Digest from #RSD2 by Peter Jones @designforcare at Relating Systems Thinking and Design 2 at AHO Oslo School of Design and Architecture
This digest was created in real-time during the meeting, based on the speaker’s presentation(s) and comments from the audience. The content should not be viewed as an official transcript of the meeting, but only as an interpretation by a single individual. Lapses, grammatical errors, and typing mistakes may not have been corrected. Questions about content should be directed to the originator. The digest has been made available for purposes of scholarship by David Ing.
European launch of Design for Care, publication is at http://rosenfeldmedia.com/books/design-for-care/
Presentation is available at http://www.slideshare.net/designforcare/european-book-launch-rsd-symposium-oslo
Introduction by Birger Sevaldson
[Peter Jones]
Trying to start a new program on healthcare design at OCAD
Current program on Strategic Foresight and Innovation, looking 50 years out
More policy work and large scale design
Rosenfeld Media started 5 to 6 years ago with craft-oriented book
Now on second generation design of book
Worked with James Caldwell on this book look
Two books before:
Team Design (now rarely used)
We Tried to Warn You: a single case study
Healthcare is different to talk about credibly, not a clinician
Had worked in point-of-care informatics
When deep in healthcare, it’s impossible to get context around the field
Depth becomes breadth
Book has 9 chapters, different cases, methods appropriate across different sectors
Person at home, in everyday life
Clinical context, providing care services
Organization / institutions in health policy
Stories about how people experience fragmentation
Main question: What if designers were included in the team, as care professionals?
Designers working in healthcare aren’t included uniquely, unless they’re in niche
Wicked problem
Designers are not helping systemically
Fields of design are fragmented
User experience / interaction design
Service design
Evidence-based design
Environmental design
Participatory design
Generative design
Disruptive innovation
Rethinking sociotechnical systems
Complex service systems, but they don’t benefit from the knowledge of service systems
In North America, no accepted design process
Institutions are reinventing design language
Sociotechnical systems, absent service design
Adapted from Humantific, 2007-2003: design geography, scales of design
Design 1.0: Traditional design
2.0: Product / service design
3.0: Organizational transformation design
4.0: Social transformation design
Healthcare involves all 4 levels
Complexity increases at each level
Design skills do not transfer up (and may not even transfer down, that well)
In healthcare, at various scales:
Design 1.0 and 2.0: Differencing, as opposed to making sense
Branding, clarity in communications
e.g. wayfinding can be done by a single experienced designer, not a team of designers
About making things stand out
Design 3.0 might have straightforward service design, e.g. providing vaccination
Could be designing IT services
Design 4.0: Healthcare may not be at level of transformation
In Canada, at current rate, healthcare will be 100% of tax dollars in 15 years
Integrating services to architecture, can’t touch on in book
Accountable Care Organization (coming with Obamacare) is a new business model being pushed down into organization
Financial incentives to push costs down
But following yesterday’s processes
Aren’t likely to change unless institutionalized
Opportunity for designers at policy level to make changes
A high-authority environment
Let’s get designers started in healthcare
Contexts of care services
Human
Work and activities
Organization
Industry
3 human-centered contexts
1. Persons, not users, or patients
People as health seekers, service customers
Evidence-based care, as scientific approach, almost ignores the perspective of nurses who take a strong care approach
2. Clinical work practices
Healthcare business must also be designed
3. Healthcare system
Design
Character: Elena
Single mother taking care of farther and daughter
Care giver’s journey
1. Health seekers
As human beings, we are homeostatic
Whether we aim for optimal health, or just normal health (where normals are measured differently)
Think of selves more as agents than as patients (unless we’re in bed)
Elena’s journey as situations:
Caregiving
Health incident
Diagnosis
Treatment
Living With
Coulter, Entwistle Gilbert (1999) Sharing decisions with patients, British Medical Journal: Information touchpoints
1. Understanding what is wrong
….
12.
An end point: Patients Like Me, started by a man whose brother died from ALS
Became a self-managed disease site
People track daily
Open and free
They are e-patients, agents in changing the way patients are treated
2. Designing for clinical services, around clinical informatics to answer questions at point of care
Doctors don’t want to read journal articles, or 14-page summary
They want 3 to 4 pages
Workflow today, IT wants to take templates that know have worked in past, and then adapt workflows
Richard Bohmer: Designing Care: Aligning the nature and management of health care, HBR press, talks about care contexts
Sequential services
Iterative services: a mix of conditions
Now 30% of patients are showing signs of diabetes or obesity in a mix of conditions
Care should be iterative
Uncertainty should be reduced during care, it’s like research through design
Improvements to treatment have to be done by trying them
More a problem-solving approach
Elena, seeing multiple specialists (for her fainting spell)
Elena is flooded by information
In clinical context, gold rush in Electronic Health Records systems number in hundreds, although only 5 are in use in the U.S. due to reimbursement systems
(Diagrams from book are available in Flickr)
Project Synapse, by IDEO and California HealthcCare Foundation 2012 (by Kauffman Foundation)
3. Healthcare Systems
Call Big Box Healthcare
Michael Porter: value-based healthcare system, driven by policy, not innovation
Cost will be the big disruptor
Center for Innovation in Complex Care in Ontario, Morra 2012 Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario
Patient-centred system
Value-Based Care, Porter and Lee in October HBR with Cleveland Clinic
Integrated practice units, distributed across organizations
Cost and outcome measurement
Designing Services to Scenario
To Design for Care is to Design for Health
[Questions]
Evidence-based medicine?
TR Reid, bad shoulder, reported across multiple systems
Can improve a lot of things in healthcare they won’t impact costs
Could be Health 3.0 or 4.0, may require policy changes
[Table of contents for book at http://rosenfeldmedia.com/books/design-for-care/table-of-contents/]
Table of Contents
Part One: Rethinking Care and Its Consumers
Chapter 1: Design as Caregiving
Chapter 2: Co-creating Care
Chapter 3: Seeking Health
Part Two: Rethinking Patients
Chapter 4: Design for Patient Agency
Chapter 5: Patient-Centered Service Design
Part Three: Rethinking Care Systems
Chapter 6: Design at the Point of Care
Chapter 7: Designing Healthy Information Technology
Chapter 8: Systemic Design for Healthcare Innovation
Chapter 9: Designing Healthcare Futures