Co.Design

The Five Biggest Ideas On The Future Of Health Care Design

Continuum's Rick McMullen breaks down the takeaways from this year's Mayo Clinic conference.

Every year, the biggest ideas in health care are presented at the Mayo Clinic’s Transform conference in Rochester, Minnesota. I was there this year to present a pre-conference workshop with a Continuum colleague on everyday creativity, and another pair of Continuum designers gave a main-stage talk entitled, "Patient Centricity: A design identity crisis." Also on the lineup were John Hockenberry and Roger Martin, bigwigs from J+J and GE Healthcare, and practitioners from the top-tier design and innovation firms. Many cutting-edge ideas were presented, along with some spirited debate on the hot topics of delivering care and the role of technology.

Here are my top five conference takeaways on the future design of health care.

First off, I keep running into the fact that…


1. Medicine is changing rapidly, and technology must keep up.

It’s often said that humans can’t keep up with technology. To a certain extent, that’s true. Generations of technology happen much more frequently than generations of people. However, there is a counterintuitive corollary to that, which is that medicine is moving so fast that the IT systems that support it aren’t flexible enough to adapt.

In some cases, it can take almost a year for an IT provider to update a system in response to an advance in medicine. By that time, the state of the art has advanced again, leaving some systems in a perpetual state of slight obsolescence. The upshot from the design perspective is that you can’t design software based on the assumption that medicine is static. The practice of medicine changes constantly, and your product will have to change as well.

Which is by way of saying that…

2. You can’t expect technology to fix all of our problems.

You have to take into account all of the ways that people are going to screw it up. Electronic Medical Records, Clinical Decision Support systems, IBM’s Watson, and other technologies are fantastic innovations, but they all have the common disadvantage/advantage of having to interact with people.

As such, they have to be designed to leverage the things humans rule at (abductive reasoning, visuo-spatial memory, decision-making), while taking into account the things people suck at (free recall, parallel processing, working memory). It’s not a new message, but clearly it still needs to be beaten into our heads: Technology is necessary but not sufficient. It is only one aspect of a complex problem that is fundamentally a human one.

Speaking of humans making mistakes all the time, I was surprised to hear that…

3. It might be more dangerous NOT to Google your condition.

I can only imagine how often modern physicians must roll their eyes at patients who, thanks to the Internet, know just enough to be dangerous. However, it came up in Dave deBronkart’s (a.k.a. ePatient Dave) talk that it might be more dangerous not to Google your condition than it is essentially to practice medicine on yourself. This was attributed to the usefulness of self-started patient communities that provide invaluable insight into what questions to ask, treatments to seek out, and condition-specific precautions to take. Dave talked about a recent study in which researchers expected to find scores of case studies of people dying because they relied on faulty health information on the web but actually found zero.

Intuitively, you just can’t design systems that allow people to cut the doctor out of the equation in favor of patient self-care. But on the other hand, if the above conclusion is true, it’s potentially encouraging that we could save time, money, and maybe even lives by using Internet resources. What if the role of the doctor changes from the go-to resource for all things health-related to more of a consultant who oversees patients who take care of themselves?

Which brings us to…

4. What exactly does "patient" even mean anymore?


When taken in aggregate, several of the presentations at Transform led me to believe that we are at a very important crossroads right now when it comes to the poorly defined role of patients in the health care system. There was debate over whether patients should be treated like consumers or not, how either important or dangerous it is for patients to help one another navigate their condition, and the pros and cons of bringing certain procedures into the home.

In many ways, we’re advocating for making health care simpler for people. But when you start to encourage patients to do their own research, make informed choices about services, and take control of their treatment, it starts to sound like we’re making things much more complicated. No right answer emerged, but it was pretty clear that the way delivery systems are designed depends critically on how you define "patient."

And finally, overarching the whole conference there was the sense that…


5. The Mayo clinic has a killer innovation consultancy within their walls, and so should you.

I took a tour of the Mayo’s Center for Innovation (CFI), and it has an internal innovation team, space, and culture that would make most commercial firms jealous.

It’s all very exciting, but I found myself wondering how much the health care community at large believes in "design," broadly defined. The attendees at Transform self-select to be on the cutting edge and are open to hearing—and even eager to adopt—radically different perspectives.

But "design" can be an intimidating word to someone in health care who has always felt removed from it, like "biochemistry" or "computational neuroscience" can be intimidating words if you went to art school. I don’t think it was intentional by any means, but there seemed to be undertones of an "us vs. them" mentality.

Really, though, we can only achieve what we want to if it’s just one big "us." It is in the best interest of everyone involved if technology, design, business, and medicine are each leveraging the others’ unique perspectives while working together toward common goals; and we would do well as the self-defined community of innovators to tailor our messaging accordingly.

[Photo by Ingred and Eric Chamberlin]

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16 Comments

  • Roderick McMullen

    @Halle I originally lifted that phrase from my old boss. I guess great minds think alike!  

  • Scott

    There’s an enormous amount of meaningful innovation that’s
    possible without the use of ‘technology’ (i.e. computers). Too often, people
    start with the question: “how can we use computers to improve healthcare?”

     

    For example, low-tech practices such as the consistent use
    of checklists (http://www.newyorker.com/repor...
    and hand-washing delivers incredible benefits to patients and payors.

     

    Similarly, incredibly effective low-tech systems have been
    developed in India that leverage clever inventions, process-thinking and specialization to deliver
    quality healthcare at a fraction of Western prices. (see the Innovation
    Sandbox, by C.K. Prahalad, http://www.strategy-business.c...

     

    Finally, enforcing basic guiding principles
    (e.g. “you don’t get antibiotics/MRI/etc. unless you really need it”) would eliminate
    a huge number of expensive, and often counterproductive, procedures.

     

    In other words, start with patients, apply brilliant non-technical
    innovations,
    and THEN think about how computer technology could be used to support or
    enhance them.

  • BlackHagen

    Regarding the patient versus consumer semantics; throughout the design process, this definition should change – it’s both and more. If we’re talking about devices where the primary operator is the patient; then “Patient” is appropriate from the clinical/efficacy perspective, “consumer” from the marketing perspective, “stakeholder” from the quality systems perspective, “user” from the industrial design/human factors perspective, “reporter” from the post market surveillance perspective.

  • Lee

    Thanks for the summary, two points first about patients- we are at the center of the crisis. (Please accept that these are generalizations, though anectdotal and statistics will bear them out). 1. The patients lack of connectivity to the cost of healthcare through the fact that we use intermediaries (either insurance/ employer relationship and or the government- medicare, VA, etc) causes us to ask for care we may or may not need. 2. We the patient's lack of taking responsiblity for our lives, thinking there is a pill, device or procedure that will cure what ails us are systemic as a cause of higher healthcare costs. I have seen the problem and it is us (the patient). While I agree that technology is not a solution, if it can improve our connection to own responsiblities or help us track the true cost of decisions we make each and every day- then maybe it will help us bring costs down in the long term.

    My second point, is that hospitals and healthcare systems represent only part of what encompasses a healthy community. A hospital is the last resort, what we need is an incentive / reimbursement system that keeps us focused on maintaining our health rather than treating us after we are already sick. It is much cheaper to prevent that to cure.

  • Carla J Bryant

    Great write-up. I wish I could have attended the meeting! I agree on all your points - technology is an enabler and not the panacea. I think people too often assume that technology means "better" and that is not always the case and in fact, I've seen instances where its added complexity to an other wise simple process. If teams take the time to do the research (analytical & ethnographic), understand the required outcome AND the brand values then they can design products/processes/experiences that are exceptional. From what I understand that is what the Mayo innovation center does so well.  

    Great question about what does "patient even mean any more". Its a debate that will continue for a long time to come. Personally - I try and think about "person/s". Consumers rile too many in the clinical field and patient is too narrow since many patients encompass their family, partners, or close friends who they rely on to help guide them through the medical maze. 

    Finally, with all the changes occurring in the healthcare industry, I think every healthcare organization would be well-served by establishing a dedicated innovation group no matter how small.  It is nearly impossible to try and drive innovation while at the same time managing day to day operations. The big CPG firms have learned this and its a best practice we would do well to emulate. I led an IT innovation group at a large health system for several years and I'm still amazed at the things we were able to accomplish and can only imagine what could be done on a broader scale.

  • Martafeio

    I lost a family member because of physicians negligence and I knew what he had based on internet :(

  • Francoise Luca

    "Technology is necessary but not sufficient."  Your statement is right on target.  Patients must take some of the responsibility for understanding their well-being.  However, the medical community must not forget the importance of a "good bedside manner".  Technology is only one tool in  is the healing process.

  • wesroberts

    We've been to Mayo there in Minnesota twice now for health issues concerning my wife.  Both times we've been blown away by their creative, deep and thorough care.  The innovation you speak of runs rampant through their organization...even in Florida and Arizona.  I've gained much for my own consulting and mentoring just by nosing around and asking questions of every level of their team we encountered.  Thankfully, my wife is doing well on the other side of some very serious issues.  How they function by design brought comfort and encouragement...even ahead of their medical wisdom and advice...as they attended to the whole person...not just the serious issue that took us there.  Well done on your article, Roderick!  Thank you!!!

  • William Plumb

    Patient-centered Health Care by any other name is Patient-centered Health Care. It makes for a great conference but it's a hard sell to the docs.  Good summary!

  • Bernard Farrell

    Don't forget that the FDA inadvertently puts a damper on external (patient-focused) technology development. I don't know if the same is true for internal IT development, if it's got some sort of patient focus I suspect it needs some FDA review.
    Re patients versus consumers. I know that our technology will start to improve greatly once companies realize we're people/consumers first and patients a distant second. I wear an insulin pump and continuous glucose monitor. The designs are very dated, it LOOKS like medical equipment and it doesn't need to.
    Amy Tenderich's pushing the envelope on this with her DiabetesMine Design Challenge. We need a lot more of these, and not just for diabetes.

  • Wayne Caswell

    So it seems the medical "industry" would benefit by using social media  to educate and engage their customers (patients) as advocates. For my part, I launched Modern Health Talk (http://mhealthtalk.com) to connect consumers with tech solutions for home healthcare. It has a good blog and many good links but is just a start.

  • guest 2

    An interesting write up. And a point well made by first commenter as that I'm a student of Medical Coding,...that is billing insurance.  I'm also mindful
    much more often of daily habits due to my studies of diseases,treatments and costs.

  • Guest

    #4 .. Insurance policies/companies is what makes healthcare complicated and the insurance side of healthcare is what takes forever to change. Ultimately, people should practice a healthier lifestyle and not look for the system to help when they do not own up to living a sedentary, non-healthy life .. end of story.