Compared to the Silicon Valley world of moving fast and breaking things, health care change often happens slowly. Some of the reasons for the inertia of our industry make sense. Change impacting patients requires a vetting process to ensure we are creating net benefit.
But this inertia also exists partly because many believe our field is so uniquely complicated that it cannot be improved using lessons from other industries. But the reality is that we could learn a lot about innovation from the for-profit world. Specifically, from design-thinking, a process that has been taught in business schools and design institutes across the country as a consumer-centered approach on how to innovate valuable solutions for customers.
Many providers do not feel like they are equipped with the skills and “business sense” to innovate in their environment or in their organizations. For any who feel that way, fear not: design-thinking essentially involves the same processes providers already use to think about their patients.
Design thinking consists of six steps:
- define the problem
Parallels of design thinking and the diagnostic process
1. Empathize. Empathy is the foundation of human-centered design because before an entrepreneur can design any solution, they need to understand the customers’ needs and experience. This step includes observing how people interact with products or services and asking about their experience.
In medicine, empathy is at the core of everything we do, starting from the initial history and exam. By gathering data from patients and their families, we can better understand their problems and what triggers may have led to their health issues.
2. Define the problem. This step begins with reviewing all the potential problems users face and exploring the insights gained during the first phase. It ends with defining a single actionable “problem statement” to focus on.
This means identifying the patient’s problem list and chief complaint in medicine.
3. Ideate. The purpose of the ideate step is to think broadly about potential solutions with a team. Once all ideas are on the table, the team creates a set of criteria upon which to evaluate these ideas to narrow them down to a few promising possibilities. This opportunity to think broadly without judgment of any ideas unleashes a team’s creativity.
The medical equivalent is developing a differential diagnosis with our team. When we are presented with a set of insights from a patient’s history and physical, our first goal is to think broadly about what diseases or illness scripts may be involved in our patient’s presentation. We must then think critically about pertinent positives and negatives to reorder our differential into the most likely cause of symptoms.
4. Prototype. From this large repository of potential solutions, entrepreneurs can start building prototypes for a few most-promising solutions that they can then test with their customers.
In medicine, this step is the initial plan. It is a set of tests we run, medications we give, and procedures we believe the patient needs based on the most likely cause of their chief complaint.
5. Test. Testing is an entrepreneur’s chance to gain feedback on prototypes by having users interact with them and provide their critique.
Doctors test out the initial plan by analyzing patients’ responses to treatment. Did a septic patient’s lactate and white blood cell count decrease with a particular antibiotic and fluids? Are they now afebrile? Doctors also elicit feedback from colleagues and consultants.
A key insight of design thinking is that we are not done after step 5. Like medical diagnosis itself, design thinking requires constant rethinking and iteration. You may find that some of the results of your testing require you to reflect on your problem statement or the ideas you have chosen to prototype—maybe a solution that was designed needs to be tweaked to better serve customers’ needs. In medicine, tests we run may reveal new information that leads us to rethink our differential diagnosis or plan.
Additionally, some models of design thinking include a sixth step of “implementation,” where entrepreneurs adapt what they have learned to work on a wider scale. In medicine, we expand our knowledge through evidence-based medicine and learning from prior patient care’s successes and failures.
How to tailor design thinking for health care innovation
One of the most important differences between the diagnostic process and design thinking is the space for “bad ideas.” It is essential to think of all the “do not miss” diagnoses in the diagnostic process. For example, when a patient presents with chest pain, we must consider deadly conditions such as a myocardial infarction, pulmonary embolism, or aortic dissection. These diagnoses need to be ruled out first. Then, we focus on generating a differential diagnosis ordered from most likely to least likely.
During ideation, design thinking participants are encouraged to list out every idea without any concern for whether they are good or bad. The right way to do this is to not provide any filter when a team is in the creative brainstorming process because they may discover a great idea somewhere in the midst of a number of ok or even bad ideas. Only when they have exhausted all possible ideas, do they start evaluating which ones to move forward with and prototype.
This willingness to brainstorm broadly without judgment is important and should be aggressively pursued in health care system innovation and in entrepreneurship. Explaining this difference can give physician entrepreneurs the freedom to be bold by giving them permission to be wrong when ideating and initially designing new systems, services, or products.
The fundamentals of design thinking parallel the same process providers use to think about their patients every day. I hope that highlighting this parallel gives providers the confidence to implement and adapt design thinking to innovate and solve problems in their environments, field, and the health care system.
Sneha S. Jain is a cardiology fellow.
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