When the Design Institute for Health was testing out its prototype for a new clinic for Dell Medical School, the staff built a model out of cardboard and set it up in an art gallery so medical providers could experience it and weigh in before the design was finalized.
It would be different from other clinics in that it was designed around the patient and provider experience, rather than around the organizational structure. For example, in this new clinic, there’s no waiting room, because the Design Institute’s research confirmed that it feels horrible to sit in a room full of other potentially contagious people when you’re sick or in pain. So they decided to design that experience out of this new clinic. Instead, each patient goes straight into an examination room. And instead of particular doctors having particular rooms, the doctors go to whichever room their patient was given.
In this new clinic, there’s no waiting room, because the Design Institute’s research confirmed that it feels horrible to sit in a room full of other potentially contagious people when you’re sick or in pain.
When Design Institute Executive Director and Founder Stacey Chang explained to health care providers that the new format would not give them a set block of examining rooms, the physicians were highly skeptical, wondering how far they would have to travel to get from one patient to another. Chang assured them it would be no more than 11 steps, no matter which room their patients were in.
“Then we told them there will be no waiting room,” Chang said, “at which point everyone loses their mind because that’s where the revenue comes from. We’re like no, no, no, just live with it for a day. If it doesn’t work, we’ll revert.”
“So,” I posed to Chang when he recounted the story to me, “you can’t fall in love with your prototype.”
“Exactly,” Chang said.
The Design Institute for Health is staffed by engineers, designers, and artists in a marriage between Dell Medical School and the College of Fine Arts, both at the University of Texas at Austin. It is tasked with “meaningfully changing health care—and improving the community’s health—by focusing on three initial areas: a creative, collaborative model for improving health; platforms to enable new innovations in health; and a resource for design execution.”
While the U.S. healthcare system is weighted down with legacy, conservatism, and a necessary aversion to risk, Dell Medical School is endeavoring to create a holistic new approach. Founded in 2013, it isn’t saddled with the problems faced by a legacy institution attempting to reinvent itself. Instead, it had the freedom and mandate to be cutting edge. The Design Institute is part of that vision.
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Getting started: Understanding the patient
To understand how to fulfill that mission, the Design Institute staff had to begin with research. They spent significant amounts of time with people from all over Austin, from all walks of life, to understand what health and health care meant to them. They weren’t looking for validation for existing ideas, but for new insights and patterns that had been missed.
[The Design Institute wasn’t] looking for validation for existing ideas, but for new insights and patterns that had been missed.
Lucas Artusi, systems designer, said they began “with full ignorance,” not presuming they knew the right questions to ask, but asking many questions about people’s lives and looking for patterns of common need across populations. Their process was a recurring cycle of convergence and divergence. The insights they received provided the staff with opportunities to innovate physical products, digital products, new organizations, systems, and brands.
“We don’t presume we know which (product or system) will be right,” Artusi said. They would test out an innovation, get feedback, integrate the feedback into the next iteration, and send it out again.
“The healthcare system generally doesn’t think about patients,” Chang said. “It’s a self-referential system that perpetuates its own business model. If you think about patients as customers, as users, or as humans, you have to ask what are the customers’ needs? What are we actually trying to do on behalf of the people being served?”
Clinics as a part of the community
Artusi said they wound up with eight key takeaways. “A couple that are interesting is that there’s a perception among most people that healthcare is a planet that thinks it’s the sun. But health and well-being is much broader than clinical care. Only about 20 percent of health outcomes come from the clinical environment, and yet what we fund, and way that we force people to get care, drives people into a clinical environment instead of pushing the clinical environment out into the community.”
“The nature of disease has changed,” Chang said. “A lot of hospitals were built to hide people who were sick, or heal them from the ravages of war, to stanch the bleeding and help them survive. Those are not the things that kill us or make us ill today. It’s diabetes, high blood pressure, suicide. Finding a time and place to exercise is far more important to addressing diabetes and blood pressure. Our care models have to start intervening on those parts of people’s lives.” For example, Dell Medical School has formed collaborations with organizations like Head Start and Meals on Wheels to expand their community outreach.
Photo courtesy of the Design Institute for Health.
They also re-envisioned the clinic model. Instead of being housed in a monolithic building that forces patients into a strange environment, the clinics are in smaller buildings in the community. Instead of giving patients 5-10 minutes to talk about their most pressing symptoms, doctors spend 45-90 minutes per patient, understanding all their lifestyle factors: diet and their access to fresh foods, their exercise and sleep habits, the financial and work situation and other possible stressors, their emotional support system or lack thereof. This uncovers much of the causality of a patient’s problems. For example, Chang said, many back problems have no physical cause—they derive from stress.
Instead of being housed in a monolithic building that forces patients into a strange environment, the clinics are in smaller buildings in the community.
The clinics also deliberately expand the circles of care to include the family and friends who will be involved with things like making sure the patient gets their meds, or going with them to the grocery store. And the healthcare providers work to convince patients that they—the patient—are the best advocates for their own health care.
A whole new kind of hospital
The Design Institute is currently working on a redesign of Austin State Hospital, built in 1861 as the Texas State Lunatic Asylum, the oldest psychiatric facility west of the Mississippi. Originally the plan was to “literally rebuild the insane asylum from 100 years ago,” Artusi said. Instead, they’re trying to reimagine what a more functional system would look like. The rebuild site states: “The priority on patient care guides every aspect of the design of the physical structure and delivery of care services, for example: single rooms, outdoor access, better sightlines for nurses, evidence-based models of care, and care that is sensitive to a person’s life experiences.”
In addition to sweeping changes, they’ve made myriad small ones. Artusi said they got to help redesign colorectal testing kits. Historically, he said, these kits came with three different set of instructions and the manufacturer would “just put the test all together and let the person figure it out.” As a result, people often threw the test in the trash rather than taking it. But the Design Institute created a much more user-friendly design and set of instructions that has doubled the rate of testing. This also saves a lot of time and money, as patients would rather take the tests at home, in privacy, instead of suffering the embarrassment of taking it in the clinic.
The difficult task of managing change
Because there was so much to be done, the Design Institute had to tackle one project at a time. Still, they kept circling back to the knowledge base they were building. Each new project and set of iterations expanded that base.
“All of us came from consultancies where we did serial projects for clients,” Chang said, explaining how each project had a finite end or set of requirements that couldn’t be built upon during any subsequent projects. “With Dell [Medical School], the team can build on the insights gleaned from the last project, and the projects continue to grow in a concentric circle. Currently, they’re working on a systems-based approach to healthcare taking in everything: the economic, sociological, and demographic makeup of the community; local, state, and national politics; transportation, the environment, available resources, culture…you name it.”
The Design Institute is combining design thinking with systems thinking to better align various aspects of healthcare, both at the micro and macro levels. And a lot of it has to do with the not-so-logical or linear process of human thinking and experience. For example, the city of Austin wastes millions on sending responders to 911 calls from people who are simply lonely, have empty refrigerators, or need a drug prescription, Artusi said. The response system is perfectly logical, but the thought process of those using it isn’t always. This is one piece where breakdowns occur and can be addressed.
The Design Institute is combining design thinking with systems thinking to better align various aspects of healthcare, both at the micro and macro levels. And a lot of it has to do with the not-so-logical or linear process of human thinking and experience.
Dell Medical School is funded by foundations who can “play the long game,” Chang said. “They don’t have the immediate economic imperative to make the numbers every quarter.” So they can afford these experiments. The fee-for-service model that currently exists in healthcare, however, hasn’t figured out a way to make this model work. And unless taxpayers pick a different system, this one has little opportunity for change.
There are also those who struggle with the change. Some patients and providers struggle with having to adapt to a new system. Part of the role of the Design Institute is to help them.
“It’s about invoking risk taking and reward in tiny increments so it doesn’t feel scary,” Chang said. “When you master a new system, you get a little bit of courage.”
For obvious reasons, he said, providers are risk-averse; as are many patients when they are fearful or don’t feel well. At the Design Institute they have to push both with a little nudge of discomfort that will presumably be followed by a sense of triumph. And so things will inch forward. To manage it, the cutting edge innovators at the Design Institute have to be very patient with people who have their own reasons to keep a foot on the brake.
“I’m managing a herd of unicorns here,” said Chang. “There are very few of us with a background in medicine. We have biomedical engineering, industrial design, linguistics…. We are creators of new futures using design as a capability. Our culture allows for productive dissent… We create things as a body better than we could as an individual; we don’t believe in the lone genius. You have to have the ability to shepherd people through courage and discovery. Mostly we’re informed by inspiration.”
Cover photo courtesy of the Design Institute for Health.