I have the privilege of training at one of the most advanced, cutting-edge pediatric medical centers in the world. We have the most #1-ranked sub-specialty services in the country according to US News and World Report. As if having so many top-ranked sub-specialties wasn’t enough to be a center of clinical excellence, Boston Children’s has a particular niche because of its abundance of sub-subspecialists. I have consulted pediatric metabolic neurologists, cardio-geneticists, and neonatal pulmonologists. We have specialists in syndromes with acronyms that are common vernacular within the hallowed walls of BCH, but are usually perceived as alphabet soup in the real world outside of Children’s. And yet, I am continuously surprised to see that we (and most other medical centers in the U.S) lack a basic specialty that could be transformative in achieving the Triple Aim and increasing the value of care we are delivering. I hypothesize that large academic medical centers could dramatically improve clinical outcomes, decrease costs, and improve patient satisfaction if they had a “Design” consult team.
The Design service would be similar to most other consultation services whereby experts in a sub-specialty would be paged on an as needed basis to help the primary inpatient team answer questions outside of their scope of practice. Just like dermatologists are consulted to inquire about a perplexing rashes or neurologists are consulted about unusual palsies, designers could be consulted when there is a user-experience glitch that is impeding optimal care delivery.
I had an experience today that highlighted the need for a Design consult. I was working in an outpatient sub-specialty clinic and observed one physician attempt to train another physician on compliance requirements for meaningful use through our EMR. Both the trainer and trainee were frustrated. Clinic workflow was interrupted. Patient care was delayed. Although no patient was directly harmed, the experience left all parties involved dissatisfied. If this level of dysfunction can occur at the #2 children’s hospital in the U.S., I am afraid of the challenges that may be faced by other care delivery systems when implementing meaningful use. Design consult, stat!
If there was a Design team available by page, we could have consulted them to at least assess the problem. Like many sub-specialty services, there are many tools at the specialist's disposal to assess and manage a consult, but I propose we start with the basics; the Design consultants could have come to the clinic and gone through a very quick design exercise including the following steps:
The designers could have observed the frustrating workflow inefficiency of an overqualified trainer disrupting the busy trainee in their care delivery (empathize). They could then define a major problem by eliciting the frustration from the trainee with an imposed new workflow that they do not perceive as a benefit to the provider or the patient (define). The designers could then empower the involved parties to brainstorm what an ideal scenario for training may look like, such as a no-pressure, reimbursed training experience with ample opportunity to practice and education about the intended goal of the meaningful use intervention (ideate). This could be followed by implementing a very small sub-component of the ideal scenario, such as having the trainer and trainee both look up the intention behind meaningful use certification on EMRs (prototype). By quickly searching the internal or external web resources, the providers could quickly discover the published justification for meaningful use which includes evidence suggesting fewer medication errors and better patient engagement when certain elements of meaningful use are implemented. The impact and learning from the prototype intervention could then be used to inform future meaningful use training experiences to improve workflow and provider satisfaction (test).
The benefit of the aforementioned design consult is a potential improvement in patient or provider experience, or at least identification and codification of the core elements of frustration. Defining the problems allows for measurement of the problem and measurement enables improvement.
The challenge that the design consult creates is an additional time burden on the provider team in order to provide the requisite information for the designers. But this is not much different from the primary clinicians providing a background history and rationale for their consult to a dermatology or neurology consultant.
Similar to other consult services, the Design team could complete part of its assessment and/or intervention immediately or inpatient and then ”follow up outpatient” for more long-term or in-depth design work on the problem requiring consultation.
Unlike most other consult services, the Design team is a generalist service that could be called upon to help with provider workflow issues, patient satisfaction issues, management challenges, branding concerns, or any other non-clinical issue whereby the problems may not be perfectly clear and the solutions to those problems are even more nebulous.
The ideal composition of the Design consult service could mirror traditional teaching-hospital consult services: a full-time designer experienced in healthcare, a full-time clinician (does NOT have to be an MD) experienced in design, couple of fellows, and some med students. And there you have a swat team that will guide patients and providers through their user experience challenges, potentially propose some solutions, and even prototype in real time with follow-up “outpatient."
Having a dedicated design team within a care delivery system is not a novel idea; Kaiser Permanente and Mayo Clinic have fully fledged design armies dedicated to solving large and small challenges within and outside of their institutions’ walls. Both are top-ranking healthcare delivery systems, which begs the question when U.S. News and World Report will develop a measure for ranking sub-specialty programs in healthcare design services!
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