The Last in Line
You read it in business publications. You hear it in seminars. You see it all around you, in your everyday experiences. It seems everywhere you look, businesses are embracing the power of design to innovate, accelerate and succeed. Business visionaries from Tom Peters to Steve Jobs have dubbed design a major competitive weapon. Companies such as Nike, Apple and Target have used design to establish a competitive advantage. According to Richard Buchanan, a professor at Carnegie Mellon University’s School of Design, design has evolved from a focus on images and artifacts to systems, organizations and environments, or how people relate to other people and the products that mediate that relationship.
So what’s the deal with health care?
Missing the Boat
If there’s one industry that desperately needs the power of design, it’s health care, and specifically it’s hospitals. After all, in what other industry are systems, organizations and environments — people relating to other people — literally a life and death proposition? Yet look around in your organization. Look at your competitors across town. Look at your peers across the country. Do you see well-designed, consistent communications? Do you see well-designed patient experiences? Do you see well-designed processes and systems? Health care in this country has made miraculous advancements, and the care patients receive is arguably the best in the world. But it could be better — much better.
Sure, there are some hospitals that have clearly embraced the philosophy of design, but they are few and far between. And maybe a service line here or a physician there in your organization has designed something remarkable. There’s a trend across the country to redesign emergency rooms to be more appealing, more “patient-friendly.” Unfortunately, these are usually the exceptions, not the rule. You want evidence? Look at hospital marketing — Why is so much of it derivative, stale, uninspiring or undifferentiated? Look at hospital finances — The hospital bill is still one of the most confounding pieces of paper you’ll ever look upon. Look at hospital procedures — Why are there so many medical errors? Look at hospital processes — Why is the way a patient moves through the system so confusing and discombobulating to that patient?
Why is this? Why does health care seem to be the last in line to embrace the power of design?
Reason One: Design is Misunderstood
It starts with perception. Unfortunately, many hospital leaders look at design as simply a subsegment of marketing, and we all know how most of them see marketing, right? Marketing is an expense. An ancillary expense not related to patient care. Marketing is a necessary evil. Or perhaps marketing is seen as “advertising” or “publicity.” How many times have you had a prominent administrator or physician say to you, “If we just put up some billboards, we’d have more patients?” Marketing is often subjugated to creating brochures, Web sites, or those “silly” logos. It’s rarely valued as the discipline of building business over the long-term. Now, if marketing traditionally has that type of reputation in a hospital, imagine where design falls. At worst, it’s a practice in “making things pretty.” At best, design is seen as a visual discipline than can help you clarify and differentiate your organization. But even taken in this light, design’s potential place in helping a business succeed is misunderstood.
The problem is that many in health care look upon design as graphic design only, or what we call in our industry, little “d” design. But design in its fullest sense is capital “D” Design. Design certainly can involve aesthetics, but it also involves utility, efficiency, comprehension, connection and fulfillment. It goes beyond the traditional role of the graphic designer and applies the philosophies and principles of design to products, environments, systems, processes and even whole organizations.
Reason Two: Layering
One of the principles of design is starting with a blank slate. It’s considering a challenge without being constrained by what currently exists, looking at the whole universe of solutions without letting existing realities limit or restrict possible solutions. Which leads to another reason design seems to be lacking in hospital organizations — the concept of layering. Layering basically means addressing challenges as they come, and simply layering the answer on top of what already exists, without considering how the most recent solution affects previous solutions. Without looking at the situation holistically. Without starting with a blank slate. Eventually, the layers can become so numerous, the end result is an incongruent mish-mash of solutions that individually may have solved a problem, but now combine to cause different, and sometimes more complex, problems.
A classic example of this is wayfinding. Look at the signage throughout your hospital — Is it a seamless system of information that anticipates and guides patients, families and others in the most effective way? Or is it a maze of old signs, new signs, posters, flyers, messages and more? If you are lucky, your wayfinding system was designed from the get-go from a patient perspective (many aren’t). But even if it was, how many times has your organization simply added new departments, wings or offices to current signs, without considering the overall impact on wayfinding?
Now take the idea of starting with a blank slate and go beyond just the visual relevance of design. A few years ago, a client of ours set out to improve their outcomes in open-heart surgery. Instead of tweaking a procedure here, or adding a program there, they took a look at the whole process. The result was the adoption of the Single-Unit Stay model. In the past, patients scheduled for heart surgery were admitted, moved to surgery, and then to a different room for recovery. Many then went to the ICU, and then moved again to PCCU for rehabilitation prior to discharge. With Single-Unit Stay, patients are admitted to one room in the CV ICU, and other than for the surgery itself, remain in the same room until they are discharged. The goal is to keep the patient in the same environment for his or her entire stay, receiving care from the same team of caregivers. The response to this patient-centered approach to care has been exceptional, with positive reactions not only from patients and their families, but also from the surgeons, nurses and other staff involved. And the results? In just two years, patient safety has improved, recovery times have been cut in half, and survival rates have increased to among the best in the nation. Now that’s a well-designed solution, and it started with a blank slate.
Reason Three: It’s the Patients, Stupid…
Effective design requires studying a problem from a consumer’s perspective, or in this case, from a patient’s perspective. But like many other businesses, hospitals have traditionally struggled with considering the consumer’s perspective. One of the reasons for this is what’s called a “silo mentality.” In business, the silo mentality is the phenomenon of internal departments and teams within an organization thinking within their own narrow, disconnected world, or “silo.” An organization afflicted with this type of thinking will find it very difficult to take a consumer’s perspective in a meaningful way. And hospitals are notoriously susceptible to silo mentality.
For example, consider the treatment of a heart attack. The patient may start in the emergency department, then encounter radiology, the cath lab, cardiovascular surgery, the CV ICU, education and rehab, followed by regular visits from their internist. To a hospital, those are naturally separated areas, with different names, different staffs, different managers, sometimes even different floors or buildings. But to a patient, that is all heart care. Patients don’t see the separation that exists behind the curtain at a hospital. And when they are exposed to it, it confuses them.
Embracing design also requires collaboration, which is the antithesis of the silo mentality. Designers learn to seek out multiple perspectives, to work with other critical contributors to a business, such as sales, engineering or customer service. Only in that way can they truly gauge how a product or service touches a customer. Do the leaders in your organization actively, honestly seek collaboration?
Take facility improvement, for example. Your organization may spend millions of dollars on a new addition, building a new heart or cancer center, or completely renovating your hospital. When this happens, how congruent is the planning? Are the architects talking to the brand manager, is your marketing department talking with patient services, are the physicians talking with IT? Forget talking. Is everyone on the team coming together to design the best solution, considering everything from patient flow to room design to signage? Or is everybody doing their own thing, and adjusting their plans whenever they bump into somebody else? Is there someone designing the entire project from a patient perspective?
Reason Four: No Time to Think
Perhaps the most significant reason design philosophy is absent in health care is time. Who has time at a hospital? Everyone is under-staffed and over-worked. But successful design takes time. Time to really consider the situation. Time to explore solutions. How often have you come together in your organization to solve a problem? Usually there’s a meeting or two (or more), a solution is arrived upon, consensus is reached, and the solution is implemented.
Designers are trained to generate a solution, set it aside, and then create another solution. And then another, and another, and another. Designers work until all angles are explored, all options considered, all variations entertained. Why? Because a well- designed solution requires consideration of all influences over time, such as customer interaction, feasibility, effectiveness and so on. And the odds of adequately considering all of those elements in one solution, or even worse, the first solution, without missing something important are long odds indeed. So designers are trained to purposely continue exploration, even if one, two or a dozen solutions have presented themselves. In addition, as part of the exploration, designers use time to let the subconscious mind go to work on the challenge. You can put a group of people in a conference room for hours and tell everybody to really think about the challenge at hand. But the best solutions will come after your brain has had a chance to stew for a while, and that requires time.
Bringing Big “D” Design to the Table
So, how can you begin to incorporate the power of design at your hospital? First, check your own perceptions of design. Are you still viewing design as a “graphic,” visual discipline, or are you open to design in an all-encompassing way, a different way of thinking about all challenges you face? Apply the process and philosophies of design to non-visual challenges and measure the results. Once you’re there, start working on your organization’s perception. And the best way to do that is practice what you preach, and show others how design can add value.
Start with a blank slate. Don’t just look at the current problem at hand, but dig deeper and see what the underlying challenges are, and don’t be restrained by the existing situation. Ask, “In a perfect world, how would we handle this?” then strive to make it so.
No matter what the challenge, look at all the ways a solution impacts a patient, and what that impact means for the different departments in your organization. Involve those departments in the process to develop a truly “patient-centric” solution.
And most importantly, take time. Take time to step back and look at the big picture. Take time to thoroughly consider the situation, and to explore multiple solutions. Take time to think and reflect. If you have good designers on staff, invite them in on challenges that extend beyond the “graphic design” realm and let them use their minds, training and creativity to address the challenge.
Unfortunately, some designers do not embrace the idea of big “D” Design, and are quite comfortable sticking to traditional graphic design. If you don’t have strong designers on staff, find some or look to an outside resource. While design has caught on in many industries, it’s still an underused and undervalued discipline in hospitals. Because of this, design offers a real and immediate way to improve the care you provide, giving you a competitive advantage in your market. The potential is fantastic!
This column was published in the April 2004 edition of Healthcare Marketing Report.