Students in a two-day course offered by the Hasso Plattner Institute
of Design at Stanford looked for ways to improve the patient
experience in the Stanford emergency department.
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 Department 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 the New Stanford 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.