Design thinking as a way to improve patient experience

Stan Nowak, PhD, a physicist at the SLAC National Accelerator Laboratory, typically spends his days using X-ray spectroscopy to understand the chemical and electronic properties of matter. But on a recent Saturday afternoon, he played the role of the estranged father of a fictional young woman brought into a simulated version of Stanford Hospital’s emergency department after an automobile accident.

The patient — actually a high-tech mannequin voiced by a woman in a nearby control room — was conscious on a gurney. “Oh, it hurts,” she said. “Ow, that really hurts!” 

Ten genuine Stanford doctors, nurses and technicians provided simulated care to simulated patients. 

The exercise was part of a two-day course in design thinking offered by the Hasso Plattner Institute of Design at Stanford, known informally as the d.school. Nowak was among the 14 students in the class. Their goal was go find ways to improve the patient experience in the hospital’s emergency department. For the exercise, they played patients and their family members to get a sense of what it actually feels like to be in the often-chaotic atmosphere of an emergency department.

Empathy is a key element of design thinking, a step-by-step approach to problem-solving that involves observing and interviewing people as they go through an experience, and then using that information to prototype and test ways of improving the product or process.

For example, before building a better toothbrush, a product designer would go into people’s homes, watch them brush their teeth and ask them about the experience.

The emergency room experience

Design thinking “is a way for health care to make changes by empathizing with our patients and their families,” said Alpa Vyas, Stanford Health Care vice president for patient experience. “We want to know what their unmet needs are. Our patients have told us they want us to know them and to understand them. Applying design thinking to health care is an invaluable way for us to do that.”

The class’s focus was on care in the emergency room — not the medicine, but the experience. Design thinking’s process, which begins by asking people how they feel, is a good way to get to that type of information. “We know that if we control pain and take care of the medical emergency quickly, we are doing our job,” said one of the class’s teachers, Alexei Wagner, MD, MBA, a clinical instructor of emergency medicine, visiting lecturer at the d.school and assistant medical director of the Department of Emergency Medicine. “We wanted to know what else we could do.”

Stanford junior Kinjal Vasavada, one of the class’s 14 students, developed a new appreciation for how change could evolve in medicine. She had participated in other d.school classes, but she said that until she entered this one, she wasn’t sure if she could find opportunities to apply design thinking to medicine, but “this class proved me totally wrong.”

Interviewing patients, families

On the first day of class, the students interviewed patients and families about their experiences with medical care. Later that day, they took part in the exercise.

The simulation “added the value of walking in a patient’s shoes, an emotional value that complemented the interviews,” said Emilie Wagner, a design strategist who co-taught the class with Marney Boughan, another design strategist who trained with d.school co-founder David Kelley, the Donald W. Whittier Professor in Mechanical Engineering at Stanford.

“Suddenly, our students could empathize,” Wagner said. “It’s a tool that encourages students to step out of designing for themselves and trust the people they’re designing for.”

That first day produced an abundance of material to guide the class’ second day of prototyping: Certain themes were quickly evident. Patients wanted a regular flow of information to help them better understand what was happening, and they wanted to know that their care providers were communicating with one another. Coordinated and clear communication, they said, would do much to relieve their heightened anxiety and fear.

The participants concluded the class by presenting their research and ideas to hospital administrators and emergency medicine professionals. With the support of S.V. Mahadevan, MD, associate professor and chair of emergency medicine, and Alison Kerr, vice president of operations at Stanford Health Care, “we are looking into some of the ideas that were presented,” Alexei Wagner said.  “I don’t think that we’d be doing this if we hadn’t had the class.”

Design thinking for new hospital

SHC administrators have also incorporated design thinking into planning the new Stanford Hospital, scheduled to open to patients in 2018.

Recently, SHC staff used design thinking to complete a plan to redesign two nursing units in the current hospital to serve only patients with cancer. “Patients and their families were involved from the start,” said Helen Waters, a design and innovation leader with Stanford Health Care. “We wanted to know what they needed and what they felt was missing.” 

The process included seven months of conducting interviews and tabletop exercises and simulating actual work routines in the proposed layouts of the nursing units to be redesigned.

Design thinking is becoming more enmeshed in all aspects of SHC’s workings, Vyas said. “We do a lot of teaching and training across the system,” she said. “We also have a d.school faculty member consult with us on a regular basis. We are looking for ways to complement the other improvement efforts we are making through the Stanford Operating System,” which is SHC’s improvement and management system.