Design thinking is an innovative way to generate value in health care
Health care is Ontario’s largest public expense at 38.7 percent of the budget. Ontario is expected to spend $51.8 billion on health care in 2016-17 and while considerable work has been done to “bend the cost curve” at the sector level, more needs to be done on the ground.
Innovation can propel Ontario’s health care sector into one that delivers greater patient outcomes at a lower cost. Design thinking is one way to systematically empower health care providers to become innovators and generate cost savings and efficiencies from the bottom up.
Increasing value in health care
Many large-scale, cost-cutting exercises are underway. Through the Patients First: Action Plan for Health Care, initiatives such as Health System Funding Reform and the integration of the Community Care Access Centres (CCACs) into the Local Health Integration Networks (LHINs) are changing the way health care is funded in the province by bundling payments and considering the end-to-end patient journey through the health care system.
But in addition to cutting costs, we need to also consider the outcomes. Michael Porter argues that health care should be measured based on value or the patient outcomes per dollar spent. One of the greatest criticisms of our provincial health care system is that Ontario spends 33 percent more per capita on health care than the OECD average, but the improved patient outcomes do not follow. By Porter’s definition, we are not benefitting from the value that should be generated based on our health care spend.
To improve value, we need ways to promote better patient outcomes or decrease costs. Innovation can achieve both simultaneously but it must be embraced by every heath care provider in the sector to ensure that small changes and efficiencies flourish and multiply to become system-wide improvements. By adopting innovative approaches to create value, cost savings can be diverted to other areas of the economy to drive productivity and growth.
Empowering health care providers to become innovative cannot be done without proper tools and a culture of innovation. On culture, the Institute’s 24th Working Paper, Licence to innovate, calls on government to embrace innovation in its policy design, process, and implementation within a culture of collaboration and focus on end users. As the majority of the health care providers in Ontario are publically-funded, this culture of innovation must not only permeate the many ministries of the provincial government, but also its funded entities.
For tools, design thinking is an innovative way to implement change quickly.
What is design thinking?
Design thinking has applications for a multitude of sectors including health care. It gained traction in the early 1990s when the design and consulting firm IDEO was established. Initially IDEO worked on traditional design projects for products such as Oral-B toothbrushes and Steelcase chairs. A decade later, IDEO began to apply design thinking to not only products but to improving the customer experience.
Within health care, design thinking promotes a new patient-centric approach to solving problems. Design thinking applies a designer’s sensibility and methods to meet patient needs using technology and business strategy. There are three, non-linear steps: empathy and deep user understanding (often done through observation and interactions); concept visualization or prototyping potential solutions; and strategic business design to implement the solution.
By emphasizing and taking on the lens of the patient, the health care provider or “innovator” can learn to understand the patient. In a hospital setting, this is often done through observation and interacting with patients. From there, the innovator can develop a concept or possible solution (known as “ideation”), and prototype quickly to get feedback from the patient. Finally, when a possible solution is found, the appropriate business strategy is applied to it. Sometimes, business model prototyping may occur to identify the best way forward.
Design thinking and innovation in health care
One of IDEO’s first successful design thinking projects was in health care with Kaiser Permanente, a US health care provider. Design thinking was applied to improve the nurses’ hand-off process. The inter-disciplinary project team first observed and interacted with nurses in each of the four hospitals and then developed and rapidly prototyped potential solutions. The team videotaped the proposed process and presented it for quick feedback. Once the feedback was incorporated and the final solution was implemented, Kaiser found that the new process halved the hand-off time and improved communication between nurses. Time saved allowed nurses to provide more care to patients. Improved communication can also decrease medical errors, a massive cost to the health care system.
Often companies look to educational institutions such as the Rotman School of Management’s I-Think Initiative to learn about design thinking. In fact, the Institute previously piloted such a program to grades 5 to 7 students. In the US, IDEO conducted workshops to teach front line medical staff and administrators design thinking to help improve the overall quality of patients’ and medical practitioners’ experiences. Both educational institutions where students learn and hospitals where students and staff are trained are natural places to teach design thinking and empowers all types of health care professionals to become innovators. In addition to educational institutions, the University of Ottawa’s Skills and Simulation Centre, a joint venture between the University and The Ottawa Hospital, offers a place to simulate and prototype processes for both students and staff.
Design thinking lends itself well to innovation because it can be applied to both tangible innovations such as products or technologies, and to processes and services. In both cases, patient outcomes can improve and efficiencies can be realized, leading to greater value generated in our health care system.