What saves a man is to take a step. Then another step.
Antoine de Saint-Exupery
More and more individuals and families will enter the U.S. healthcare system in coming years, and it seems obvious that this in and of itself is a good thing. But as this trend continues, total healthcare expenditures will likely rise as well, which is not such a good thing. So, there is a rather clear and important question to be answered: How do we provide more and higher quality healthcare, to more and more people, while simultaneously lowering the cost of delivering that care? Is that even a possibility?
As with most big challenges, the answer is more likely to be found in little steps and little changes, rather than grand strategies and grand ideas. The use of innovative design thinking and strategies can be a big contributor to creating more efficient healthcare delivery, continuous improvement in quality, and lower total cost. Here’s a story that can illustrate how design principles applied to planning can lead to higher quality and lower cost health care.
I recently talked with a team of healthcare providers and a team of design thinking consultants who joined together to solve some interesting health care delivery challenges. Venice Family Clinic, a leading community health center in Venice, California, faced the challenge of opening a new children’s clinic serving low-income families, many on Medicaid, and many uninsured. A typical clinic patient would be struggling to balance work, family and school responsibilities, as well as financial, transportation and language barriers. As clinic leaders began the planning process, they made a commitment to addressing patient issues in advance, and to staying mindful of the need to control cost without compromising quality.
Laney Kapgan is the chief development officer for the clinic, and she recognized at the outset the need to avoid a business-as-usual approach. But how to do this? “We know,” Kapgan observed, "that more Americans than ever have health care coverage through the Affordable Care Act. But now the real work begins. How can we keep our families well and maintain a responsible position relative to cost?”
The answer was to adopt a design-thinking approach to building out the clinic and the patient experience. The clinic leadership asked Leon Segal and Scott Underwood of Innovationship to develop a design-based approach to building out the physical infrastructure, processes and systems of the new children’s clinic. They were glad to do this, and promptly took on the project . . . pro bono. They convened an energetic and committed team of design leaders, clinic administrators, medical staff and others and set about totally redesigning the patient experience, the clinical space, workflow and operations.
The premise of the combined teams was simple: Improve quality and lower cost. But it was the inherent contradiction in this premise that was the challenge. Oftentimes, quality, profitability and sustainability operate at odds with each other. But Venice Family Clinic’s team wanted to address both objectives – fostering good health and profitable, sustainable operations. This is why the use of design thinking was critical to their success. First, it helped to address inefficiencies and perennial organizational crises that interfere with healing and disrupt the patient experience. And second, it helped the team discover and apply paradigm-shifting innovations in how they thought of the entire health journey, from pediatrics to geriatrics.
As a starting point, the design team developed an action plan involving site visits, observations and interviews. This helped the clinical, operations and administrative teams see how working smarter could lead to a happier and more productive staff, and better care for kids. They then went into design action mode and began addressing the challenge of higher quality care, patient experience and cost control.
Anita Zamora serves as the clinic’s chief operations officer and was a member of the design team. As the design process unfolded, she saw the opportunity to “spark continuous improvement in health care. Design thinking provides a great framework, a great way of thinking, and can considerably improve health care experience and outcomes.” As with others on the team, she discovered the power of design thinking to help the clinic leadership address a number of challenges in new, and likely more effective, ways, from the most mundane to the breakthrough.
For example, the teams asked this simple series of questions: Should there be a check-in desk taking up most of the lobby? Should thirty waiting patients be funneled through six reception windows to receive care in the twenty two available exam rooms? Must the patients be left idle while they wait for care? Or is there a better way to use the clinic space and the patients’ time? The answers were: “No. No. No. Yes!”
This perspective on the patient experience led the teams to understand the reception area as an inherent problem of efficiency. They learned how pit crews at auto races rehearse to shave fractions of a second off their driver’s wait and then asked themselves: Could the receptionists at Venice Family Clinic choreograph their work like that? Then, in a typical design thinking turn, the team had another insight: maybe reception itself should be mobile. What if someone with an iPad or other tablet walked up and welcomed each patient individually?
As the team grappled with these workflow and experience challenges, Leon Segal suggested a novel prototyping approach. In collaboration with the Art Center College of Design in Pasadena and architects from Houston/Tyner in Torrance, the team created a full-scale mock-up of key functional areas of the future children’s clinic. The healthcare providers and operations staff then could actually move about in, interact with and role play in the space -- as they designed it. This real-world engagement with the space led the team to a final version that they liked even better than the initial plan.
The interplay of design thinking with the experience and skills of healthcare professionals led Venice Family Clinic to what they hope will be new levels of efficiency and improved patient experience. What the clinic team learned in this process is as much about the future as it is about the present. Leon Segal and Scott Underwood see this as a paradigm shift in how healthcare professionals can think about healthcare delivery.
By learning design thinking, those on the front lines of hospitals, clinics, and related service organizations gain the "creative confidence" to make change happen. This confidence boost requires a change in mindset from leadership as well, so staff is both supported and encouraged to apply their knowledge to improving the lives of everyone who interacts with healthcare professionals – that is, with everyone.
“In the end,” Segal thinks, “design is all about empathy. This is what leads to creativity, inspiration and breakthrough solutions to problems.”
Because the Venice Family Clinic team had the vision and commitment to utilize design thinking as a framework during planning, the results of their work will lead to better care and more efficient processes. And we are reminded that transformational leadership in healthcare can happen anywhere.
Henry Doss is a venture capitalist with T2VC, a volunteer in higher education, and a student and musician.
