2013/10/10 15:00 “Design for Care: Human-Centering in Healthcare Service Systems” | Peter Jones | Relating Systems Thinking & Design 2013

Digest from #RSD2 by Peter Jones @designforcare at Relating Systems Thinking and Design 2 at AHO Oslo School of Design and Architecture

This digest was created in real-time during the meeting, based on the speaker’s presentation(s) and comments from the audience. The content should not be viewed as an official transcript of the meeting, but only as an interpretation by a single individual. Lapses, grammatical errors, and typing mistakes may not have been corrected. Questions about content should be directed to the originator. The digest has been made available for purposes of scholarship by David Ing.

European launch of Design for Care, publication is at http://rosenfeldmedia.com/books/design-for-care/

Presentation is available at http://www.slideshare.net/designforcare/european-book-launch-rsd-symposium-oslo

DesignForCare

Introduction by Birger Sevaldson

[Peter Jones]

Trying to start a new program on healthcare design at OCAD

Current program on Strategic Foresight and Innovation, looking 50 years out

  • More policy work and large scale design

Rosenfeld Media started 5 to 6 years ago with craft-oriented book

  • Now on second generation design of book
  • Worked with James Caldwell on this book look

Two books before:

  • Team Design (now rarely used)
  • We Tried to Warn You:  a single case study

Healthcare is different to talk about credibly, not a clinician

  • Had worked in point-of-care informatics
  • When deep in healthcare, it’s impossible to get context around the field
  • Depth becomes breadth

Book has 9 chapters, different cases, methods appropriate across different sectors

  • Person at home, in everyday life
  • Clinical context, providing care services
  • Organization / institutions in health policy

Stories about how people experience fragmentation

Main question:  What if designers were included in the team, as care professionals?

  • Designers working in healthcare aren’t included uniquely, unless they’re in niche
  • Wicked problem

Designers are not helping systemically

  • Fields of design are fragmented
  • User experience / interaction design
  • Service design
  • Evidence-based design
  • Environmental design
  • Participatory design
  • Generative design
  • Disruptive innovation

Rethinking sociotechnical systems

  • Complex service systems, but they don’t benefit from the knowledge of service systems

In North America, no accepted design process

  • Institutions are reinventing design language
  • Sociotechnical systems, absent service design

DFC003: Figure 1.2

Adapted from Humantific, 2007-2003:  design geography, scales of design

  • Design 1.0:  Traditional design
  • 2.0:  Product / service design
  • 3.0:  Organizational transformation design
  • 4.0:  Social transformation design
  • Healthcare involves all 4 levels
  • Complexity increases at each level
  • Design skills do not transfer up (and may not even transfer down, that well)

In healthcare, at various scales:

  • Design 1.0 and 2.0:  Differencing, as opposed to making sense
  • Branding, clarity in communications
  • e.g. wayfinding can be done by a single experienced designer, not a team of designers
  • About making things stand out

Design 3.0 might have straightforward service design, e.g. providing vaccination

  • Could be designing IT services

Design 4.0:  Healthcare may not be at level of transformation

  • In Canada, at current rate, healthcare will be 100% of tax dollars in 15 years
  • Integrating services to architecture, can’t touch on in book
  • Accountable Care Organization (coming with Obamacare) is a new business model being pushed down into organization

Financial incentives to push costs down

  • But following yesterday’s processes
  • Aren’t likely to change unless institutionalized
  • Opportunity for designers at policy level to make changes
  • A high-authority environment

Let’s get designers started in healthcare

Contexts of care services

  • Human
  • Work and activities
  • Organization
  • Industry

3 human-centered contexts

1. Persons, not users, or patients

  • People as health seekers, service customers
  • Evidence-based care, as scientific approach, almost ignores the perspective of nurses who take a strong care approach

2. Clinical work practices

  • Healthcare business must also be designed

3. Healthcare system

  • Design

Character: Elena

  • Single mother taking care of farther and daughter
  • Care giver’s journey

DFC001

1. Health seekers

  • As human beings, we are homeostatic
  • Whether we aim for optimal health, or just normal health (where normals are measured differently)
  • Think of selves more as agents than as patients (unless we’re in bed)

Elena’s journey as situations:

  • Caregiving
  • Health incident
  • Diagnosis
  • Treatment
  • Living With

Coulter, Entwistle Gilbert (1999) Sharing decisions with patients, British Medical Journal: Information touchpoints

  • 1. Understanding what is wrong
  • ….
  • 12.

DFC042: Figure 6.1

An end point:  Patients Like Me, started by a man whose brother died from ALS

  • Became a self-managed disease site
  • People track daily
  • Open and free
  • They are e-patients, agents in changing the way patients are treated

2.  Designing for clinical services, around clinical informatics to answer questions at point of care

  • Doctors don’t want to read journal articles, or 14-page summary
  • They want 3 to 4 pages
  • Workflow today, IT wants to take templates that know have worked in past, and then adapt workflows

Richard Bohmer:  Designing Care: Aligning the nature and management of health care, HBR press, talks about care contexts

  • Sequential services
  • Iterative services: a mix of conditions
  • Now 30% of patients are showing signs of diabetes or obesity in a mix of conditions
  • Care should be iterative
  • Uncertainty should be reduced during care, it’s like research through design
  • Improvements to treatment have to be done by trying them
  • More a problem-solving approach

Elena, seeing multiple specialists (for her fainting spell)

  • Elena is flooded by information

In clinical context, gold rush in Electronic Health Records systems number in hundreds, although only 5 are in use in the U.S. due to reimbursement systems

(Diagrams from book are available in Flickr)

Project Synapse, by IDEO and California HealthcCare Foundation 2012 (by Kauffman Foundation)

3.  Healthcare Systems

  • Call Big Box Healthcare
  • Michael Porter:  value-based healthcare system, driven by policy, not innovation
  • Cost will be the big disruptor

Center for Innovation in Complex Care in Ontario, Morra 2012 Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario

  • Patient-centred system

Value-Based Care, Porter and Lee in October HBR with Cleveland Clinic

  • Integrated practice units, distributed across organizations
  • Cost and outcome measurement

Designing Services to Scenario

To Design for Care is to Design for Health

[Questions]

Evidence-based medicine?

  • TR Reid, bad shoulder, reported across multiple systems
  • Can improve a lot of things in healthcare they won’t impact costs
  • Could be Health 3.0 or 4.0, may require policy changes

Design for care

Peter jones

[Table of contents for book at http://rosenfeldmedia.com/books/design-for-care/table-of-contents/]

Table of Contents

Part One: Rethinking Care and Its Consumers

  • Chapter 1: Design as Caregiving
  • Chapter 2: Co-creating Care
  • Chapter 3: Seeking Health

Part Two: Rethinking Patients

  • Chapter 4: Design for Patient Agency
  • Chapter 5: Patient-Centered Service Design

Part Three: Rethinking Care Systems

  • Chapter 6: Design at the Point of Care
  • Chapter 7: Designing Healthy Information Technology
  • Chapter 8: Systemic Design for Healthcare Innovation
  • Chapter 9: Designing Healthcare Futures