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what if corporate personality tools were used in medicine?

Treat me how I want to be treated at that moment without knowing me or how I feel. Seems like a reasonable request, right? Maybe not so much. And still, it’s what our modern —indeed overdue —conversation about patient-centered care demands. Patients and providers are clamoring for better partnerships; they desire to communicate effectively, to understand one another. But we don’t really have great tools and processes in place to support fast, low-effort assessments of learning styles and communication preferences.

Are you visual or aural? Do you need control or want to be directed? Does the nature of a situation affect how you might answer that question? Do you want reenforcement, an opportunity to teach back, an opportunity to question? Do you need time to reflect, or do you make quick decisions? And how many of even clearly know these things about ourselves in our daily lives, let alone when we are dealing with our health and wellbeing.

Imagine this scene: you arrive at your annual physical. Except for the occasional cold, you really only see your physician once a year. How well do you really know each other? You are highly visual and prefer diagrams to lengthy documents. You also like to have all the facts and tend to worry when you feel under informed. You are ok to let someone else plan things, so long as you know the plan. Your physician, in her spare time, is an amature writer. She would much prefer writing to talking, and is often reserved during your interactions. She is of a generation where her training reinforced a paternalistic, I know best style of practice.

You have 25–30 minutes together for your visit. Most of that time is spent doing a physical exam and updating your history. But your physician finds something unexpected, a lump. “Get an MRI and I’ll call you soon when we know more…”

Do things break down?

Do you leave feeling informed or terrified or somewhere in between? Could you describe to your spouse what happened, where the lump is and what it might be?

The challenge with treat me how I want to be treated at that moment without knowing me or how I feel is the unfair burden it places on both parties. How, in a time-restricted environment are two parties supposed to quickly get to know one another’s styles and preferences in a way some spouses even spend years working towards? And, for patients and physicians who have a long-standing relationship, wouldn’t an aid at least help remind you of the other person’s prefernces, so you don’t have to rely on memory or assumptions?

When I worked for a large multi-state health system, we used a commercial tool called Personalsys. Everyone in a management role took an online personality preference test. The computer spit out a brief narrative and color-coded chart. As will not be a surprise to those who have worked with me, I tend to be highly energized by ideas and creative brainstorming and am less driven by deadlines than others (something I’ve had to build systems to help support). Many of my healthcare finance coworkers, at the risk of generalizing, were, conversely, highly structured. They like plans and deadlines and clear objectives. If we had a meeting, someone would see my chart and the spikes in my green creative areas, where they might have spikes in their red structure areas. “Ohhh you’re one of those aren’t you? All creative and loosey-goosey…” And we’d laugh and poke fun at each other’s personality traits and preferences. “yeah, well I bet you’re all tightly wound and obsessed with numbers…”

Personalysis

In reality, the framed charts behind everyone’s desks became a bit of an inside gag. The insecure among the lot would cast their doubts on the efficacy of the hippie tools and new age management practices. But even the doubters knew there was some benefit to understanding how their colleagues work and think. You could walk into someone’s office, and know within seconds how they like to interact and work with other people, and in turn what you might expect from them.

There are other examples of these types of tools which are being deployed increasingly in large corporate settings. The DISC assessment, for instance, looks at how a person feels about control using the vernacular of dominance, inducement, submission and compliance. And what discussion of personality inventories would be complete without a mention of my personal favorite, the Myers-Briggs Type Indicator (I’m an ENFP for the inquiring minds out there)?

DISC

Visual and narrative aids like Personalysis or the DISC assessment, are not commonly a part of patient-provider interactions. But why shouldn’t they be used? Imagine if every patient had a card with a visual indicator on one side, in a short narrative about their preferences and styles on the other. What if every doctor had a similar tool framed on the wall of their exam room and office? Patient styles and preferences would be stored in medical records and patients could learn about their physicians’ styles online before visits.

Now imagine this scene: you arrive at the emergency room with chest pains and shortness of breath. You are scared, but not in dire straits. You are taken back, immediately, into an exam bay. A physician comes in, sees your chart and knows right away that you like to be in control of situations. You are aural and work better with big pictures than minutia. How might their communication style change to meet your needs, where you are, at that exact moment? Perhaps, in stead of patting you on the shoulder and saying “you are going to be fine dear…” they might instead offer “Ok, we’re going to move quickly, my concern is a blockage, so we’re going to get you to the cath lab, you’ll remain conscious, this is a great team who has done more of these than anyone else in town, after the cath, we’ll know more. Is that plan ok with you?”

To be fair, I suspect the later example is more typical of modern physician communication styles than my patronizing former example. But there is still room for a tool to help aid the process.

We need something quick, easy to understand and effective. It should be a two-way tool, allowing both patients and providers to quickly understand each other and meet in the middle. If this idea of participatory shared decision making is to work, it’s going to need some aids. The good news is some examples already exist. The folks at Diagram Office, a New York-based design firm have created some fantastic conversation aids around shared decision making.

Diagrams OpenIDEO submission

I’m still looking for a solution which fits upstream of decision making. I’m suggesting something which exists as the very first step between a patient and provider, before a word is ever spoken.

Anyone have a prototype?

Designing for happiness

I have the privledge of conduting new employee orentation for my health system. There is an excersize I ask the new hires to go through which I’ll share with you here.

Take a few moments and think about something in your life you cannot imagine being without….something where you think I don’t remember how I got along without XYZ… It can be a thing, or a place, or even a person.

What did you think of?

9 out of 10 new hires usually shout out “my iPhone”.

Sure, some folks reply with non-consumer answers such as my family, my children, or my last vacation. But for the ones who say it is their phone, what makes it such a compelling device, why could they not live without it? What they often tell me is it’s just magic, it just works. Apple’s marketing department would be happy with that response. I believe its just magical is a proxy for it was designed well.

Over the weekend I had the chance to re-watch one of my favorite documentaries, Objectified. Objectified is director Gary Hustwit’s homage to industral design and designers. The film moves from vignettes of iconic design to narritaves of personal insight from famous designers. It is a wonderful film and part of a trillogy where Hustwit focuses on asthetics and design.

In healthcare, we often think about design in a few very narrow contexts. We think about the archatecture of new buildings. Sometimes we think about the shape and styling of medical devices. Yet, that’s not how designers see the world. As Jony Ive, head of design for Apple, puts it: “it’s part of the curse of what we do… think about how everything we encounter is designed.”

In Objectified, Erwan Bouroullec, of the designers says the goal of design about creating an enviroment where people feel good.

Isn’t that sort of also the goal of a hospital or doctor’s clinic? Don’t doctors start practing medicine because it feels good to take care of people? Don’t we go to the doctor because we want to feel good?

Regrettably, so many of our processess for delivering care were designed by consensus, rather than with a goal of creating an eivnroment where people feel good.

A few months ago I wrote a post about designing for experience where I suggested many processess are designed by consensus, or created through committees which often involve compromise for political agreement or to avoid conflict.

Try my new hire exercise again only this time think about an object or process which makes you feel frustrated or challenged when you interact with it.

My guess is whatever that thing is, it was probably not well-designed. It may be the result of design through consensus or it may simply not have been designed with attention to user experience or detail.

Now, more than ever healthcare needs to begin to apply design thinking to its processes and services. Design thinking has two major benefits: first it builds things which are in empathetic towards the user. Secondly, as Bouroullec says, it makes people feel good.

Davin Stowell, a principal designer at SmartDesign discussess working with OXO, the kitchenwares company on their vegitable peeler. Stowell says it’s not as important to understand how the average person who use the vegetable peeler. What matters is the extreme usecase - the person with arthirtis in his example. “When you design for extremes, the middle takes care of itself…” says Dan Formosa, also of SmartDesign.

Healthcare has an opportunity to embrace its extreme users too.

Examples most certinally include those who identify as ePatients. ePatients want to participate in the development and implementation of their treatment plans. They often lament a lack of access to their clinical data, or even access to their physicans using modern things like text messaging or skype.

We might also look at other extemes for inspiration. What can a “frequent flier” in the ER tell us about processess in the emergency room? What can the single, working mother with three kids tell us about process in the familiy medicine clinic?

These users are all around us, yet for some reason, we fail to consider them when designing care delivery processess and services. Instead, we design for the middle, creating average offerings rather than standout offerings.

There are competitive advantages to good design. It gets more people in the door. There are also imporant humanistic aspects. If good design really does create an enviroment that makes us happy, doesn’t healthcare have an obligation to design things well?

It is not my intent to judge our entire industry unfavorably. Good design can be as ambigious as the term itself. If it were easy, every phone manufactureer would have invented the iPhone years ago, right?

Still, there are ways to learn and practice design thinking:

  • Watch Objectified - pretty good place to start. It’s on Netflix for streaming. Listen to the designers talk about the objects they’ve designed and apply their terms and language to processess and experiences in healthcare.
  • Be empathatic - Empathy might be the single most important skill for anyone working in healthcare. Practice by thinking "Today, I’m not a provider or administrator. Today, I’m the patient walking in these doors for the first time. What do I see? Riff on the idea, always challenging yourself to put yourself in the patient’s shoes. How would a patient use this service? What would a patient think of this cafeteria food?
  • Embrace extreme usecases - Identify the extreme users of your services and observe their behaviour and listen to their communications. What can you learn from them? Are your waiting room seats uncomfortable for the elderly? Do ePatients with smartphones portend the future for the entire next generation of patients? What processess would you develop or change based on the answers?
  • Engage designers - OXO didn’t re-invent the vegitable peeler on their own. They worked with SmartDesign. Healthcare providers can find local or nationally renound tallent. Sure, it comes at a cost, but think of a well designed offering as a compeitive advange. You’d pay a reasonable price for a consultant who could help you grow marketshare, right?

By the way, healthcare device manufacturers and supply vendors are no strangers to working with designers. IDEO and SmartDesign have both worked with vendors on items such as:

  • Cardinal Health Endura Scrubs

    Many hospital workers complain about the baggy, pajama-like, and unprofessional look of traditional ‘scrubs’. Furthermore, over 70% of hospital employees are women, yet they are forced to adapt to clothing that was designed for an XL-sized man. The Endura Performance Apparel Scrubs is a line of cost-effective high performance scrubs that we designed as true unisex wear with benefits for women and men alike. They are a vast improvement on their predecessors because of design innovations such as collars that don’t blouse open to over-expose females…

  • Ethicon Endo-Surgery Generator

    Equipment in the operating room environment can be complex and intimidating, prompting the need for intuitive technology solutions that help OR nurses focus more on patient care. The new EES Generator combines advanced technology, multifunctionality, and intuitive touch screen simplicity into one compact, easy-to-operate unit.

  • Lifeport Kidney Transport System

    The LifePort Kidney Transporter provides a new high-tech alternative to the conventional method of organ storage and transportation—a cooler filled with ice.

  • Finally, here’s IDEO’s Tim Brown at the 2009 TEDmed event on Designing Healthcare