“Design thinking,” traditionally regarded as a means for creating user-friendly products, is now being used to improve services and drive innovation in many industries. We, and others, believe that design thinking can be a powerful tool in health care to improve care delivery, train future physicians, and improve the experience for both patients and providers. In our own community of Philadelphia, we are on the path to do just that, starting with medical students.
At Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University (TJU), we engage students early in their careers to use design thinking to solve problems in health care delivery. We inoculate our students with human-centered design in their first year to prevent the cynicism and burnout that often occurs when physicians later encounter seemingly intractable problems in health care. With support of both our Provost and the CEO of our health system, we are using design thinking as a framework for innovation and transformation in the medical school and across our local health care ecosystem.
First, what is design thinking? Tim Brown, leader of the global design firmIDEO, describes it as a “human-centered approach to innovation that draws from the designer’s toolkit to integrate the needs of people, the possibilities of technology, and the requirements for business success.” Its methodology, summarized as “empathy with users, a discipline of prototyping, and tolerance for failure,” has been popularized by the Hasso Plattner Institute of Design at Stanford University and IDEO.
Nearly everything in health care has been designed — patient gowns, medical devices, and hospital bills. We may not realize this because so many of these processes and products are so poorly designed. Design is not about making the things look pretty or creating bright shiny objects. Design — particularly in health care — is about ease of use, efficiency, and an improved user experience for both clinician and patient.
Too often innovation is outsourced to industry or to a select few within a health system. Although medicine has a rich history of creativity and problem solving, most physicians have not been exposed to design thinking tools and processes that could help them tackle some of the tough problems in health care delivery. Innovation will be held back until clinicians are empowered to play a greater role in designing services, devices, and products. Engaging physicians in design thinking can unleash innovation. Working on design can help physicians combat the resignation and frustration of health care’s challenges.
The principles of design thinking already are making their way into health care. Kaiser Permanente since 2003 has been using human-centered design to improve patient care and provider experience. The Mayo Clinic’s Center for Innovation has used designers since 2008. An often-cited example of using design thinking to improve patient experience is the story of GE designer Doug Deitz. He was proud of the MRI and CT scanners he built until he realized that many frightened pediatric patients could not be scanned without sedation. This horrified him and compelled him to reimagine the experience for children. Using design principles, he transformed the CT/MRI suite into an imaginary landscape representing a camp, outer space, or the ocean — reducing stress and the need for sedation.
Engaging Medical Students in Design Thinking
Two years ago, SKMC launched JeffDESIGN, the first design program within a medical school. The program exists alongside the regular curriculum, and students who participate for 3½ years receive a certificate in design. Starting in the beginning of their pre-clinical years, medical students are challenged to redesign clinical services, medical devices, and physical spaces. They participate in interactive, hands-on workshops with designers, architects, and device makers learning to solve real problems in health care with their hands through physical prototyping. Using design thinking, medical students have produced recent prototypes that include a redesigned patient exam room (which we are working to implement in partnership with a furniture company), a smartphone app to improve medication reconciliation, and a messaging system to remind patients of appointment times.
This spring a group of 2nd year medical students in the JeffDESIGN program won 2nd place in the AMA Medical Education Innovation Challenge. They described a curriculum with the core elements of the JeffDESIGN program (design thinking and design making) to show other medical schools what such a curriculum would look like. The students drew from their own experiences in JeffDESIGN, such as working with patients to make their own blister packs of medications at the hospital bedside.
In a separate initiative, a group of students (including some “JeffDesigners”) identified a gap in their own education — the lack of foundational knowledge and skills to prepare them to become leaders and innovators. Embracing the “bias towards action” core tenet of design thinking, they created the Physician Executive Leadership (PEL) program. The student-run program, open to all medical students at SKMC, offers bi-monthly large group sessions led by accomplished physician leaders and CEOs and small group sessions led by senior students on topics such as patient experience and care model redesign. It also connects students with summer internships and provides opportunities for original publications. The program has evolved and expanded rapidly and was recognized by the AAMC as a Transformational Student Initiated Innovation for 2016. Since its inception less than 3 years ago, more than 400 students have participated in PEL and at least 30 have written editorials in “The Diagnostic” blog, including a recent post that explores design thinking.
Using Design to Change our Local Health Care Ecosystem
TJU is involved in other initiatives to create a design-centric culture in our community and incorporate design thinking into medical practice and health care delivery. Many of these steps could be taken at any academic medical center with supportive leadership:
- Rapid prototyping is critical to innovation. A hospital makerspace provides a way for providers to design and create physical solutions to health care problems. A makerspace contains prototyping tools such as 3D printers, laser cutters, and electronics and enables clinicians to build and assemble novel solutions to everyday challenges within the hospital. After two device designers from MIT installed the first hospital makerspace at UTMB’s John Sealy hospital in Galveston, for example, nurses used that space to design and build a portable shower for burn victims. This MakerHealth Space inspired us at Jefferson to launch this month a makerspace for students, the first of its kind for a medical school.
- Collaboration is fundamental to the design process, but our students and physicians lacked opportunities to interact with professionals and academics outside of the hospital. To foster collaboration across the city, a local chapter of the Society of Physician Entrepreneurs (SoPE), was established on the Jefferson campus and is now led by Dr. Rosen. This created a space where we interact with entrepreneurs, innovators, technologists, and start-up companies from all corners of the Greater Philadelphia Region.
- TJU also created an Innovation Engagement Speaker Series; Startup Healthcare Competitions; a Healthcare Hackathon; and JeffSolves, a rapid medical device program in which two student teams prototyped several novel medical devices and are now filing for provisional patents.
- Furthering its commitment to a design-centric culture, TJU has announced plans to integrate with Philadelphia University, which will allow us to access programs in Industrial Design, Architecture, Engineering, and a Strategic Design MBA.
Equipping students, faculty, and practicing clinicians with the tools of design thinking enables us all to move forward with optimism and creativity. The result: Design thinking taps into the problem-solving nature of physicians, offering a focus and a set of tools to enable the delivery of better care and greater satisfaction for both patients and clinicians.
Associate Professor of Emergency Medicine and Director of JeffDESIGN, Sidney Kimmel Medical College, Thomas Jefferson University
Fourth-Year Medical Student and Founder and President of Physician. Executive Leadership, Sidney Kimmel Medical College, Thomas Jefferson University
Paul Rosen, MD, MPH, MMM
Associate Professor of Pediatrics and Faculty Mentor for Physician. Executive Leadership, Sidney Kimmel Medical College, Thomas Jefferson. University; Pediatric Rheumatologist and Clinical Director of Service and Operational Excellence, Nemours Children’s Health System; Head of SoPE-Philly (Society of Physician Entrepreneurs)