Patient Experience Lab: System Thinking in the Trauma Bay

Week 4: Avenues of Care

The challenge for this week was to figure out how to present the research results thus far to the collaborative partners, and outline the design directions. The preliminary research had yielded an understanding of the stages of the emergency intervention process, and pointed out around 45 observations of opportunity along nine avenues of care provision.

Kat crafted a clever design exercise for exploiting this newfound research organization. She had the whole design team sit down and watch a slideshow of all 45 of these observations. At each one, the team spent 5 minutes coming up with design concepts, either in sketch or verbal form. No idea was too outlandish (indeed, Kat was consistently in favor of just dropping patients in through the ceiling somehow).

This exercise generated a huge volume (9 x 45 = 405) of ideas. Many of them, perhaps due to juiced creativity within the time constraints of the exercise, were massively original and clever, and formed the core of the design approach from here on. Ideas like the "super-gurney," which I will be discussing frequently from next week on, and many of the architectural innovations the team has devised came from this relatively quick exercise.

Paperweights and Inspiration

I have a big metal paper-weight that says “There’s no inspiration like the deadline.” Week IV of this project saw the first real deadline: a collaborative partner presentation on Friday. Real thoughts were going to have to be presented to people with a real interest in the outcome of the overall project. Perhaps it was this looming pressure, but by early Thursday morning the team had established a new intellectual framework for the whole project and was busily reorienting and rearranging sketches, ideas and research into it. The new dynamic? Well, it had to do with cars.

Of Cars and Healthcare

“Ok, let’s put it this way,” said Alex Blue. “Your family has a family car. A Camry, or something. It’s reliable. It’s safe. It gets you where you need to go. You like it just fine. But perhaps it could use a new radio, because the current one is, you know, 1995-chic. And your Mom would really like a GPS, because although she gets places fine, she gets nervous about getting lost somewhere. And your dad would maybe like a new set of snow tires so he can get better traction in the winter. That’s what we’re doing with these,” he points to the wall to his left. “We’re not reinventing everything, we’re improving the current state of the art. Small fixes, that kind of thing.”

“And over here,” said Matt Supplee, gesturing and walking off to his right, “you’ve got the expression of the ‘Concept Car.’ You ever see those concept cars at auto shows? They’re radical. They’re expressions of what could be possible years and years down the line. With a concept car, you start with a blank slate and go from there.”

“We were finding that the bulk of our sketches and ideas were in either one or the other of these veins, with very little overlap,” said Nicole Latorre. “So we’ve got the family car expression, where we’re really making just relatively small but much-needed enhancements to the current state of the art. Then we’ve got the concept car expression, where we’re going with a totally clean slate. It’s a lot more revolutionary in concept.”

So these are the broad, perhaps vertical expressions of design thinking. The horizontal themes that cut across these two expressions are “Patient-Centric,” “Staff-Centric,” and “Critical Connections.” By “patient-centric,” the design team meant all topics and designs related to patient privacy, support, comfort and identification. Staff-centric designs embrace organization, efficiency and ease of use. Critical connections is an umbrella term for patient identification, the documentation process, communication, and information transfer and format.

Collaboration in Action

The presentation on Friday was attended by representatives from all the collaborative partners, and the design team.

The team started with a summary of their research results. They briefly recapped the history of emergency medicine and their research on different models of emergency care. They had looked at the military model, the European and Japanese models, and what happens (if anything) in the developing world. If this project were to have some kind of global appeal, it would have to at least be partially applicable to each of these systems.

The team then went through the stages of the intervention process, and started pointing out the observations they had made of where improvement was possible. They also displayed some of their preliminary sketches in the family car/concept car dynamic, and preliminary summaries of the focus groups.

Information and Drilling Down

I think it’s fair to say that the collaborative partners were impressed by the research thus far. But they had some thoughts. The partners honed in on how they thought the project was a lot more information-based than the team was letting on. Information management throughout the process should be a key factor, and it didn’t look like the team was considering it as a major design theme. This comment clearly hit home, as we'll see next week.

Others were rather adamant about “drilling down” the list of “unmet needs” for nurses, doctors and techs. For example, one of the chief desires of the nurses is, simply, more nurses. “Why is that? Do they really need more nurses, or do they need a changed environment or practices that makes much better use of what they have?" That’s the kind of thinking the partners were going for, and the design team clearly took notice. I've heard on more than one occasion since then that the team needed to "drill down," a phrase that was not in usage prior to this progress presentation.

Posted July 30, 2007 10:50 PM by Allan Tear | Permalink