Everything in Healthcare Is Design

I've been thinking a lot about health and communities lately, what with Steve Downs' building health into the OS vision, Alphabet's CityBlock initiative, and -- oddly enough -- Amazon's recent narrowing of candidates for their HQ2.  I've even written about how what "local" in healthcare might mean in the near future. 

But I keep coming back to Dr. Bon Ku is doing at JeffDESIGN.

I am somewhat late to this game.  Dr. Ku co-founded JeffDESIGN three years ago, as a "college within a college" (it is part of the Sidney Kimmel Medical College of Thomas Jefferson University).  Since then it has received local, regional, and national attention.  Dr. Ku has done a TEDx talk on their efforts.  So I'm not exactly breaking new ground here.

More importantly, though, they are.

Basically, the goal of JeffDESIGN is to teach medical students "to apply design thinking to solve healthcare challenges." As obvious as that might seem, they believe it is the first such program in a medical school. 

Their Health Design Lab is located in a former bank vault (pictured above).  It looks more like a start-up than a medical school classroom, full of configurable tables, computers, whiteboards, even 3D printers.  As Robert Pugliese, JeffDESIGN's associate director says in the video below:

Space is powerful and it changes the way you think.  Everybody in the academic environment is so used to these big stadium-style rooms where you have one person in the middle of the room and everybody else is supposed to be quiet and take notes. You start to realize that that’s not an environment that’s conducive to creative thought.

Students get to take on actual problems in the healthcare system, develop solutions, prototype them, and perhaps see them put into use.  Dr. Pugliese told NextCity:  "These kids are all going to graduate as physicians, and they’re going to have a whole new language that nobody who’s ever graduated from a med school has had before."

That's pretty cool.

Dr. Ku is by training an ER physician, and his experiences there shaped his views of the broader forces impacting health.  As Dr. Ku told NextCity

One of our mission statements is, how do we design healthier cities?...Some people argue that’s not the health system’s job, that’s a public sector job....I want caring about these disparities and social injustices to be in the DNA of physicians.

And, remember, this program -- and, presumably, this point-of-view -- is unique among medical schools.  It shouldn't be. 

We simply don't think enough about design in healthcare.  Not the right designs, for the right reasons.  In a a podcast for Knowledge@Wharton, Dr. Ku complained that:

We settle for design mediocrity, like I said. When we design hospitals, we should want to design the best and most beautiful building which happens to be a hospital, but instead, we design mediocre buildings.

He went so far as to say: "most of us don't realize that everything in health care is design."

Think about that:  Everything. In. Health.  Care. Is. Design.

None of this is to say that Dr. Ku and JeffDESIGN are the only ones emphasizing design thinking in healthcare.  In a 2016 NEJM Catalyst article, Dr. Ku and colleagues gave credit to some of the early leaders, including Kaiser Permanente and The Mayo Clinic.  The indubitable Dr. Joyce Lee --  Doctor As Designer -- constantly preaches this way of thinking.  Design firm IDEO pushes it in their design and education efforts. 

There is no shortage of people who know we need more design thinking in healthcare.  There may be a shortage of them, but there are smart people who are actively working to apply it to our existing healthcare system. 

The problem that JeffDESIGN has, through no fault of its own, is that even if all physicians were similarly trained, physicians can't change everything that needs to be redesigned (or, as some would say, actually designed) -- not in healthcare and certainly not in our society. The problems go much deeper.

To name a few:

• We have medical schools and academic health centers that design programs to teach medical students/interns/residents much about health problems, but not so much about health;
• We have medical facility designers who build those "mediocre buildings" Dr. Ku doesn't like;  
• We have urban designers who plan all those tall buildings, roads, highways, parking lots, retail and housing units, hopefully a park or two, that we live and work in;  
• We have software and hardware designers who have led us into the tech revolution that has profoundly changed our lives;
• We have automobile designers that have turned us into a nation of car addicts, and are now working on 21st century versions that may be self-driving computers-on-wheels;
• We have food designers who know how to most effectively deliver foods that tickle our cravings.

Too many designers are designing only within their bubble, and no matter how well designed that bubble is, all-too-often they don't think enough about how their bubble overlaps with the others.  Our health is impacted by everything we touch and interact with, and many of those interactions are not designed with our health in mind.  

Design thinking in healthcare isn't about making the process of getting medical care easier, although it should do that too.  Design thinking in healthcare should be about making the process of being healthy easier.  That's a much taller order of magnitude, and that's what Steve Downs meant by wanting to build health into the "operating system" of our daily lives.  

Dr. Ku, Dr. Lee, and the folks at IDEO would all agree: you don't have to be trained as a designer to use design thinking.  Dr. Ku boils it down: "I think at the core of human-centered design or design thinking is deep empathy for the end user.”

Certainly anyone working in or around healthcare should have that.  

Patients aren't the end users.  People are.  Care is not the end result.  Health is.  Let's design for them and for that.  If you don't have that kind of empathy, maybe you should be doing something else.