Design Thinking for Doctors and Nurses

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The trauma area at my hospital is similar to thousands of others. When a patient with a gunshot wound or a motor vehicle accident arrives, a bed is prepped, the right supplies are on hand, and up to 20 nurses, respiratory therapists and physicians are ready to spring into action.

There is one difference: The leader of our trauma team now wears an orange vest.

The easy-to-spot garment, called the trauma team leader identification vest, clearly identifies who’s in charge. It’s a simple yet effective innovation created by a nurse after a hectic gunshot trauma simulation, in which a huddle of highly stressed emergency room staff members spoke over one another and there were no clear roles. In particular, no one knew who was leading the trauma code. The orange vest became routine part of emergency care at our hospital earlier this year, and the trauma team reports it has helped clarify who’s in charge and strengthened communication among members.

The innovation also illustrates why hospitals should support novel ideas by all members of the health care team. Health providers are good problem solvers, and because they work in the hospital and other health care settings are uniquely positioned to come up with fresh solutions to health care problems.

In recent years, a growing number of health care workers have been stepping up to create innovations by applying “design thinking” – a human-centered approach to innovation that was originally developed in the business world to create new products. Traditionally, hospitals were designed with input from administrators. With design thinking, the innovations come from those who actually work there, providing feedback to designers to improve the final product.

A 2016 report that looked at ways in which a health system can implement design thinking identified three principles behind the approach: empathy for the user, in this case a patient, doctor or other health care provider; the involvement of an interdisciplinary team; and rapid prototyping of the idea. To develop a truly useful product, a comprehensive understanding of the problem the innovation aims to solve is paramount.

“Design thinking is useful for when we need a paradigm shift, for instance when something is fundamentally broken about a service,” said Thomas Fisher, one of the authors of the report and the director of the Minnesota Design Center at the University of Minnesota. “It allows for the creative, multidisciplinary thinking around solving the issue.”

At Thomas Jefferson University in Philadelphia, where Dr. Bon Ku serves as director of the Jefferson Health Design Lab, medical students, nurses, doctors and other hospital personnel are given the freedom to design, manufacture and prototype their ideas, which they can then present back to the hospital. One of the innovations the lab has fostered is a new pediatric pain scoring system called CareCube.

Normally, patients are asked to rate their pain on a score of 1 to 10. But health care workers at the university recognized that a toylike object could be at once both more inviting and more effective for children. Each of the six sides of the cube has a facial expression, such as a frown or a grimace, that corresponds to established pain scores. When asked about their pain levels, children in the hospital can simply take the cube and point to a face, which helps the nurse decide if their pain is being managed well.

This year, Dr. Ku, an emergency medicine doctor, and his colleagues introduced a course that pairs medical students with architecture students. The group is using design thinking to develop a digital mapping tool that uses GPS-like software to understand how patients, doctors and nurses move about and interact in the emergency room, with the aim of improving communication and decreasing wait times.

A design thinking approach was used by a group of researchers at McGill University in Montreal, who found that the closer a sink was to a patient with Clostridium difficile, a hard to treat and highly contagious hospital infection, the more likely hospital workers were to wash their hands after seeing the patient. The lead author of that study, Dr. Yves Longtin, says that to improve hand-washing rates, most clinical care at their hospital has been moved to a newer part of the building, where sinks are installed within plain sight.

Health care workers may also invite patients to the health innovation table. At the University of Michigan, Dr. Joyce Lee, a designer turned physician, is a co-leader of an interdisciplinary collaborative called Health Design By Us. The group supported a patient-designed mobile system for diabetes management that grew out of the work of one young patient’s father who was looking for easier ways to monitor and report his child’s glucose levels. The system, called Nightscout, attaches to the patient’s glucose monitor and transmits digital readings to the cloud, where they can be easily accessed through a phone, tablet or smartwatch to ultimately guide clinical decisions in real time.

Online communities that support innovation are also springing up. Dr. Diana Anderson, an architect who went on to get a medical degree, was a co-founder in 2016 of Clinicians for Design, an international network of health care providers. The group offers online discussions as well as workshops and digital resources, with a focus on improving health care delivery and the hospital’s physical layout.

When I think of something as basic as a bright orange vest, it amazes me that such a simple and inexpensive idea from an experienced nurse could lead to improvements in how real trauma cases are handled. By fostering simple innovations through design thinking in hospitals, we can tackle many challenges in the hospital in new ways, saving both dollars and lives.