Better health by design

Despite our best efforts, we have curated a health system, like author Mary Shelly created Frankenstein in her novel of 200 years ago – by bringing together bits and body parts and expecting them to function as a synergistic whole – when it is in fact a complex system, an ecology.

Healthcare is arguably the most complex system of human kind and it is anticipated to get worse - the level and rate complexity is predicted to grow. New thinking and approaches are needed to generate sustainable systems change and provoke human centred technology and product innovation that solves real problems for patients and improves the quality and experience off healthcare.

While the value of collaborative design in public sector innovation is gaining momentum globally, including health system reform, there are limited robust systemised examples in Australia that bring together patients and families in genuine partnership with clinicians and other service providers, executives and administrators to drive sustainable service improvement, systems change, research and technology innovation.

Emerging trends in healthcare

The ageing demographic is a global mega-trend. The world’s population is expected to increase by one billion people by 2025. Of that billion, 300 million will be people aged 65 or older, as life expectancy around the globe continues to rise. Additional healthcare resources and service innovation is needed globally to deliver the long-term care and chronic disease management services required by a rapidly increasing senior population.[1]

A burgeoning middle class is another global mega-trend fuelling increasing demand for more health options. It is predicted that 65% of the global population will be middle class by 2030. The majority of the world’s middle class will live in cities and become increasingly sedentary which will inevitably lead to greater incidence of obesity, diabetes and other costly chronic health conditions.[2]

There is a growing global burden of chronic diseases which comprise the largest component of the health and economic burden of diseases in developed and developing countries. The World Health Organization predicts that chronic disease prevalence is expected to rise by 57% by the year 2020 and will account for almost three-quarters of all deaths worldwide.[3]

To fight the growing burden of chronic diseases, many countries are shifting focus from the treatment of diseases to preventive health care. Australia reportedly spends more than $2 billion on prevention each year, or around $89 per person. This is equivalent to 1.34 per cent of all health spending and 0.13 per cent of gross domestic product (GDP). While Austalia spends close to the average of all OECD countries on health care in total, it is substantially less than Canada, the USA, the UK and New Zealand.[4]

One size fits all to personalised care

These factors are driving non-health based industries to become increasingly involved in the development and provision of preventative innovations and management solutions such as retail, telecommunications, technology as well as a growing wellness and fitness industry.

Genome sequencing in the development targeted drug therapies are fast becoming a reality and there is potential for computer simulated clinical trials to hasten the existing clinical trial processes which often take many years to get from the laboratory bench to the bedside.

Transactional to predictive and proactive care

There is a growing shift from transactional, fragmented care towards more integrated, holistic patient and consumer centred care.[5]

There is a growing consumer demand and recognition of the inefficiency and ineffectiveness of fragmented care driving the shift from transactional, disjointed care towards more integrated, holistic outcomes for individuals and their families.

This extends to to the design of our urban environments and the importance of clean air and water, fresh local produce, social interactions and cultural offerings with access to green space and where its easy to walk, cycle or swim.[6]

Institutionalised to decentralised care

Consumers are also increasingly demanding greater independence in managing their own health and wellbeing. The World Economic Forum predicts that within ten years the doctor and the patient will not need to be in the same place at the same time in many circumstances.[7]

Paternalistic to empowered care

Progress in Patient and Family Centred Care Practices are driving improvements in information flow, streamlining patient care in hospital and enhancing communication between hospitals and community-based health providers. Patients are also increasingly demanding quality service independent of time and place.

Technology is driving personalised care

The emergence of mass data, the Internet of Things, informatics, analytics and advances in data/cyber-security are driving our ability to share information, collect, analyse, compare, share and reuse data, across the continuum from prevention through to tertiary care improving clinical and the translation and impact of research.

The pace of developments in technology is rapid, ubiquitous and exponential, such as robotics, wearables, nanotechnology, 3D printing, virtual reality, augmented reality. Innovation and interoperability between these systems is predicted to transform diagnosis, treatment and the experience of healthcare.[8]

The value of Collaborative Design

To improve the experience and quality of of care health services must locate patients and families at the centre of care, however, this must be done in genuine partnership with clinicians, other service providers, health executives and administrators.

EXAMPLE: The Mayo Clinic – Center for Innovation. The Center’s role is to transform the experience and delivery of health care with a patient-centered focus.  It offers a multidisciplinary team to turn innovative ideas for medical practice into practical solutions that change how patients receive health care. [9]

Strengthens organisational relationships, wellbeing and culture.

Collaborative Design builds trust and mutual respect among partnersand values interdependence towards a shared purpose – which is highly unifying. Empathy is central, which motivates individuals towards meaningful action and to move beyond assumptions they didn’t even know they had.

Evidence demonstrates a number staff benefits in relation to purpose and wellbeing:

•          engaged employees are significantly happier, have lower levels of stress and are less likely to be diagnosed with depression than those who are disengaged [10]

•           employees who can link their work to a larger purpose are likely to have greater levels of interest[11]

•           those who pursue goals that match their personal values and interests are more likely to attain those goals.[12]

Builds on existing strengths.

Collaborative Design acknowledges and builds on existing core operational strengths, positive qualities and past successes. A positive culture and upward cycle is built when prior experience sets the foundation for future activity and when future activity builds upon and reinforces prior experiences.[13] The process of Collaborative Design manages expectations and allows for limitations and complexity to be acknowledged and valued.

EXAMPLE: The Waitemata District Health Board (WDHB) in New Zealand have developed a co-design approach specifically for the health environment to improve patients’ experiences of services as well as the services themselves. The WDHB have developed a co-design website which describes a six stage process and and guiding principles and how to apply the process in various scenarios such as; developing a new service, improving an existing service and solving a particular issue. The website hosts a range of tools and a guide to navigating ethics as well as ways to amplify sustainable change. [14]

Intrinsically Sustainable.

As Collaborative Design brings together to patients and families in genuine partnership with clinicians, other service providers, health executives and administrators to design improvement and builds on exsisting strengths it is intrinsically grounded in what is desirable, feasible and viable. [15]

EXAMPLE: A network of 11 European partners, entitled Sharing Experience Europe (SSE) present a series of case studies and tools in the Design for public good report, to enhance the understanding of design for public sector innovation and facilitate the integration of its methods into mainstream practice. The Design for public good report describes the three step ladder for effecting change in the public sector and highlights best practice examples.[16]

The Collaborative Design approach applied at the unit level or at scale across a hospital or health region has potential to generate sustainable systems change, flexible infrastructure development and provoke and embed human centred technology and product innovation that genuinely improves the quality and experience of healthcare.

 

Trish Hansen is the Founding Principal of Urban Mind, a strategic consultancy, leading purpose driven systems change for collective impact,  through collaborative design. This work is inspired by her work as a former senior clinician as well as her personal experience of breast cancer.

 

 

 

[1] United Nations World Population Prospects 2017 https://esa.un.org/unpd/wpp/

[2] Global Economy & Development Working Paper (100). February 2017

https://www.brookings.edu/wp-content/uploads/2017/02/global_20170228_global-middle-class.pdf

[3] World Health Organisation. Nutrition Health Topics – The global burden of chronic disease. http://www.who.int/nutrition/topics/2_background/en/

[4] Preventive-health-How-much-does-Australia-spend-and-is-it-enough Department of Public Health, La Trobe University

and the Australian Prevention Partnership Centre

http://fare.org.au/wp-content/uploads/Preventive-health-How-much-does-Australia-spend-and-is-it-enough_FINAL.pdf

[5] MaRS Discovery District, Dr Zayna Khayat

https://www.marsdd.com/news-and-insights/transforming-health-shifting-from-reactive-to-proactive-and-predictive-care/

[6] What works wellbeing- places, spaces and social connections https://whatworkswellbeing.org/blog/places-spaces-social-connection-and-peoples-wellbeing-what-works/

[7] World Economic Forum, Value in Healthcare: Laying the Foundation for Health System Transformation.

http://www3.weforum.org/docs/WEF_Insight_Report_Value_Healthcare_Laying_Foundation.pdf

[8] Ten ways technology is changing healthcare http://medicalfuturist.com/ten-ways-technology-changing-healthcare/

[9] The Mayo Clinic – Centre for Innovation http://centerforinnovation.mayo.edu/

[10]  Rath, Harter, & Harter, 2010

[11] Wrzesniewski et al.,1997

[12] Sheldon & Houser-Marko, 2001

[13] Scott DeRue & Kristina M. Workman. Driving Leadership Development with Positivity, 2013. White Paper. University of Michigan, Ross School of Business.

[14] http://www.healthcodesign.org.nz/about.html

[15] IDEA Human Centred Design Toolkit https://www.ideo.com/post/design-kit

[16] Design Council UK Design for Public Good report.  http://www.designcouncil.org.uk/knowledge-resources/design-public-good