Earlier this year, I participated in a panel discussion “Designing within a healthcare system: challenges and strategies” at HxRefactored 2016 on April 5, 2016. This post is rather late, but here are the slides to my talk “Design Is Culture,” which builds upon my earlier article “Design Tools for Social Engagement in Organizations”
After seven years of teaching art and design full-time at The University of the Arts in Philadelphia, last month I left academia to work as a designer in a large medical center. Last week I started as an experience design strategist at The University of Vermont Medical Center in Burlington, a large teaching hospital with over 7,300 staff and 450 inpatient beds. The transition is huge, not just for me but for my family, and we all left a lot behind in Philadelphia — family, friends, colleagues, a supportive community — to embark on this professional and personal Vermont adventure, which brings many unknowns.
The opportunity is a challenging new phase, and for me it builds upon a wealth of experiences, learning, and doing in the realm of social design, social practice, and community organizing. With my new role as designer embedded in a hospital, I’m not exactly sure how all of these threads intertwine, but I know that they have informed the practice and methodology which I bring to this environment. The truly exciting aspect of this work is being intentional in how the threads do intertwine within the scope of my role. I’ve been given a great deal of autonomy here to find willing partners interested in applying human-centered design to better people’s experience as patients, but also support their longterm health and wellbeing. And I am humbled by the potential and responsibility of my contribution to the domain of healthcare. As I dig into the work, I hope to continually share what I learn through the process with collaborators near and far.
I’m grateful to all of the friends, family, and colleagues who have supported me in getting to this point. This group of people includes fellow faculty at UArts and other design colleagues who have taught me a helluva lot about designing with the people we wish to impact. It also includes family members who have had to endure difficult experiences in healthcare and have therefore revealed so much to me about why this next phase of my professional life is so important and meaningful.
I recently had the pleasure to develop and lead two design workshops for first year medical school students at Thomas Jefferson University in Philadelphia at the invitation of Dr. Bon Ku, director of a new design co-curriculum in the medical school. The CwiC (College within a College) Design Track “seeks to foster creative thinking in medical students in order to assist them in developing novel and innovative approaches to challenges in healthcare delivery, research, and education.” This amibitious and visionary program will organize a series of design workshops, lectures, site visits, and capstone projects for a select group of students accepted into the program. This will be no small feat for the students to complete, given that this curriculum runs in addition to an already grueling schedule in the regular med school curriculum.
The first cohort of med students began the track in early February with a day-long design thinking introductory bootcamp led by David Janka, who is on faculty at Stanford’s d.school. After David gave the 15 students a crash course in the basics of design process, I then built on that foundation with two workshops focused on redesigning aspects of the patient experience in Jefferson University Hospital’s emergency department.
The first workshop helped them understand in more depth a suite of basic design research methods, and how these are so essential for understanding complex systems and services, and for building empathy with the people who are a part of them. With a set of contextual inquiry methods and tools in hand, the med students set off for the ER, shadowing physicians, nurses, other staff, and patients in different environments and processes. They returned to the following workshop with dozens of photos and pages of notes documenting what they saw and heard, as well as their initial interpretations.
With all of their raw documentation of the ER gathered, for the second workshop the med students began to make sense of the qualitative data through visualization techniques, affinity diagramming and stakeholder mapping. They created personas based on what they learned and who they had spoken to in their research, and then they used those personas to better understand the systems they were zeroing in on through user journey mapping. This helped them to identify a few pain points within the systems, which they then used to define a problem to address through rapid ideation and prototyping. Interestingly, many of the students had learned from patients about how frustrating waiting in the ER is (in various stages of the care process) and how uncommunicative the system is about wait times — not surprising for anyone who has visited the ER! What was so compelling was that each team of students had identified multiple and different underlying issues causing long waits and the associated frustrations. Each of their prototypes then attempted to either alleviate the symptoms of prolonged wait times, or tackle one of the root causes for wait times and poor communication.
These were very quick, albeit intense, experiences for the students, and they will continue to accumulate more of them over the coming semesters in the CwiC Design Track. The creators of the design curriculum believe that it will transform them as physicians and give them a new set of capabilities and mindsets rooted in design thinking, thus better equipping them to lead within an uncertain future for healthcare in this country. As an outsider looking in, I am impressed with how fearless and passionate the 15 med students are for embracing the design process. It’s exciting to be a part of such an important shift in how future doctors are trained.
To be sure, the very cause of the need for medical care and hospitalization is a factor in this shift in identity. The illness itself changes our perception of that person — as it probably does alter that person’s self-perception — and this change would seem to be connected to the severity of the illness. But there is also something powerful about the institution of modern medical care that objectifies people, overwhelms them, and somewhat disconnects them from themselves and their loved ones to a significant degree.
Having spent so much time within a medical institution as a visitor these past few weeks, I have been struck by sheer monumentality of the infrastructure and bureaucracies that comprise them. My own reaction to these has been one of both fascination and fear. When one enters the machine as a patient, one becomes a tiny object within it, thus subsumed to the alien logic of healthcare that hovers between science and magic. I mean “science” in that there is a great body of medical knowledge, method, and technology deployed in order to solve for the patient’s illness; and I mean “magic” in that there seems to be a surprising amount of subjectivity, guesswork, and dumb luck with respect to which treatments actually improve or neutralize a patient’s medical condition. According to this alien logic, the patient must become objectified as the focus of techno-medical processes which do a number of things to the patient. Amidst this mechanization, we look for glimpses of humanity which might restore some sense of connection to the non-medicalized, organic world: a kind word from a nurse and staff member, a story shared by another patient, an unscripted encouragement from a doctor.
When I look at my loved one lying in the hospital bed, I am faced by a person transformed by both her illness and the treatment prescribed for her. I see two identities: the one which I’ve known my entire life and the one, less familiar to me, which is the patient, surrounded by the apparatus of the medical institution. I wonder if this perception is a product of some failure on my part to accept the current situation — but might it also be a product of the failure of the medical institution to treat people as whole people? Either way, I struggle to reconcile these identities and tension between them.