From bedside to bench to bedside

Some patients told me they got used to not being able to use their legs. Not having bladder-control is what really affects their quality of life. These statements really changed my point of view” recalls Markus. He is a d·HEALTH Barcelona fellow and, for the last 4 weeks, he has been immersed with his team at Institut Guttmann, a centre specialized in neurorrehabilitation.

Markus’ reflection resumes what discovery is about: being in the right place at the right time but also about being receptive to new ideas and opportunities when they arise. Through the clinical immersion stage, the Design Health Barcelona program challenges its’ fellows to find and address new opportunities for innovation based on clinical needs.

Identifying and understanding clinical challenges and problems that impose a significant medical burden is the first step to later develop novel solutions. Finding them it may seem simple and obvious, but it is not. The identifying process is a profound experience that requires innovators to use observation skills and find new ways of looking at procedures and events at hospital settings.

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Àngel Calzada, Markus Wilhelms, Imma Herrero & Marc Benet, d·HEALTH Barcelona team at Institut Guttmann

Since 1st November, d·HEALTH Barcelona fellows, divided into three teams, are immersed in three different clinical environments: the Thorax Clinical Institute at Hospital Clínic, the neurorrehabilitation specialized Institut Guttmann and the neonatology area at Hospital Sant Joan de Déu.

It is curious how many procedures are done without considering if they are the most efficient way. The hectic schedule leaves to physicians little time to rethink the methodologies they have been implementing for years” say Lalis, Mateu, Roger and Alfred, the team of fellows working at the Hospital Clínic.

The healthcare system offers fertile ground to search for unsolved problems.  To detect them, innovators must try as much as possible to become integral part of the group being studied to understand the perspective of the “insiders”. “What I did is to be a doctor’s shadow the first week, follow him/her with few or no questions, just listening and observing and after some days, once I had the basic knowledge and a first-hand insight to the problems and conflicts doctors face, start questioning. This, with lots of patience, observation and a proactive attitude allowed me to identify clinical needs” explains Arnau, immersed at the Neonatology unit at Hospital Sant Joan de Déu.

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Lalis Fontcuberta, Roger Benet, Alfred Ramírez & Mateu Pla, d·HEALTH Barcelona team at Hospital Clínic

To get into the mindset of the people delivering (or receiving) treatment to thoroughly understand the circumstances requires substantial time and energy. For example, if an innovator is seeking to identify the problems associated with the use of a device in a certain surgical procedure, he/she needs to arrive at the hospital when the surgeon does, watch several unrelated cases and the observe the entire procedure and the post-operative routine.

It’s amazing the amount of devices they use and the ease with which physicians handle complex situations such as a heart attack! It is very interesting to be on the other side and to see the disease from another perspective” says the team at Hospital Clínic.

All of the observer’s senses have to be focused on identifying issues or problems that have never before been seen or noticed. Because one never knows when these types of trigger may occur an open-mind and multiple levels of observations are essential.

The first day I saw a patient with no mobility in the arm due to spasticity. A month later he had regained a lot. I remember therapist’s face showing the emotion for the progress!” remembers Marc at Guttmann Institut. “Before immersing at Guttmann I knew that an accident can change your life forever but I was not really aware of the many needs that remain unsolved to improve the quality of life and facilitate integration of the spinal cord and brain injuries” adds Imma.

d·HEALTH Barcelona teams will spend eight weeks performing intense, embedded observation activities. After that, in most cases, the idea flow slows down. A sign of this might be that there are fewer and fewer observations but a few others keep coming up repeatedly.

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Marc Rabaza, Susan Feitoza, Arnau Valls & Mattia Bosio, d·HEALTH Barcelona team at Hospital Sant Joan de Déu

We have already identified over 300 needs. We have not experienced a big “aha moment” yet but I believe we are on the right way. In the weeks ahead we expect to find more deep and valuable needs than the first ones that might be the obvious ones” says Marc, at Hospital Sant Joan de Déu.

To be able to identify many needs these first weeks we have done an intense work of team building in a real environment and have received a lot of support from the professionals at Guttmann. Their collaboration is a key factor in our success” adds Angel.

When teams have identified viable clinical problems that seemingly now require to begin harvesting those ideas. When preparing to move on to the next step, it is always recommended to maintain good relationships with the patients, providers and representatives of the clinical setting who have been observed. Once a need statement has been developed and additional research performed, it will be necessary to return to the clinical environment to validate the need before concept generation begins. Having these relationships to leverage in the validation process is extremely helpful.

Beyond the professional part, the clinical immersion is a very rich and very human experience” resumes the team at Hospital Clínic. “There is a clarity of mission and purpose in the healthcare setting often missing in the business world” adds Susan, at Hospital Sant Joan de Déu. “It feels good to be part of the process of helping people” ends Markus.

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Design Thinking, the innovation’s engine

When Thomas Edison invented the electric light-bulb, he didn’t know he was creating, also, an entire industry around it. He just envisioned how people would want to use what he made and he engineered toward that insight.

Edison’s approach is an early example of what is now called “design thinking”, a methodology that has become business innovation process’ fuel and engine. As Tim Brown (@tceb62), CEO of the design consultancy IDEO wrote in an article at Harvard Business Review in 2008, “design thinking can be described as a discipline that uses the designer’s sensibility and methods to match people’s needs with what is technologically feasible and what a viable business strategy can convert into customer value and market opportunity.

Design sensibilities include empathy, creativity, a human-centered focus and deep curiosity about the world while design methods consist of observational techniques, visualization, prototyping, sketching, storytelling, brainstorming, and so on.

Historically, design has been treated as a downstream step in the innovation process. Designers just come to put a beautiful wrapper around the idea. Now, companies are asking them to create ideas that better meet consumers’ needs and desires. Any industry can benefit by employing design thinking and achieve better results, including healthcare.

Recently, the US federal government took the Department of Veterans Affairs’ current health record system, which looks and feels like a receipt, and challenged designers to reimagine a new electronic medical record output to describe a patient’s health history. The challenge received over 230 submissions. The winner, will hopefully, replace the actual format.

Design thinking process applied to innovation consists of four key stages.

Define the problem: Sounds simple but doing it right it is perhaps the most important of all. In design thinking observation takes center stage and requires cross-functional insight into each problem by varied perspectives.

Create and consider many options: Design thinking requires that no matter how obvious the solution may seem, many solutions be created for consideration. And created in a way that allows them to be judged equally as possible answers. Looking at a problem from more than one perspective always yields richer results.

Refine selected directions: Even the strongest of new ideas can be fragile in their infancy. Design thinking allows their potential to be realized by creating an environment conducive to growth and experimentation.

Pick the winner, execute: At this stage prototypes of solutions are created and testing becomes more critical and intense. At the end the problem is solved and the opportunity is fully uncovered.

“Design Thinking starts with a need and ends with an idea for a product or service” – Paul Yock (Founder of Stanford Biodesign Program).

 

At Design Health Barcelonawe will apply design thinking to deliver change within healthcare. To design clinical experiences that meet patients’ needs, different teams of fellows will immerse for eleven weeks at three clinical settings in Barcelona, Sant Joan de Deu Hospital, Clínic Hospital and Guttmann Institute. They will identify dozens, even hundreds, of unmet needs, understand them and select the most promising ones to, finally, get the winner idea. In the following months, and until the program finishes, they will mature and evolve them until they are ready for the patient.

If you want to know more about design thinking we recommend you to watch this video to learn how to think like an artist or Design & Thinking the movie (here is the trailer) and then share your comments with us! Do you think that design thinking has the potential to change our lives?

Lessons Learned:

  • Thinking like a designer can transform the way organizations develop products, services, processes, and strategy.
  • Design thinking is an approach to solve problems understanding consumers’ needs and developing insights to solve those needs.
  • Design thinking relies on our ability to be intuitive, to recognize patterns, to construct ideas that are emotionally meaningful as well as functional and to express ourselves through means beyond words or symbols.
  • Design thinking brings together what is desirable from a human point of view with what is technologically feasible and economically viable.
  • Design thinking is as much a mindset as a process.
  • Design thinking is a system of three overlapped spaces: inspiration, ideation, and implementation.
  • Only through contact, observation and empathy with end-users you can design solutions that fit into their environment.