. For Waters, its importance cannot be overlooked. “How can we deliver human to human care in a way that is meaningful and high quality and sustainable if we don’t design something that takes all parties needs into consideration at the same time?”