Innovation and design thinking as a tool
Editor’s note: The following column explores patient safety from the perspective of a newcomer to the field. Columnist Catherine Hinz, MHA, is the patient safety lead at HealthEast Care System in St. Paul, MN. Prior to taking her position at HealthEast, Hinz worked for seven years as an ED health unit coordinator, completed a patient safety internship with the Agency for Healthcare Quality and Research, and finished a residency experience with The Studer Group. In her monthly contribution, she will express her thoughts, emotions, and ideas related to patient safety.
Innovation and design thinking is a fascinating methodology that holds much promise for healthcare. Although other industries, such as manufacturing and telecommunications, have harnessed the power that design thinking can hold, healthcare is just beginning to truly embrace and apply some of the innovation maxims.
Utilizing the principles of design thinking with medical devices, pharmaceuticals, and the built environment, for example, has led to big payoffs in healthcare in terms of quality, access, cost reduction, and revenue generation. However, using design thinking in less tangible ways, such as with process and system design for improved patient safety, is still in the early stages.
The basic tenets of design thinking are incredibly applicable for the process of delivering care to patients and developing patient safety practices. Design thinking demands that we:
- Think big, start small, and move fast. Patient safety projects can quickly get stifled in organizational red tape, the mantra of “we’ve always done it this way,” hierarchical boundaries, and so on. Proposing a near impossible idea in a room full of executives is a scary thing to do. However, in the end, doing so gets you much closer to true innovation. Small tests of change are also important: Plan-Do-Study-Act, rapid cycle improvement, and Define-Measure-Analyze-Improve-Control processes all share a commonality of pilot testing small changes. Finally, move fast—successes, results, and failures will be brought about sooner, providing a richer platform for making real progress.
- Welcome failure and ensure that it happens often throughout the design process. You cannot design a process perfectly from the very beginning. Team members, leaders, and frontline staff members need to embrace failure as a part of the iterative improvement process. Fear of failing can inhibit and slow progress.
- Ingrain the exercise of prototyping. This is meant to fuel idea generation and work through unforeseen barriers. Prototyping gives people a tangible way to think out loud and arrive at solutions in a just-in-time manner. Prototyping includes physically building models of a final product, doodling ideas on paper, or even role-playing a certain service interaction. With minimal cost and time investment, talk about a valuable learning experience that would improve the process going forward.
- Experience and observe the life of frontline customers (and engage end users). This immediately sparks ideas to meet needs that previously went unnoticed. Before kicking off any project, I spend hours on a nursing unit or OR watching our frontline staff and taking notes. For example, we needed to improve the timeliness and documentation of critical lab values at each of our hospitals. I spent more than eight hours observing and interviewing nurses as they worked on units during multiple shifts. I learned information I never would have had I simply invited nurses to offer their input during a work group session. The lessons I learned by watching the nurses work on their unit guided the rest of the project.
- Capture the brainpower and wisdom of the crowd. The crowd, of course, being diverse in nature and free from hierarchical barriers and stereotypes. The language alone excites me—capturing, sparking, prototyping, engaging, provoking, animating, teaming, branding, iterating, experimenting, imagining, etc.
The patient safety industry is desperately in need of an energetic approach to process design. Spend only minutes on a Web site like IDEO, the innovation giant, and the fun of this approach pulls on your imagination strings. Firms and organizations all over the world (healthcare included) are beginning to engage all types of designers to solve problems in ways never done before.
Recently, many patient safety professionals have been discussing the 10-year anniversary of To Err Is Human and questioning whether we have achieved measurable improvement since the release of the report. The aggregate response, no matter how it’s been measured, is that progress has been slow and minimal.
Enter design thinking and innovation
The real icing on the cake is that the product of a new, innovative process can result in less patient harm and improved patient safety. In many healthcare organizations (i.e., those I’ve had the opportunity to be a part of, observe from afar, or research), patient safety is often seen through a lens of process improvement and quality management. I agree with this approach; there are many aspects of patient safety that require certain amounts of tweaking, reinforcement, amendment, and development. However, I believe that some of the purely transformational leaps in patient safety have come out of creative think tanks that don’t solely ask, “How can we improve?” but instead ask (and eventually answer) something more akin to, “How can we create a new way?”
That is why I get thrills from design thinking. The emphasis of design thinking and innovation is right for patient safety—it is intensely placed on our “end users,” the patients and staff who experience incredible healing and care in front of us each day. Process improvement, on the other hand, can become enveloped by rules, regulations, constraints, targets, goals, measurements, and scorecards—the patient-centered focus gets lost in the mix. The design methodology goes beyond improvement; it breaks through organizational red tape and routine meetings to deliver awesome revelations. It can bring us solutions customized for feasible and successful implementation.
There are barriers to using design thinking and innovation methodology. In many cases, the barriers might be the actual teams of people we’d want to join in on the creativity. Tenured leaders and seasoned employees are comfortable in the organization, know what to expect, and, in many cases, work in patterns and habits—essentially supporting business as usual.
This can run contrary to what innovation demands. Creative sessions will require that people move out of their comfort zones and be willing to try things in daring and different ways. In multiple organizations and settings, I’ve attempted to conduct meetings that embrace design thinking. Colored sticky notes, music, videos, magic markers, tape and glue (for prototyping, of course), candy, off-site venues—these are all ingredients for stirring brainpower with the intent of improving patient safety.
Although sticky notes and markers are easy to bring to a meeting, it is difficult to bring humor and good fun, break down hierarchy, and encourage others to move away from the comfortable norms of highly organized meetings. The good news is that we, as patient safety leaders, are finding ways to break through this culture under the premise (and promise) of patient safety. Many organizations are creating “safe” places to do this sort of planning—under the guise of centers for innovation or design labs. Although many dedicate and reserve these areas for strategic planning, marketing, or product development, patient safety deserves a rightful spot at the table of innovation.
It is no small task to somehow inject fun and innovation into patient safety. How can you when the threat of patient falls, medication errors, or patient misidentification can result in harm and death? I don’t pretend to think that this is a breezy process. Innovation is hard, and design thinking can be exhausting. Yet it is the optimism of arriving at a new, safer way that makes it valuable and indispensable for our patients.