Applying Design Thinking to Healthcare
It started with a phone call and a conversation with my mother in law regarding the design of a patient’s experience in a waiting room
I was inspired to write out how I would go about solving this problem and sent her an email detailing my process. Of course, this is not uncharted territory — both Stanford's d.School and IDEO have paved the way to push “Design Thinking” into the mainstream.
How might we improve the patient’s experience in the waiting room so we can enhance their overall satisfaction and increase the number of return visits? I decided to outline my thought process on this topic.
Design Thinking
In the following paragraphs, I explain how I’d approach this problem using Design Thinking. Design thinking is a methodology that provides a solution based approach to solving problems. It quickly breaks down like this:
Step 1. Empathize: Seek to understand. Interviews. Non-Judgemental. Observations. Shadowing
Step 2. Define: Roles. Challenges. Pain points. Personas. Involves reframing the problem in human-centric ways.
Step 3. Ideate: Share ideas. Big brainstorming. Yes, and. Prioritize objectives
Step 4. Prototype: Mockups. Simple. Fail fast. Iterate quickly. Hands on.
Step 5. Testing: What works? What doesn’t? What can be improved upon? Start over.
Problem statement:
How might we enhance the patient's experience in a waiting room so we can improve their overall satisfaction and increase return visits?
Empathize:
I start by using empathy to understand who is impacted by the problem and what specific issues they are having. Before I can focus on putting forth solutions, I need more details. Using a combination of interview methods, in person studies, and observation I’d set out to answer the following:
- Who does this problem impact?
This is who we’re trying to help.
- Who else does it impact secondhand?
Other people will benefit from the solutions, besides the main identified persona. Who might they be?
- Who does it impact that we aren’t thinking about?
There's always someone this problem impacts that aren’t considered in the initial research. Its good practice to identify these outliers.
- Who is paying for this to get done?
This is important. Who is funding this project?
- What is the patient’s overall journey?
Every “touchpoint” in a patients journey needs to be identified and understood. From the moment their appointment is made until they leave the doctors office (and everything in between). It is important to think about emotional reactions as well as physical actions as well.
• What did the patient eat for breakfast?
• How did the patient arrive at the doctor's office?
• How does the patient feel about their upcoming visit?
• How do they feel about a recent diagnosis?
Here is an example of what a typical customer journey map looks like. Each journey tells a “story” and is helpful to understand how an experience can be improved by looking at the whole narrative in a holistic manner.
- What is the average time per patient in a waiting room?
This will be helpful if a goal is “reduce wait times”.
- Do certain providers have a history of making patients wait longer?
Since human beings are more than just numbers on a spreadsheet, additional analysis will be done to understand what factors contribute to this outcome. Digging deeper I could learn that:
• This specific doctor likes to spend extra time with her patients. She wants to make sure the patient is comfortable with a treatment plan or diagnosis
• The doctor is in high demand and is double booked on a regular basis
• The doctor is often called into emergency surgery with no notice
• This doctor is overscheduled, tired, doesn’t get proper breaks and is 36% more likely to make a life-threatening mistake.
By using empathy to understand “human problems”, additional areas for improvement will usually be identified.
Define
I would start by asking who are we improving the experience for: We identified “patients in a waiting room” and will focus on this primary persona. We’ll identify a handful of individuals that benefit from the solution.
Other personas that can benefit in this specific scenario could be:
- A practice manager
- A physician
- A Nurse
- A practice administrator
This is what a sample persona looks like. They don’t have to be fancy and capturing the information in a spreadsheet works just as well.
WHAT are the biggest problems that patients are experiencing in the waiting room?
There are a few ways to find this out:
1. Interviews with different patients to find out their biggest “pain points” with the waiting room experience
2. Observation and analysis
3. Short surveys (exit surveys, in-person surveys)
Using these methods, I’ll come up with a list of assumptions surrounding the identified problem. I’ll validate them throughout the design thinking process.
Taking a look at “Pain Points”
Next, I’ll take a look at a list of pain points I’ve captured and group them into categories.
A sample list of pain points for this scenario:
• The patient feels like their individual needs do not matters
• A patient has been waiting for 40 minutes even though they showed up on time
• The reading material is unintentionally making patients feel worse (Shape Magazine, Cosmo)
• The dull lighting creates an atmosphere of sadness and boredom
• Close proximity to other patients breeds resentment
• Uncomfortable furniture
• Outdated interiors lend to a feeling that their care providers don’t think their comfort matters
Organizing my ideas (at any stage)
After a workshop, a brainstorming session or several interviews the results can be overwhelming! How do I go about organizing all the “insights” and data that come from these activities? My personal favorite is to use something called an “affinity map”. This means I cluster and organize ideas based around a common theme. An affinity map is another design thinking “tool” that can be helpful in “sorting” ideas at any stage of the process.
There are several ways to organize ideas but this is a my personal favorite for two reasons:
1. It can be done quickly — If I’m running a workshop where participants use sticky notes to brainstorm, I can quickly organize an affinity map while the group is working on another activity (or even on their lunch break)
2. I’m a visual thinker — This activity allows me to see everything in front of me and make changes as often as I’d like. It allows others to get involved and becomes a highly visible, group collaboration activity
Here is what a sample affinity map looks like:
Ideate
A design thinking workshop is a great place for ideation to take place. The workshop usually starts out with a “How might we” prompt and results in an activity where everyone is involved in defining the objective for a project.
The premise is: get the “right people” in a room together for a couple of hours (or days) and encourage them to align on big decisions. Together they’ll brainstorm, think “big” without constraints and get a little silly. You might find the CEO sketching ideas alongside developers, product managers, designers and the head of finance. When the workshop ends, everyone is excited and ready to enable the right resources to execute the “big vision”.
I’ve started workshops where high-level business leaders roll their eyes and scoff at the idea of “getting involved” in unconventional ways but by the end, they always want more! I’ve attached some resources at the bottom of this article of Design Thinking workshops.
The next part happens really quickly — because our motto with design solutions is to “fail fast and iterate”
Prototype
We start implementing these solutions as a “prototype” and gather feedback on them as fast as possible. The prototype can be as simple as a room “staged” to look like a waiting room. Real life participants would be guided through the different touchpoints in this room in order to gather feedback related to the patient experience.
A prototype can be a few pieces of paper, made to look like an application or software.
We iterate these solutions based on real feedback. It's a cycle of test, feedback, iterate, test, feedback, iterate. Sometimes this process can take years, sometimes months or even a few short weeks.
Set Goals that can be measured
Patient satisfaction is an easy goal to measure. This can be done with exit surveys, voting style machines in the waiting room and in a number of different ways.
Other types of goals:
- Increase revenue by a %
- Lower waiting times
- Return visits
The outcome is a multi-phased solution:
- Patient Information Stations: Deliberate “stations” for patients in the waiting room. Netflix in a booth, brain games on an iPad, informational reading material in another
- Environmental Factors: A team of industrial designers will be called upon to analyze the furniture and provide the most ergonomically comfortable solutions. Ambient lighting to improve mood and stability -
- A software team: To build an algorithm that helps predict wait times based on last-minute scheduling changes in the back office. A companion app to go along with it
- Clear and welcoming signage: Doctors’ waiting rooms can feel terribly impersonal and bureaucratic. I recommend boards that introduce the doctors on duty (complete with portraits, so they aren’t just faceless names) with information about healthy activities and classes.
- Healing hearts room: An area for patients that have just received bad news that focuses on comfort. Tea, tissues and a safe environment (drawn upon from personal experience).
Design Thinking Resources
Design Thinking in Harvard Business Review
Design Thinking 101 from Nielson Norman Group
A great resource from Stanford on how they run their Design thinking workshops
