/ Considering the changes that are occurring in the healthcare industries, what is the role of the design thinker and the strategist?
PJ: I think we need to get more depth in healthcare organizations and how they are managed, more depth in healthcare strategy and how to create value in the industry. Large hospitals and healthcare organizations are run like businesses, but often not very well because they have always been managed as healthcare institutions first and businesses second. It needs a more collaborative approach that includes organizational design and clinical practices and innovating better business models. Don’t think of the hospital as the monolithic box, a single organization with thousands of employees anymore; the direction of policy and decision-making in the near future is the accountable care organization. This is a democratic opportunity to distribute specialized clinics or community clinics, which are close to the points of needs within the communities. This way they can address the known problems at the community level. I think this is the future of strategic design and innovation in healthcare systems. The real innovation should be in the organizational and managerial level for the coordination of new types of practices that drive the new roles of healthcare closer to the community.
To be treated seriously in any way within this new space of healthcare, there needs dedication to years in the field. If there is one thing I have noticed in the industry, it is that people can become a designer by working through healthcare, but it is very hard for designers who aren’t dedicated to the field to have impact. They may be able to do some work, and assist some vendors in making interesting though usually one-off things, such as patient portals. That does not make them healthcare experts. It takes a strategic view that connects the patients and the care institutions, the hospitals and the clinics, where the experiences occur, and understanding the complete journey.
/ How can vendors be integrated within the healthcare system in providing a more holistic and healthy patient experience?
PJ: Hospitals will always be run as a lean business model because the costs are very high, and will remain high as they take on more and more people. Therefore, vendors need to be realistic and connect with consortiums and teams of providers that can supply broader access across the service spectrum. They all believe they are doing the right thing but they all lack foresight. They may be good forecasters, but they are not good foresighters in terms of the future of their own and complementary industries such as IT, which significantly impacts the investments they make.
The real breakthrough needs to be a change on how we think about services within the healthcare sector. Certainly, there will be a lot of opportunity for things in the pharmaceutical sectors and the major device industries. But the healthcare industry comes down to taking care of the human condition, human diseases, and the needs for care that we all have. By looking at it from that perspective, along those lines of service, the owners of the experience of the healthcare industry are the clinical practices.
So the biggest opportunities for service design and service thinking will be in finding new ways to integrate different points of care that are so fragmented today.
/ How does foresight come into play for the future of healthcare?
PJ: Foresight needs to be pushed by vendors as well in order to plan for the near term future.
Policy may have used foresight, but hospitals, practices and vendors have hardly used foresight at all. There has been a rise of innovation centers within hospitals, but they are usually staffed by process improvement people who are very analytical. They are very good at driving down costs, but foresight takes a different angle. In foresight we create future value by identifying desirable end states, and creating scenarios and pathways to achieve those end states. This may be more expensive now, but create greater value.
Healthcare is a very scientific, evidence-based, traditionally managed field with hyper-educated people that already know everything. They don’t think they need designers because they figure it can’t be that hard. A fair number of doctors are becoming innovators. As analytical thinkers, however, they can’t get it all. Healthcare needs synthesists, foresight, and long-range thinkers, and it needs to accept more imaginative presentation of proposals for structure and function. In this, designers need to be integrators.
Those who are now showing up to the hospital for the first time due to Obamacare-like policies are going to be registered and tracked, which will have a huge impact. Of these people, 30% are obese and 25% have diabetes. These diseases commonly co-occur, but also complicate everything else: cancers, cardiac conditions, digestive conditions. Now you have complex disease co-morbidities showing up. This has resulted in 5% of all patients taking up 50% of all healthcare costs. It is expected to double, and what happens when 10% of patients take up 100% of healthcare costs? Not to mention this bracket of people coming into poor health are also leaving the job market. Economically, it’s a nightmare. There is not a similar size cohort of well earning people contributing to paying for them. This seriously needs good foresight and new business models.
Peter Jones, PhD., is the author of Design for Care, founder of Redesign, and Associate Professor of the Strategic Foresight and Innovation program at OCADU.